Transfer factor and allergy.

Although various mechanisms involving antibodies and various cell types participate, a Thl and Th2 cells imbalance seems to play a central role for allergy development. Other lymphocyte subpopulations, such as Th17, CD4 FOXP3, and Th9 positive regulatory T lymphocytes may also be involved in the allergic response. Regulatory processes are an appealing target for therapeutic approaches aiming to solve allergic reactions by restoring the delicate balance within the immune system. Transfer factor (TF) or dialyzable leukocyte extract is meant to transfer cell-mediated immunity from immune competent donors to unsensitized or deficient recipients. A PubMed search on the current knowledge on TF indicates that TF may restore the Th1/Th2 balance and improve immune regulatory mechanisms of patients receiving it. Our preliminary results demonstrate that TF induces mRNA expression of IFN-g, osteopontin, RANTES, and hBD-2 in human healthy subjects. TF has been used to treat a variety of immune dysfunction related-pathologies, such as allergy, autoimmunity, immunodeficiencies, infectious diseases and tumors. Patients receiving TF together with their conventional treatment often have better clinical evolution than without it, as we have witnessed, adding TF to the usual medical treatment of allergic diseases as an attempt to provide allergic patients with those regulatory elements that they apparently lack but require to achieve properly regulated immune responses and thus obtain a faster and better resolution of allergic reactions.

[Pulse oxymetry in the diagnosis of asthma in children]. / Oximetría de pulso en el diagnóstico de asma en el niño.

BACKGROUND: Asthma is a chronic disease that requires an early diagnosis to avoid the phase of remodelation. OBJECTIVE: To evaluate transcutaneus tension of oxygen in challenge test with distilled water in pediatric patients with asthma. MATERIAL AND METHODS: Thirty patients of 1-5 years old were included: 15 with asthma and 15 control healthy subjects. Inclusion criteria were: clinical diagnosis of asthma (cough, respiratory difficulty and wheezes more than three times in the previous year), without using steroids four weeks before the study, or bronchodilators. Exclusion criteria were: respiratory infection and severe disease. A challenge test with cold distilled water was applied and O2 saturation and basal and 5, 10, 15, 20 and 30 minutes heart frequency were measured. RESULTS: O2 saturation statistically significant decreased from the basal to 5, 10, 15, 20 and 30 minutes; for cases: 96.4 and controls: 97.8, p = 0.00224. Heart frequency did not have a statistic change at basal, 5, 19, 15 and 20 minutes; but it had a statistically significant change at 30 minutes post-challenge (120.7 beats/min in cases vs 112.7 beats/min in controls, p = 0.0127). CONCLUSIONS: Pulse oxymetry has a significant value and is related to severity of illness.

[Immunological mechanisms in contact dermatitis]. / Mecanismos inmunológicos en la dermatitis de contacto.

Contact dermatitis is an altered state of skin reactivity induced by the exposure to an external antigen which begins a series of mechanisms where Langerhans cells and keratinocytes play an important role in antigen presentation and have an effective response by chemokines, interleukins and lymphocytes T.

[Dendritic cells and their role in atopic dermatitis]. / Las células dendríticas y su papel en la dermatitis atópica.

Dendritic cells in the epidermis have an important role in the skin inmunity since they have an immunogenic capacity. The dendritic cell prototype is Langerhans cell (LC), however, nowadays it is known that there are other dendritic cells in the skin as dermic dendritic cells (DDCs). In this review we examined the functions and characteristics of these cells and their role in the atopic dermatitis.

[Assessment of the clinical efficacy and safety of epinastine plus pseudoephedrine vs loratadine plus pseudoephedrine in perennial allergic rhinitis]. / Evaluación de la eficacia y seguridad clínica de epinastina más pseudoefedrina vs loratadina más pseudoefedrina en rinitis alérgica perenne.

