[Drug allergy: Fundamental aspects in diagnosis and treatment.] / Alergia a medicamentos: aspectos fundamentales en el diagnóstico y tratamiento. Reporte de grupo del Colegio Mexicano de Inmunología Clínica y Alergia.

BACKGROUND: Any substance used as a treatment for any disease can produce harmful or unpleasant events called adverse drug reactions (ADRs). They are due to inherent biological effects of the drug and are caused by immunological and non-immunological mechanisms. OBJECTIVES: To describe the immunological mechanisms of hypersensitivity reactions (HSR) to drugs, their epidemiology, risk factors, classification, clinical manifestations, diagnosis, treatment, and prognosis. METHODS: A review of the most current literature in English and Spanish was carried out, in the main databases, related to the HSR of various drug groups. RESULTS: This study describes the terms used to define ADRs and HSRs, their classification and clinical manifestations, current diagnostic tools, treatment algorithms and prognosis of the most frequently used medications and with the highest prevalence of reported adverse events. CONCLUSION: ADRs are a challenging entity, with a complex pathophysiology that has not been fully understood. Its approach requires a careful consideration since not all drugs have validated tests for their diagnosis nor a specific treatment. When indicating the use of any drug, the severity of the disease, the availability of other treatments and the potential risks of developing future adverse events should always be taken into consideration.

ANTECEDENTES: Cualquier sustancia prescrita en el tratamiento de algún padecimiento es capaz de producir eventos dañinos o desagradables, y se denominan reacciones adversas a medicamentos. Estas reacciones se originan por mecanismos inmunológicos y no inmunológicos. OBJECTIVOS: Describir los mecanismos inmunológicos de las reacciones de hipersensibilidad a medicamentos, epidemiologia, factores de riesgo, clasificación, manifestaciones clínicas, diagnóstico, tratamiento y pronóstico. MÉTODOS: Se revisó la bibliografía actualizada, en inglés y español, asociada con reacciones de hipersensibilidad a medicamentos en las principales bases de datos. RESULTADOS: Se describen los términos para definir las reacciones adversas y de hipersensibilidad a medicamentos, su clasificación y manifestaciones clínicas, métodos diagnósticos actuales y en estudio, algoritmos de tratamiento y pronóstico de los medicamentos más frecuentemente prescritos y con mayor prevalencia de eventos adversos reportados. CONCLUSIÓN: Las reacciones adversas a medicamentos representan un reto, con una fisiopatología compleja y no del todo comprendida. Su abordaje requiere un enfoque cuidadoso, porque no todos los fármacos cuentan con pruebas validadas para establecer el diagnóstico y tratamiento específico. Antes de indicar cualquier medicamento debe considerarse la gravedad de la enfermedad, disponibilidad de otros tratamientos y riesgos potenciales de sufrir eventos adversos.

[Sensitization to house dust and storage mites in allergic adults from the South of Mexico city]. / Sensibilización a ácaros intradomiciliarios y de almacenamiento en adultos alérgicos del sur de la Ciudad de México.

BACKGROUND: Mites are the most common cause of respiratory allergy. Sensitization to house dust mites is estimated at 30%. Families Euroglyphus and Dermatophagoides, are the most important. Recently, storage mites, from the families Acaridae and Glyciphagidae, have become more important as a cause of allergic respiratory diseases. OBJECTIVE: The aim of this study was to identify sensitization to house dust and storage mites by skin tests in adult patients with allergic respiratory diseases. METHODS: This is a descriptive study in patients with asthma and/or allergic rhinitis, with the approval of the local research committee 2009-3601-46. Patients underwent skin prick tests, with seven standardized extracts of mites (IPI ASACR). The results were analyzed with descriptive statistics. RESULTS: A total of 150 patients, 109 women and 41 men, with an average age 31 years (±11) were studied. The more common allergic diseases in this group of patients were: asthma and rhinitis 72 and 26%, respectively, and asthma plus rhinitis 3.2%. Positive skin tests for Dermatophagoides pteronyssinus and Dermatophagoides farinae were 82.1% 71.5%, respectively, and for storage mites: A. siro 51.7%, Tyrophagus 47.4%, Glycyphagus 47.7%, B. tropicalis 39.7% and Lepidoglyphus 39.1%. Storage mites produced greater sensitization than house dust mites, 32% vs 10%. CONCLUSIONS: The results show that adult patients with respiratory allergy, in southern Mexico City, have a higher rate of sensitization to storage mites than the one reported in the literature.