A Systematic Review and Meta-analysis of Mobile Health Applications and Telemonitoring in Atopic Dermatitis Self-Management.

INTRODUCTION: Up to 25% of children and 5.6% of adults in the USA have atopic dermatitis (AD), with substantial impacts on quality of life. Effective control can be challenging despite therapy efforts. The emergence of information and communication technologies (ICT) in AD management prompted this study to assess its impact on self-management. We conducted a meta-analysis to assess outcomes from peer-reviewed clinical trials evaluating the effectiveness of teledermatology, mobile health (mHealth) apps, and electronic devices for managing AD. METHODS: We searched PubMed, Web of Science, Scopus, and Embase for articles written in English and published until May 2023. RESULTS: Twelve trials with 2424 participants were selected from 811 studies. A meta-analysis of 1038 individuals reported a mean difference (MD) of -1.57 [95% confidence interval (CI): -2.24, -0.91] for the Patient Oriented Eczema Measure (POEM). A meta-analysis of 495 individuals reported a Dermatology Life Quality Index (DLQI) MD of -0.59 [95% CI: -0.95, -0.23]. Despite heterogeneity (I2 = 47% and I2 = 74%), the impact was significant (P ≤ 0.001). SCORing Atopic Dermatitis (SCORAD) showed an insignificant MD of -0.12 (P = 0.91). CONCLUSION: mHealth applications and telemonitoring show significant improvement in patients' quality of life (DLQI) and self-management (POEM) but no significant impact on AD severity (SCORAD).

Consenso para el manejo práctico de la urticaria en atención primaria

Introduction: urticaria has a high impact on the quality of life of patients with this condition. While there are multiple evidence-based guidelines, these tend to be aimed at providing management recommendations for specialists rather than primary care physicians, who are usually the first to care for patients with urticaria. Objective: to develop a consensus document aimed at presenting evidence-based recommendations to help general practitioners, family doctors, pediatricians, internists and emergency physicians provide timely care for patients with urticaria, facilitating its diagnosis and timely care, and thus avoiding delays for the patients. Methods: international urticaria guidelines with recommendations based on the GRADE system were used as the source of information. Delegates of the interested scientific societies were convened, and, through structured meetings, treatment barriers and possible solutions for the application of the recommendations in primary care were identified. Results: the main barriers for primary care physicians in applying the guidelines were identified: confusion in the diagnosis, proper timing of treatment, first-line medications, and management of special situations. Possible consensus solutions were proposed for each identified barrier. Conclusion: this consensus document contains recommendations for the management and treatment of acute and chronic urticaria which help primary care physicians provide timely and effective treatment for patients with this disease. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2722).

Fractional exhaled nitric oxide and eosinophil count in induced sputum to guide the management of children with asthma: a cost-utility analysis.

INTRODUCTION: Previous evidence has shown that fractional exhaled nitric oxide (FeNO) and eosinophil count in induced sputum (EO) are cost-effective relative to standard of care in guiding the management of children with persistent asthma. There is some doubt as if there are differences between these two biomarkers in terms of costs and benefits. Clarifying this doubt would allow prioritization of the design of clinical practice guidelines. The study aimed to compare in terms of costs and benefits these biomarkers in patients with asthma between 4 and 18 years of age. METHODS: A Markov model was used to estimate the cost-utility of asthma management using FeNO and EO in patients between 4 and 18 years of age. Transition probabilities, cost and utilities were estimated from previously published local studies, while relative risks were obtained from the systematic review of published randomized clinical trials. The analysis was carried out from a societal perspective. RESULTS: The expected annual cost per patient with EO was US $1376 (CI 95% US $1376-US $1377) and for FeNO was US $1934 (CI 95% US $1333-US $1334), with a difference of US $42.3 between these strategies. The Quality-adjusted life years (QALYs) per person estimated with EO was 0.95 (CI 95% 0.951-0.952) and for FeNO was 0.94 (CI 95% 0.930-0.940), with a difference of 0.01 between these strategies. The NMB with EO was US $4902 (CI 95% 4900-4904) and for FeNO was US $4841 (CI 95% 4839-4843). The incremental cost-effectiveness ratio of EO was $3566 per QALY gained regarding FeNO. CONCLUSION: Our study demonstrates that induced sputum-guided management is a strategy cost-effective over FeNO and standard asthma management in Colombia. This evidence should encourage the adoption of any of these techniques to objectively guide the management of children with asthma in routine clinical practice in low-resource settings.