BACKGROUND: Several drugs for the treatment of perennial allergic rhinitis and its symptoms have been investigated since some years ago. These drugs are: steroidal-type immunoregulators, immunotherapy and antihistamines. Because of first generation of the last ones originated several side effects, pharmacological research was oriented to the search of formulas with the same of higher efficacy, but with fewer effects on central nervous system. OBJECTIVE: To compare the efficacy and safety of epinastine 10 mg plus pseudoephedrine 120 mg vs loratadine 5 mg plus pseudoephedrine 120 mg, twice a day, in the treatment of perennial allergic rhinitis. MATERIAL AND METHODS: A comparative, random, open, prospective, longitudinal and multicenter study was made in 62 patients with an average age of 26.17 +/- 9.75 years (13-56 years) with diagnosis of perennial allergic rhinitis, who attended to external consultation of the different departments of allergy of the participant institutions. All patients were submitted to: complete clinical history, physical exploration, measurement of vital signs, nasal exploration, qualification of allergic symptoms and record of daily symptoms. Moreover, washout during a week and pharmacological treatment was given during two weeks. Symptoms referred by patient and findings of physical exploration during the different visits, as well as rhinoscopic findings, were assessed by a scale of five parameters of rhinitis. Tolerance grade of drugs was assessed based on frequency and severity of side effects. RESULTS: According to the basal clinical assessment symptoms qualification of patients of groups of epinastine and loratadine was of 9.12 +/- 2.78 and 7.90 +/- 2.7, respectively. Seven side effects appeared: three cases of somnolence, one of sickness and one of anxiety in patients of group of loratadine and one case of somnolence and one of dysmenorrhea in the subjects of group of epinestine. Although it did not have statistically significant difference, it is clinically important for patients. Frequency of side effects was higher in the loratadine group. CONCLUSION: Both drugs are efficient for the treatment of perennial allergic rhinitis.

[Airway hyperreactivity in patients with allergic and non-allergic rhinitis]. / Hiperrespuesta de las vías aéreas en los pacientes con rinitis alérgica y no alérgica.

BACKGROUND: Epidemiologically there is an association between allergic rhinitis and asthma due to a common inflammatory process. Asthma can affect 40% of the patients with rhinitis and 80% of asthmatics present rhinitis. The relationship between the two diseases is explained by the term of "a united airway". Some patients with allergic rhinitis have nonspecific bronchial hyper-responsiveness, specially during the exacerbation stage. These patients have a unique physiologic characteristic that differs from the asthmatic and healthy subjects developing bronchoconstriction not related to clinical bronchospasm, therefore, allergic rhinitis is considered a risk factor for the asthma development. OBJECTIVE: To determine if there is bronchial hyper-responsiveness in patients with allergic and not allergic rhinitis, by correlating with the eosinophilia in nasal mucosa. MATERIAL AND METHODS: We studied a total of 32 patients with an age range from 18 to 38 years, of both sexes (11 men and 17 women) of the Hospital Regional Lic. Adolfo Lopez Mateos, ISSSTE. They were submitted to clinical history, laboratory studies (blood count cell, serum IgE levels, eosinophils of nasal mucosa), roentgenograms (paranasal sinus and esophagus-gastroduodenal series) and allergy skin tests with 32 allergens. It was taken biopsy of nasal mucosa for the search of eosinophils and it was carried out bronchial challenge with distilled water. Twenty-eight patients concluded the study, they were divided in two groups: a group of 15 patients with diagnosis of allergic rhinitis and another group of 13 patients with diagnosis of non allergic rhinitis. RESULTS: Fifty-six spirometry studies were performed and only 4 patients (26.6%) with diagnosis of allergic rhinitis presented fall of the FEV1 in the bronchial challenge in comparison with the group of non allergic rhinitis in which there were no changes in the FEV1 later to the bronchial challenge. This difference was statistically significant (-4.3 and 0.15, respectively with a p < 0.0370, CI 95%). Moreover, only in the group of allergic rhinitis eosinophils were found in the biopsy of nasal mucosa (93.3%). CONCLUSIONS: Nonspecific bronchial hyper-responsiveness is present in patients with allergic rhinitis. The presence of nasal eosinophils is a persistent inflammation parameter suggesting the allergic origin in these patients.

[Psychological, immunological, and endocrinological implications of atopic dermatitis]. / Implicaciones psicológicas, inmunológicas y endocrinológicas en la dermatitis atópica.

BACKGROUND: The atopic dermatitis is a chronic disease with immunological alterations, neuro-immune-endocrine implications and repercussions in the psyche. OBJECTIVE: To determine the effectiveness of the use of psychological support in the treatment of atopic dermatitis. MATERIAL AND METHODS: This study included 20 patients (from 15 to 50 years old) with moderated and severe atopic dermatitis based on the Hanifin and Rafka modified criteria. They were classified in three groups of treatment: A) 10 patients with transfer factor and psychological support, B) 10 with transference factor without psychological support, C) 10 healthy individuals as a control group. At the beginning and ending of the analysis the degree of severity of the illness was determined using the SCORAD scale. RESULTS: There was a more statistically significant clinical improvement on group A than in group B, besides a decrease in anxiety and depression, at a laboratory level including hormonal behavior, without meaningful changes. CONCLUSIONS: It was demonstrated that the treatment with immune-modulator and psychological support on the moderated and severe atopic dermatitis improves the clinical and immunological evolution of this illness.

[Lymphocyte apoptosis in atopic dermatitis treated with transfer factor]. / Apoptosis de linfocitos en dermatitis atópica en el tratamiento con factor de transferencia.

BACKGROUND: Atopic dermatitis is an inflammatory dysfunction in whose physiopathology the lymphocytes T play an important role in the regulation of the inflammatory process. OBJECTIVE: To determine and to characterize the role of apoptosis of lymphocytes in patients with moderate to severe atopic dermatitis before and after treatment with transfer factor. MATERIAL AND METHODS: Fifteen patients with moderate to severe atopic dermatitis in a range of age from 5 to 45 were included in the study. Fifteen healthy subjects were taken as a control group. In all subjects it was determined the apoptosis of the lymphocytes by means of annexin and TUNEL techniques, as well as the expression of CD95 cells. The 15 patients with atopic dermatitis received treatment with transfer factor in stepped dose as follows: 1 U/day/5 doses, 1 U/week/3 doses, 1 U/15 days/2 doses, 1 U/30 days, until completing three months. At the end of this period new determinations were done to measure apoptosis of lymphocytes and PMN. At the beginning and at the end assessments of the severity in relation to the scale SCORAD were made. RESULTS: By means of both techniques no significant difference was found in the percentage of apoptotic lymphocytes between patients and control subjects. Differences of the expression of CD95 between patients and control subjects before and after treatment were not significant. There was a significant difference (p < 0.01) of severity from the beginning to the end of treatment with transfer factor in patients with atopic dermatitis. CONCLUSION: No significant differences of apoptosis of lymphocytes were found in patients with atopic dermatitis who received treatment and control subjects, neither before not after the treatment with transfer factor. It was verified the decrease in the severity of the symptoms related to the treatment with transfer factor.

[Measurement of cytokines in patients with exercise-induced asthma treated with anti-leukotrienes]. / Determinación de citocinas en pacientes con asma inducida por el ejercicio y tratada con un antileucotrieno.