Multicentric and Observational Study of Omalizumab for Chronic Spontaneous Urticaria in Real-Life in Colombia.

Background: Although chronic urticaria (CU) is a common, cause of medical consulting both in general practitioners and allergist specialists worldwide, there is little information about its behavior and management in Latin America. Currently, national and international guidelines recommend using Omalizumab for cases refractory to management with antihistamines. Despite advances in the knowledge of Omalizumab for the management of CU, although there are few studies in underdeveloped countries, there are many studies evaluating the impact of Omalizumab treatment. There is not clinical information related with CSU-Omalizumab in patient settled in the Caribbean area. This research aims to evaluate the management of CU with Omalizumab in a real-life scenario in Colombia. Methodology: We conducted an observational, descriptive, and retrospective study with patient recruitment between 2014 and 2017 of individuals diagnosed with Chronic Urticaria (CU) treating allergology specialists in five Colombian cities. We included patients with CU who failed to achieve disease control after treatment for 4 weeks with fourfold doses of second-generation H1-antihistamines, as recommended by the EAACI/GA2LEN/EDF/WAO guidelines and who received treatment with Omalizumab. Results: We included 123 patients, 73.1% (n = 90) were women. The mean age was 47.1 years (Standard Deviation, SD: 16.2). The median of the total months of disease evolution was 30 (IQR = 13-58). 81.3 % (n = 100) of patients were diagnosed with chronic spontaneous urticarial (CSU). 4.8% (n = 6) had inducible CU (CIndU), and 13.8% (n = 17) reported mixed urticaria (spontaneous CU with at least one inducible component). Regarding emotional factors, 34.9% (n = 43) of subjects indicated anxiety symptoms, 34.1% (n = 42) had exacerbations associated with stress, and 14.6% (n = 18) manifested episodes of sadness. The percentage of patients with CSU controlled according to medical criteria at 3 months with Omalizumab were 80% (n = 80/100) and at 6 months 87% (n = 87/100). The frequency of adverse events was 29.2% (n = 36), with headache being the most frequent adverse event. Conclusions: This real-life study with Omalizumab at CU describes percentages of effectiveness and safety similar to those observed in pivotal and real-life studies conducted in other regions around the world.

Prevalencia e impacto clínico de la sensibilización a látex y frutas en estudiantes de odontología de la Universidad de Antioquia y su relación con alergia a frutas / Prevalence and clinical impact of sensitization to latex and fruits in dentistry students at the University of Antioquia, and its relationship with allergy to fruits / Prevalência e impacto clínico da sensibilização a látex e frutas em estudantes de Odontologia da Universidade de Antioquia e sua relação com alergia a frutas

Objetivo: determinar la prevalencia y el impacto clínico de la sensibilización al látex y a cinco frutas tropicales (banano, aguacate, kiwi, piña y maracuyá) en estudiantes de odontología. Métodos: estudio transversal analítico de 128 estudiantes de odontología de la Universidad de Antioquia; se recolectó la información mediante un cuestionario y se hicieron pruebas intraepidérmicas con látex y frutas. Resultados: todos los estudiantes habían tenido contacto con látex; nueve refirieron al menos un episodio de reacción adversa al contacto con látex sin sensibilización probada al mismo. Cinco informaron al menos una reacción con una de las frutas, pero los resultados fueron negativos en las pruebas cutáneas. Cuatro de los 14 que informaron síntomas gastrointestinales estaban sensibilizados al látex o a alguna de las frutas. La tasa global de sensibilización al látex fue del 3,1%. Conclusión: el porcentaje de sensibilización al látex hallado en nuestro estudio está por debajo del publicado lo que puede ser debido a la expresión de mecanismos inmunológicos diferentes a la mediación IgE. No se logró demostrar más sensibilización al látex en función del mayor número de semestres cursados. Se debe destacar la asociación entre síntomas gastrointestinales y la sensibilización tanto a frutas como al látex.