BACKGROUND: Exercise-induced asthma is defined as the transient broncho-spasm, that occurs after 3 to 8 minutes of continuous exercise; one of two mechanisms are implicated: the first is given by a hyper-osmolar environment interchange with the warm respiratory air and the water loss, the second due to reactive hyperemia or bronchial blood vessels edema. OBJECTIVES: To determine the effectiveness and safety of Zafirlukast treatment in exercise induce asthma, and in mild and moderated persistent bronchial asthma. Evaluate the security with laboratory test IL-2, IL-4, INFg, and CD69, to determinate TH1 and Th2 cells, laboratory and thorax x-ray determinations before and after zafirlukast treatment in exercise induce asthma, plus the functional respiratory test, and assert the clinical and adverse reaction with Zafirlukast. MATERIAL AND METHODS: A open, prospective, longitudinal study. Challenge test on a treadmill for 8 minutes. Twenty patients from the Allergy Service at Lic. Adolfo López Mateos Hospital, ISSSTE, in México City, fifteen female and five males. Aged 15 to 35 years. There was a control group of ten healthy subjects with similar age and sex. The drug Zafirlukast was administered 20 mg twice a day for eight weeks, with patient's informed and signed consent. Laboratory test: Blood Cell count, transaminases, bilirubins A, G, M and E immunoglobulins thorax X-ray, electrocardiogram, functional respiratory test before and after treatment. RESULTS: Zafirlukast blocked exercise induced asthma in the early and late phases. There was a statistically significant improvement of a VEF-1 after exercise with a p > 0.001; furthermore, there was significant improvement in the mid-spiratory speed before the exercise with a p > 0.05. The mid-spiratory speed after the exercise, improved (p > 0.01). There were no collateral reactions, such as Churg-Strauss, only transitory headache in six and nauseas in two. There were no statistically significant changes in the cytokines assessment. CONCLUSIONS: There were no statistically significant changes in the cytokines assessments, in four cases the IL-4 decreased after the treatment. The anti-leukotriene improved the bronchospastic answer during the early and late phases, reducing the FEV-1, decreasing the recovering phase.

[Gastroesophageal reflux disease in pediatric patients with asthma]. / Enfermedad por reflujo gastroesofágico en pacientes pediátricos con asma.

BACKGROUND: Nowadays, the gastroesophageal reflux is a predisposing factor for the development of asthmatic attacks. OBJECTIVE: To determine the prevalence of gastroesophageal reflux in pediatric patients with asthma of the Service of Allergy and Immunology at the Hospital Regional Lic. Adolfo López Mateos. MATERIAL AND METHODS: It was made an observational study from July 2000 to July 2001. Gastroesophageal gammagraphic and endoscopy (with taking of esophageal biopsy) were carried out to each of the patients in order to find out if there was gastroesophageal reflux. RESULTS: 112 patients with moderate persistent asthma (54 women and 58 men) were included and divided in three different age groups (group I, from 1 to 5 years old; group II, from 6 to 10 and III, from 11 to 16 years old). The prevalence of gastroesophageal reflux was 138, 100 and 93, respectively, being specially high in males. Differences in the prevalence among different groups were statistically significant between group I and II (p < 0.001) and between I and III (p < 0.001). Significant changes were not observed between group II and III (p = NS). CONCLUSIONS: The prevalence of gastroesophageal reflux the structured was high, situation directly related with the diagnostic suspicion in our asthmatic population.

[Apoptosis]. / Apoptosis.

The apoptosis phenomenon was identified approximately 40 years ago. In 1972, Kerr coined the term of apoptosis (programmed cellular death) to indicate that this way of cellular death was related to organic damage; but in contrast to other ways of death characterized by active cellular necrosis, in this, there is very little tissular reaction surrounding apoptotic cells. Apoptosis refers to the morphologic findings characterized by cellular shrink, nuclear condensation, fading of the membrane and fragmentation of this in apoptotic bodies with changes that possibly guide to the phagocytosis of the affected cell. Although there is great advance on phagocytosis mechanisms, signaling roads and pathology findings; a little is known about the molecular ways of apoptosis, intervening a great quantity of genes, surface receptors of T and B cells; ligand/receptor of death systems (particularly CD95), receptor of the tumoural necrosis factor (TNF-R), several interleukins with antiapoptotic activity, (specially IL-2), costimulatory receptors such as CD28 and proteins of the family Bcl-2 also with antiapoptotic activity. However, at this moment, the attention is focused in the apoptosis signaling pathways mediated by caspases, from which, 14 are known. Apoptosis has an important biological role in the development and homeostasis of cellular populations and in the pathogenesis and expression of diseases' processes. An excessive or insufficient apoptosis contributes to the pathogenesis of a wide variety of ischemic, neurodegenerative, and autoimmune diseases and viral infections, besides of participating in the growth and regression of tumoural processes. This article presents a general outline of the different apoptosis signaling pathways, the integration of multiple involved genes and receptors and the participation in several diseases of this programmed cellular death, either in excess or insufficient.

[Aspirin induced asthma, urinary leukotriene E4 and zafirlukast]. / Asma inducida por aspirina, leucotrieno E4 en orina y zafirlukast.

OBJECTIVE: To evaluate the efficiency of zafirlukast in patients with aspirin-induced-asthma trough a measurement of VEF1, during the treatment and the symptoms daily reported. To evaluate the safety of treatment through a record of adversed events and laboratory and cabinet monitoring, to know the effect of zafirlukast on urine LTE4 level. MATERIAL AND METHODS: It was an open, controlled, prospective, longitudinal, observational study. Twenty patients with aspirin-induced asthma were included and 10 extrinsic asthma patients as a group control. On the aspirin-induced asthma, age range was between 28-82 years old patients with an average of 55. 17 female and three male and group control with demographic similar features. All patients were included in a 30 days wash period avoiding anti-inflammatory medication like steroids, cromons, etc., on the initial phase treatment. A determination of blood cell count, transaminases, bilirubins, immunoglobulins, GAME, electrocardiogram, thorax study and LTE4 urine analysis was carried out. Twice a day 20 mg. zafirlukast dosis was administered to both groups, VO, during eight weeks. A symptoms report diary was given to each of the patients. A weekly and beginning sphirometric was carried out along the study to determine VEF1. Same laboratory and cabinet variables were determined on the final checking. RESULTS: 17 patients from the study group were analyzed and 10 from control group, an improvement of 12% average was reported on final VEF1, in comparison to the basal for both groups (p < .001) having this relation with the clinic improvement in the diary symptoms report. LTE4 urine levels diminished in similar form on both groups. This reduction was important (p < .001). Just three limited slight cephalalgia cases were reported (7.9%). CONCLUSION: Asthmatic patients belonging to extrinsic or aspirin-induced asthma groups irrespectively showed an improvement from zafirlukast treatment on spirometric and clinic levels. No serious disadvantage was found associated to zafirlukast and side effects were slight after two months. In LTE4 level drop was found in urine, in possible relation with zafirlukast, interruption on the pulmonary chronic inflammatory process.

[New prospects for the treatment of systemic lupus erythematosus]. / Nuevas perspectivas de tratamiento del lupus eritematoso sistémico.

The systemic lupus erythematosus is a significant therapeutic challenge: Multiorgan involvement and a variable disease course, characterized by clinical exacerbations and remissions, make difficult to predict the outcome. Few products have been specifically developed for this affection, and most accepted therapies have not been tested in randomized controlled trials of systemic lupus erythematosus. A variety of biological agents under investigation as potential treatments for systemic lupus erythematosus are designed to interfere with specific immunologic responses, hopefully avoiding generalized immunosuppression. Agents, which interfere with T cell-B cell collaboration, such as CTLA-4-Ig and anti-CD154 ligand monoclonal antibodies, may result in long-term therapeutic benefit. Products designed to decrease production of anti-dsDNA antibodies or inhibit complement activation, may prevent immune complex deposition and ameliorate organ-specific manifestations, such as renal disease. More aggressive interventions include gene therapy and stem cell transplantation.