Objective: To determine the prevalence and clinical impact of sensitization to latex and to five tropical fruits (banana, avocado, kiwi, pineapple and passion fruit) in dentistry students. Methods: Analytical cross-sectional study of 128 dentistry students at University of Antioquia in Medellín, Colombia. Information was collected by means of a questionnaire and skin prick tests with latex and fruits were done. Results: All students reported having had contact with latex. Nine of them informed at least one episode of adverse reaction to contact with latex without proof of sensitization to it. Five reported at least one reaction with one of the fruits, but skin prick tests were negative. Four of the 14 students who reported gastrointestinal symptoms were sensitized to latex or to one of the tested fruits. Overall, latex sensitization rate was 3.1%. Conclusion: This percentage of sensitization to latex is lower than that in other studies; this may be due to the expression of immune mechanisms other than IgE mediation. We failed to demonstrate a higher sensitization rate to latex as students advanced in their career. The association between gastrointestinal symptoms and sensitization to both fruit and latex is to be emphasized.

Objetivo: determinar a prevalência e o impacto clínico da sensibilização ao látex e a cinco frutas tropicais (banana, abacate, kiwi, pinha e maracujá) em estudantes de odontologia. Métodos: estudo transversal analítico de 128 estudantes de odontologia da Universidade de Antioquia; coletou-se a informação mediante um questionário e se fizeram provas intraepidérmicas com látex e frutas. Resultados: todos os estudantes tinham tido contato com látex; nove referiram ao menos um episódio de reação adversa ao contato com látex sem sensibilização provada ao mesmo. Cinco informaram ao menos uma reação com uma das frutas, mas os resultados foram negativos nas provas cutâneas. Quatro dos 14 que informaram sintomas gastrointestinais estavam sensibilizados ao látex ou a alguma das frutas. A taxa global de sensibilização ao látex foi de 3,1%. Conclusão: a porcentagem de sensibilização ao látex achado em nosso estudo está por embaixo do publicado, que pode ser devido à expressão de mecanismos imunológicos diferentes à mediação IgE. Não se conseguiu demonstrar mais sensibilização ao látex em função do maior número de semestres cursados. Deve-se destacar a associação entre sintomas gastrointestinais e a sensibilização tanto a frutas como ao látex.

Inmunoterapia con alérgenos: cuándo y por qué? / Allergen immunotherapy: when and why? / Imunoterapia com alérgenos: quando e por quê?

La inmunoterapia específica con alérgenos es el único tratamiento que modifica el curso natural de algunas enfermedades alérgicas como asma, rinitis, conjuntivitis, dermatitis atópica y alergia al veneno de himenópteros. Sin embargo, aún existe cierta controversia respecto a su seguridad y su utilidad clínica. En el presente artículo se presenta una revisión de los mecanismos moleculares, las indicaciones y contraindicaciones de dicha inmunoterapia, y se evalúan su seguridad y eficacia en cada una de estas enfermedades mediante casos ilustrativos y una breve revisión del tema.

Allergen specific immunotherapy is currently the only treatment that modifies the natural course of allergic diseases. Its present indications are asthma, rhinitis, conjunctivitis, atopic dermatitis and hymenoptera venom allergy. However, there still is some controversy regarding its safety and clinical utility. In this article, we present a review about the molecular mechanisms, indications, contraindications, safety and efficacy of immunotherapy in each one of these diseases, by means of illustrative cases.

tratamento que modifica o curso natural de algumas doenças alérgicas como asma, rinite, conjuntivite, dermatite atópica e alergia ao veneno de himenópteros. No entanto, ainda existe certa controvérsia com respeito a sua segurança e sua utilidade clínica. No presente artigo se apresenta uma revisão dos mecanismos moleculares, as indicações e contraindicações de dita imunoterapia, e se avaliam sua segurança e eficácia em cada uma destas doenças mediante casos ilustrativos e uma breve revisão do tema.

Desensibilización al ácido acetil-salicílico como tratamiento para la enfermedad respiratoria exacerbada por antiinflamatorios no esteroides / Desensitization to acetyl-salicylic acid as a treatment for non-steroid anti-inflammatory drugs (NSAIDs)-exacerbated respiratory disease

La coexistencia de hipersensibilidad al ácido acetil salicílico (ASA) y a otros antiinflamatorios no esteroides (AINE) con enfermedad de la vía aérea superior (rinosinusitis/poliposis nasosinusal) o inferior (asma) se denomina enfermedad respiratoria exacerbada por ASA (EREA). Las opciones de tratamiento incluyen la evitación de todos los analgésicos inhibidores de la ciclooxigenasa 1 (COX-1) o la desensibilización a ASA, continuando su consumo diario. Esta última opción terapéutica ha demostrado mejorar la calidad de vida, reducir la formación de pólipos nasosinusales, los episodios de sinusitis infecciosa, la frecuencia de las hospitalizaciones y de las cirugías para resección de pólipos; también mejora la hiposmia y reduce la necesidad de tratamiento con esteroides sistémicos. Se han usado múltiples esquemas de desensibilización, tratando de reducir el riesgo asociado con el procedimiento y los efectos adversos derivados del consumo crónico de ASA. En este artículo se presentan una revisión de los diferentes esquemas de desensibilización y dos casos clínicos ilustrativos que sirven de ejemplo para comprender mejor los factores que influyen en la elección del tratamiento para los pacientes con esta enfermedad.