Eficacia y seguridad de la fexofenadina y la cetirizina en el tratamiento de la rinitis alérgica / Efficacy and safety of fexofenadine compared with cetirizine in the treatment of allergic rhinitis

Antecedentes: la rinitis alérgica afecta a 20 millones de personas en Estados Unidos y a un número muy superior en el resto del mundo. Objetivo: evaluar la eficacia y la seguridad de la fexofenadina en comparación con la cetirizina en el tratamiento de la rinitis alérgica. Material y método: se realizó un estudio prospectivo, doble ciego, comparativo, al azar y multicéntrico en pacientes con rinitis alérgica con edades comprendidas entre los 12 y 65 años. En la primera fase se administró placebo durante tres días a todos los pacientes y posteriormente se asignaron por azar para recibir fexofenadina a la dosis de 120 mg o 10 mg de cetirizina en dosis única al día durante 14 días. Al inicio y al final del estu dio se realizaron pruebas de laboratorio y gabinete que sirvieron como parámetros para conocer la inocuidad, eficacia y evaluación global por parte del investigador. Resultados: se incluyeron 176 pacientes, 63.6 por ciento de ellos eran mujeres. La edad promedio fue 27.8 años (ñ 12.0). El 47.7 por ciento de la muestra recibió fexofenadina y 52.2 por ciento cetirizina. No se encontró una diferencia significativa ni en parámetros de eficacia ni en la inocuidad. Conclusión: los resultados de este estudio permiten corroborar la eficacia e inocuidad de la fexofenadina.

Pruebas cutáneas con determinantes mayores y menores en pacientes con alergia dudosa a la penicilina / Cutaneous tests with major and minor determinants in patients with doubtful allergy to the penicillin

Antecedentes: en la actualidad, las pruebas cutáneas son uno de los métodos más aceptados para el diagnóstico de alergia a la penicilina. Objetivo: evaluar la eficacia y seguridad diagnóstica de las pruebas cutáneas con determinantes mayores y menores de penicilina, y penicilina cristalina, en pacientes con reacción dudosa a la penicilina. Método: estudio comparativo, controlado, en el que se incluyeron pacientes con antecedentes de reacción dudosa a la penicilina (grupo problema) e individuos sanos (grupo control). Ambos grupos se sometieron a las siguientes pruebas: 1) pruebas cutáneas con determinantes mayores (PPL) y menores (MDM) de penicilina, y penicilina cristalina (PCr), mediante métodos de escarificación e intradermo-rreacción; 2) en caso de negatividad, se practicaron pruebas de provocación con penicilina. La formación de roncha con o sin eritema igual o mayor de 3 mm en relación con el control positivo o reacción de tipo sistémico se consideró prueba positiva. Resultados: se incluyeron 47 pacientes (24 para el grupo problema y 23 para el grupo control). El 50 por ciento del grupo problema mostró positividad con el método de escarificación y ninguno en el grupo control (p < 0.001); con el método de intradermorreacción, 79.16 por ciento del grupo problema y sólo 13.4 por ciento del grupo control mostraron positividad (p < 0.001). Las pruebas cutáneas sólo reportaron efectos locales. La historia clínica mostró una sensibilidad del 88 por ciento; el método de escarificación 50 por ciento y el método de intradermorreacción, 95 por ciento. Conclusiones: las pruebas cutáneas demuestran un alto rango de seguridad y eficacia para el diagnóstico de alergia a la penicilina en pacientes con reacción dudosa a betalactámicos.

Asma y reflujo gastroesofágico: correlación diagnóstica entre gamagrafía y endoscopía digestiva / Asthma and reflux gastroesofagico: diagnostic correlation between gamagrafía and endoscopic digestive

Antecedentes: la prevalencia del reflujo gastroesofágico entre asmáticos se estima en la actualidad entre 33 y 89 por ciento. Los síntomas del reflujo gastroesofágico pueden ser clásicos o atípicos y 30 por ciento de los pacientes tendrán de reflujo silencioso. En la actualidad se considera como estándar de oro al monitoreo del pH esofágico de 24 horas y a la endoscopía digestiva y la biopsia, determinándose una menor sensibilidad a la gamagrafía gástrica pero quizá una mayor utilidad diagnóstica en relación con su disponibilidad y facilidad de acceso. Objetivo: comunicar los resultados de un estudio comparativo que reporta la sensibilidad-especificidad del gamagrama gástrico en relación con la endoscopía digestiva y reportar los hallazgos de la biopsia. Método: seleccionar de la consulta externa del servicio de alergia e inmunología a todo paciente asmático de difícil control no mayor de seis años de edad. Determinar la gamagrafía gástrica y posteriormente la panendoscopía con toma de biopsia. Integrar la sensibilidad-especificidad para gamagrafía. Resultados: se estudió a 44 pacientes en un lapso de ocho meses; el rango de edad estuvo entre 1.4 y 6 años. El gamagrama gástrico fue positivo en 25 pacientes (56.8 por ciento) y negativo en 19 (43.1 por ciento). El estudio endoscópico demostró la existencia de incompetencia del hiato en 33 (75 por ciento) pacientes, esofagitis de grado variable en 20 pacientes (45.4 por ciento), gastritis en 8 (18.1 por ciento) y endoscopía normal en 8 (18.1 por ciento). Los hallazgos histopatológicos fueron: esofagitis de grado variable en 33 pacientes (75 por ciento), gastritis crónica en dos pacientes (4.5 por ciento), esófago de Barrett en 2 pacientes (4.5 por ciento) y estudio histopatológico normal en 7 (15.9 por ciento). De los 44 pacientes, 81.5 por ciento mostraron significativo reflujo.Se integra una sensibilidad y especificidad de gamagrafía gástrica de 71.4 y 54.2 por ciento, respectivamente. Conclusiones: el gamagrama gástrico aporta una sensibilidad media pero aceptable para el estudio diagnóstico inicial de reflujo gastroesofágico. En asmáticos de difícil control se debe considerar inicialmente la endoscopía digestiva. En todo paciente asmático siempre debe tomarse en cuenta la probabilidad de reflujo gastroesofágico.

Hipersensibilidad a medicamentos / Drugs hypersensitivity

La hipersensibilidad a los medicamentos es una reacción adversa provocada por una respuesta inmunológica desencadenada por el consumo de un medicamento o, bien, por la reacción a uno de sus metabolitos. En la actualidad se estima que 10 por ciento de la población general tiene antecedentes, es susceptible o hipersensible a un medicamento o producto biológico. Estas reacciones obedecen a un patrón de factores del individuo y del medicamento, que definen el grado de alergenicidad del fármaco; con base en sus características se puede desarrollar cualquier tipo de daño inmunológico (Gel & Coombs). A pesar de ello, debe establecerse que aún existen mecanismos de hipersensibilidad a medicamentos que todavía no se conocen del todo, por lo que no se integran a esta clasificación y se catalogan como un tipo de reacción no definido. Además, existen medicamentos que provocan alguna reacción farmacológica debido a respuestas no inmunológicas que corresponden a los diferentes efectos agresores del fármaco. Con base en los conceptos señalados, en esta revisión se exponen algunos aspectos básicos de los diversos mecanismos de hipersensibilidad inmunológica y no inmunológica de los fármacos, así como algunos conceptos diagnósticos y terapéuticos necesarios para el manejo de la hipersensibilidad a medicamentos.

Estudio de Marcadores de superficie celular en pacientes con rinitis alérgica frente a reto con Der p y Der f / Estudy of the markers of cellular surface in patients with allergic rinitis forehead to challenge with Der p and Der f

Los padecimientos alérgicos están genéticamente determinados y afectan del 20 al 30 por ciento de la población general en países desarrollados; en la última década la prevalencia se ha incrementado. El desequilibrio manifiesto en los padecimientos atópicos se encuentra en las células presentadoras de antígeno (monocitos y células B) y en los linfocitos T CD4+. La asociación de moléculas como CD80, CD 86 (moléculas co-estimulatorias) en monocitos y células B; y CD30, CD62L, ALL, CD11a, CD28, CD124 y CD152 en CD4+, ha demostrado ser de particular interés en padecimientos atópicos. Sin embargo, no se encontró una diferencia estadísticamente significativa entre pacientes y controles y entre reto nasal con solución salina y alergeno. Por esto se sugiere que los cambios en la activación, proliferación y cooperación se dan en el sitio de la lesión, sin una aparente repercusión en las células de la sangre periférica.