The coexistence of hypersensitivity to acetylsalicylic acid (ASA) and other NSAIDs with disease of the upper or the lower airways (rhinosinusitis/sinonasal polyposis, or asthma) is defined as NSAIDs-exacerbated respiratory disease. Treatment options include the avoidance of all analgesics that inhibit COX-1 or ASA desensitization, continuing its daily consumption. The latter treatment has shown to improve quality of life, reduce the formation of sinonasal polyps, the episodes of sinus infection, the frequency of hospitalizations and surgeries for resection of polyps and the need for systemic steroid treatment. Multiple desensitization schedules have been used, trying to reduce the risk associated with the procedure and the adverse effects of chronic use of ASA. In this paper we present a review of the different methods of desensitization and two illustrative clinical cases to help understand the factors that influence the choice of treatment for these patients.

[Effectiveness of allergen immunotherapy in patients with vernal keratoconjuctivitis]. / Efectividad de la inmunoterapia con alergenos en pacientes con queratoconjuntivitis vernal.

BACKGROUND: Allergen immunotherapy has demonstrated usefulness in the management of allergic diseases such as asthma, allergic rhinitis and conjunctivitis. However, little is known about its effectiveness in vernal keratoconjunctivitis (VKC), a disease mediated by IgE and lymphocytes, that can cause loss of visual acuity in a permanent way. OBJECTIVE: To describe safety and effectiveness of allergen immunotherapy in a group of patients with VKC. METHODS: From a sample of 575 patients sensitized to house dust mites, who received ultra-rush immunotherapy for asthma, allergic rhinoconjuctivitis or atopic dermatitis, 28 patients with VKC were selected and a retrospective analysis was performed with the evaluation of factors related to safety, pharmacological treatment and clinical response to immunotherapy.. RESULTS: Twenty eight patients with VKC who received allergen immunotherapy were studied. There were 21 men and 7 women, with an average age of 11 years. A total of 490 doses were administered (35 for build-up and 455 for maintenance) for different periods. The average number of doses per patient was 17. There were no local or systemic reactions. Seventy one percent of the patients presented a clear reduction in the use of medications, with an improvement in symptoms 89% and physical findings 68%. CONCLUSIONS: Allergen immunotherapy seems to be a safe and efficient treatment for patients with VKC, and can contribute along with pharmacological management to the improvement of symptoms and reduction in the use of medications.

Características fisicoquímicas de los gases y partículas contaminantes del aire. Su impacto en el asma / Physicochemical characteristics of gaseous and particulate air pollutants. Their impact on asthma

El asma es una enfermedad multifactorial caracterizada por un proceso inflamatorio que afecta las vías respiratorias. El incremento epidemiológico que ha tenido en los últimos años parece deberse principalmente a factores ambientales. El aumento en las concentraciones de los contaminantes atmosféricos, secundario a la liberación de gases y pequeñas partículas producidos a partir de la combustión de derivados del petróleo, el humo del cigarrillo y otras fuentes antropogénicas, parece tener una fuerte asociación con el aumento de las enfermedades alérgicas, bien sea como disparadores de las exacerbaciones asmáticas o como posibles mediadores importantes en el inicio del asma y la rinitis y en la sensibilización con aeroalergenos. En este artículo se presenta una revisión de las principales características de los gases y partículas que han sido considerados factores de riesgo para el desarrollo del asma.

Asthma is a multifactorial disease characterized by an inflammatory process that affects the airways. Its epidemiological increase in recent years seems to be mainly due to environmental factors. Increase in the concentration of air pollutants, secondary to the release of gases and small particles produced by the combustion of petroleum products, cigarette smoke and other anthropogenic sources, seems to have a strong association with the increase of allergic diseases both as triggers of asthma exacerbations, and as possible mediators in the onset of asthma and rhinitis, and in the sensitization to aeroallergens. In this article a review is presented on the main characteristics of gases and particles that have been considered risk factors for the development of asthma.