Pruebas de función respiratoria en asma inducida por aspirina / Tests of respiratory function in asthma induced by aspirin

Introducción: el asma inducida por aspirina es un síndrome establecido, con un cuadro clínico distintivo. Los ataques de asma por aspirina y otros antiinflamatorios no esteroides es la marca distintiva del síndrome. Objetivo: determinar la dosis mínima necesaria para padecer asma en una población de riesgo y valorar la sensibilidad de pruebas de función respiratoria VEF-1 y FEF 25-75. Material y método: estudio prospectivo, abierto, transversal y comparativo de 20 pacientes divididos en dos grupos de 10 cada uno. El primero integrado por pacientes con antecedente de asma inducida por aspirina (AlA) y el segundo por pacientes con asma extrínseca; a ambos grupos se les practicó prueba de reto con aspirina. A todos se les hicieron estudios de rayos X de senos paranasales y telerradiografía de tórax, pruebas cutáneas a alergenos y espirometría. Se tomó en cuenta el criterio para apoyar el diagnóstico de AlA de caída de 15 por ciento ó más del VEF-1 en los dos grupos. También se evaluaron los exámenes de laboratorio y gabinete para correlacionar el diagnóstico y las complicaciones. Resultados: en el primer grupo se observó una caída estadísticamente significativa de los valores de VEF-1 y FEF 25-75 de más de 15 por ciento (p<0.05). En el segundo grupo se observó una caída del 5 al 9 por ciento de dichos valores (p > 0.5) no estadísticamente significativa. La dosis mínima en el grupo de estudio fue de 100 mg de aspirina; las complicaciones más frecuentes, luego del reto, fueron sibilancias, disnea, tos y broncoespasmo severo. No ocurrió ninguna defunción. Conclusiones: la dosis mínima para realizar el diagnóstico de AlA es de 100 mg de aspirina. La caída de VEF-1 es dependiente de la dosis de aspirina en los pacientes con AlA. Los pacientes con asma bronquial extrínseca sin antecedente de idiosincrasia a la aspirina no tuvieron reacciones adversas. La complicación más severa en los pacientes sometidos a reto con aspirina y antecedente de idiosincrasia a la aspirina es el broncoespasmo severo que ameritó apoyo con ventilación mecánica.

Alergia al látex en una población de riesgo / Latex allergy in population of high risk

Antecedentes. La alergia al látex es una enfermedad cuya prevalencia se ha incrementado en forma muy significativa en los últimos años. Objetivo. Conocer la incidencia de alergia al látex en población de riesgo, así como identificar los síntomas relacionados y la importancia del papel que juegan los antecedentes de atopia y tiempo de contacto con el látex para el desarrollo de la enfermedad. Método. Realizamos un estudio prospectivo, descriptivo, experimental y transversal en población de riesgo, en el servicio de alergia e inmunología clínica del Hospital Regional Lic. Adolfo López Mateos, ISSSTE. Se incluyeron 100 pacientes de uno y otro sexo, con edad de 20 a 50 años, con el antecedente de ser personal médico y paramédico y haber tenido contacto con material de látex. Se realizó prueba cutánea por prick a látex con control positivo a base de solución de histamina y control negativo con solución de Evans y lectura inmediata de la misma. Resultados. El 22 por ciento de los pacientes estudiados resultaron con la prueba cutánea positiva, con un tiempo de exposición promedio de 10 años, 68 por ciento tuvieron antecedente de atopia personal o familiar. Así mismo, los síntomas concomitantes fueron en 33 por ciento dermatológicos, 54 por ciento nasales, ninguno manifestó síntomas bronquiales y se reportó 9 por ciento asintomático. Conclusión. La prueba cutánea inmediata al látex por escarificación es un parámetro importante de apoyo diagnóstico para alergia a látex de tipo 1