Clinical and immunological changes of immunotherapy in patients with atopic dermatitis: randomized controlled trial.

Background. Immunotherapy has proven to be an useful tool in the management of allergic respiratory diseases; however, little has been studied in atopic dermatitis. Objective. To evaluate the clinical and immunological impact of immunotherapy with mites allergen extracts in atopic dermatitis. Methods. Patients with atopic dermatitis were assigned with computer-generated randomization to either of the following groups: (a) controls received only topical treatment with steroids and/or tacrolimus and (b) actively treated patients received topical treatment plus immunotherapy. Levels of serum total IgE, mites-specific IgE and IgG4 were assessed at study start and after one year of immunotherapy. Results. 31 patients in the active group and 29 in the control group completed the study. Symptoms and medication scores were significantly reduced in the active group after six months. Three patients in the control group showed new sensitizations to mites, while 3 patients in the active group showed neosensitization to shrimp with negative oral food challenge. We observed significant increase of mites-specific IgG4 levels in active group. Conclusion. Specific allergen immunotherapy induced a tolerogenic IgG4 response to mite allergens associated with favorable clinical effects in atopic dermatitis patients.

Epigenética en asma / Epigenetics in asthma

El asma es una enfermedad respiratoria crónica con alta heredabilidad. Se ha propuesto que en supatogénesis participan varios genes con efectos variables al igual que factores ambientales, y se hasugerido que los mecanismos epigenéticos pueden mediar parte del efecto de los factores ambientalesen el comienzo y la evolución de la enfermedad. La epigenética describe los cambios en la expresión génica heredables durante las mitosis y meiosis que no son codificados en la secuencia de ADN. Ellos incluyen la metilación o desmetilación del ADN y la acetilación, desacetilación,ubiquitinación, sumoilación y fosforilación de histonas, cambios en los microARN y alteraciones cromatónicas. En esta revisión se describen hallazgos que establecen una relación entre algunos mecanismos epigenéticos y el proceso inflamatorio y la exposición a factores ambientales en elasma.Ellos incluyen: el aumento en la actividad de las acetilasas de histonas y de la expresión de las enzimas acetiladoras; la disminución de las enzimas desacetiladoras en los pulmones de individuos asmáticos; el aumento de la expresión del factor nuclear NF-¦ÊB durante el proceso inflamatorioal¨¦rgico; cambios en la metilación/desmetilación del ADN durante la diferenciación de los linfocitosy la estimulación/supresión de genes como los de la IL-4 y el IFN-¦Ã, respectivamente. El humo delcigarrillo, las infecciones bacterianas y virales, la dieta materna y la polución ambiental son otros factores que desencadenan procesos epigenéticos como la acetilación de histonas, la inducción decitoquinas inflamatorias, la inactivación de las desacetilasas de histonas, la polarización de la respuesta inmune hacia el tipo Th2 y una mayor producción de IgE y citoquinas de este perfil.

Epigenetics in asthma is a chronic respiratory disease with a highheritability. It has been postulated that several genes withvariable effects are involved in its pathogenesis alongwith environmental factors. It has been suggested thatepigenetic mechanisms can mediate the effects ofenvironmental factors on the onset and progression ofthe disease. Epigenetics describes inheritable changes ingene expression inherited during meiosis and mitosis thatare not encoded in the DNA sequence. They include DNAmethylation/ demethylation, acetylation, deacetylation,ubiquitination, SUMOylation and phosphorylation ofhistones, changes in microARN and alterations ofchromatine. In this article we review some findings thatestablish a relationship between some epigeneticmechanisms and the inflammatory process in asthmaand exposure to environmental factors. They includeincreasing the activity of histone acetyl-transferases andthe expression of histone acetylating enzymes, decreaseof deacetylating enzymes in the lungs of asthmatics;increased expression of the transcription factor NF-¦ÊB inthe allergic inflammatory process, changes inmethylation/demethlylation of DNA during thedifferentiation of lymphocytes and the stimulation/suppression of IL-4 and IFN¦Ã genes, respectively.Smoking, bacterial and viral infections, maternal diet andenvironmental pollution are also factors that triggerepigenetic processes such as histone acetylation andinduction of inflammatory cytokines, inactivation ofhistone deacetytransferases, polarization of the immuneresponse toward the Th2 type and increased productionof IgE and cytokines of this profile.