Factors associated with allergic rhinitis in children from northern Mexico City.

BACKGROUND: The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire allows users to find factors associated with allergic diseases, but thus far most of the studies on risk factors for allergic diseases have been devoted to asthma and not to rhinitis. OBJECTIVE: To determine the main factors associated with symptoms of allergic rhinitis and rhinoconjunctivitis in school children and adolescents in northern Mexico City. PATIENTS AND METHODS: A cross sectional, multicenter survey was conducted in northern Mexico City, in children aged 6-7 and 13-14 years. The survey instrument was the Phase Three B ISAAC questionnaire, which was validated and standardized in Spanish. RESULTS: There were 4106 6-7-year-olds and 6576 13-14-year-olds. The total prevalence of diagnosis of allergic rhinitis was 4.6%. The prevalence of cumulative and current symptoms of rhinitis was considered high (>29%), but the prevalence of the diagnosis of allergic rhinitis was considered low (ranging from 3.4% to 5.6%). The prevalence of symptoms of rhinitis with conjunctivitis had intermediate values (ranging from 20.3% to 30.2%). Cumulative symptoms of allergic rhinitis, current symptoms of allergic rhinitis, and rhinoconjunctivitis were related to symptoms of current or cumulative asthma, symptoms of current or cumulative atopic eczema, and current use of paracetamol (odds ratio > 1, P < .05). CONCLUSION: The present results support the concept of rhinitis and asthma as common chronic respiratory diseases, and this study also found a relation between paracetamol use and rhinitis in children.

Formoterol vs. albuterol administered via Turbuhaler system in the emergency treatment of acute asthma in children.

BACKGROUND: Formoterol is a new beta 2 agonist with a duration of 8-12 hours. Albuterol is a beta 2-agonist with rapid onset of action and a duration of approximately 6 hours. OBJECTIVE: The aim of the present study was to compare the onset of action between formoterol and albuterol, both administered through a Turbohaler. MATERIAL AND METHOD: In a double-blind, parallel-group study design 36 patients were randomly allocated to receive either formoterol 12 microg or salbutamol 200 microg. The two drugs were administered through a Turbohaler system. Response (% forced expiratory volume in one second [FEV1]) was evaluated 3, 30 and 60 minutes after drug administration. RESULTS: The %FEV1 values at 3, 30 and 60 minutes were similar in both groups: 82 15.0 for formoterol and 82 14.4 for albuterol at 60 minutes (p > 0.05). CONCLUSIONS: Formoterol 12 microg has a similar onset of action and potency to albuterol 200 microg when administered via a Turbuhaler in children with a mild acute asthma crisis.

Formoterol vs. Albuterol administered via Turbuhaler System in the emergency treatment of acute asthma in children

Background: Formoterol is a new β2-agonist with a duration of 8-12 hours. Albuterol is a β2-agonist with rapid onset of action and a duration of approximately 6 hours.Objective: The aim of the present study was to compare the onset of action between formoterol and albuterol, both administered through a Turbohaler®. Material and method: In a double-blind, parallel-group study design 36 patients were randomly allocated to receive either formoterol 12 μg or salbutamol 200 μg. The two drugs were administered through a Turbohaler® system. Response (% forced expiratory volume in one second [FEV1]) was evaluated 3, 30 and 60 minutes after drug administration. Results: The %FEV1 values at 3, 30 and 60 minutes were similar in both groups: 82 ± 15.0 for formoterol and 82 ± 14.4 for albuterol at 60 minutes (p > 0.05). Conclusions: Formoterol 12 μg has a similar onset of action and potency to albuterol 200 μg when administered via a Turbuhaler® in children with a mild acute asthma crisis (AU)

Información básica: Formoterol es un nuevo Beta2-agonista con un efecto de 8-12 horas. Salbutamol es un Beta2-agonista con una acción de comienzo rápido que dura aproximadamente 6 horas. Objetivo: El objetivo del presente estudio era comparar el inicio de la acción entre formoterol y salbutamol, ambos administrados mediante Turbohaler. Material y método: En un estudio doble ciego y de grupos paralelos se distribuyó aleatoriamente a 36 pacientes para recibir formoterol 12 mg o salbutamol 200mg. Los dos fármacos se administraron por medio de un sistema Turbohaler. Se evaluó la respuesta ( por cientoFEV1) 3, 30 y 60 minutos después de la administración del fármaco. Resultados: Los valores de por cientoFEV1 a los 3, 30 y 60 minutos fueron semejantes entre los grupos (p > 0,05), p. ej., 82 ñ 15,0 con formoterol y 82 ñ 14,4 con salbutamol a los 60 min. Conclusiones: Formoterol 12mg tuvo un inicio de acción y una potencia similares a las de salbutamol 200mg cuando se administraron a través de Turbuhaler a niños con crisis asmáticas agudas leves (AU)

Use of OM-85 BV in children suffering from recurrent respiratory tract infections and subnormal IgG subclass levels.

BACKGROUND: Recurrent acute respiratory tract infections (RARTIs) in children are related to IgG subclass deficiencies. The aim of the trial was to evaluate the effect of OM-85 BV in the number of RARTIs as well as in the IgG subclass levels. METHODS: This was a randomized, double-blind, placebo-controlled clinical trial. Patients of ages three to six years, having three or more documented ARTIs during the last six months with subnormal IgG subclass levels were included. Patients took either one capsule of OM-85 BV (3.5 mg) or placebo orally every day for ten consecutive days per month during three consecutive months. Patients were followed three further months without drug intake. IgG subclass levels were determined before and after treatment. RESULTS: IgG4 levels diminished after the OM-85 BV treatment (-3 [-8.0, -1.0] median difference [95 % CI] p < 0.05 by Wilcoxon test). No other significant changes in IgG subclasses were observed. After six months the patients in the OM-85 BV group (n = 20) experienced 2.8 1.4 (mean SD) ARTIs, while the patients in the placebo group (n = 20) suffered 5.2 1.5 ARTIs (-2.4 [3.3, -1.5] mean difference [95 % CI] p < 0.001 by Student's t test). Three patients with OM-85 BV had gastrointestinal events related to drug administration, as well as three placebo patients. CONCLUSION: This study demonstrated the clinical benefit of OM-85 BV in patients suffering from RARTIs and subnormal levels of IgG subclasses. This trial opens new perspectives in the research of the mechanism of action of OM-85 BV.

Use of OM-85 BV in children suffering from recurrent respiratory tract infections and subnormal IgG subclass levels

Background: Recurrent acute respiratory tract infections (RARTIs) in children are related to IgG subclass deficiencies. The aim of the trial was to evaluate the effect of OM-85 BV in the number of RARTIs as well as in the IgG subclass levels. Methods: This was a randomized, double-blind, placebo-controlled clinical trial. Patients of ages three to six years, having three or more documented ARTIs during the last six months with subnormal IgG subclass levels were included. Patients took either one capsule of OM-85 BV (3.5 mg) or placebo orally every day for ten consecutive days per month during three consecutive months. Patients were followed three further months without drug intake. IgG subclass levels were determined before and after treatment. Results: IgG4 levels diminished after the OM-85 BV treatment (-3 [-8.0, -1.0] median difference [95 % CI] p < 0.05 by Wilcoxon test). No other significant changes in IgG subclasses were observed. After six months the patients in the OM-85 BV group (n = 20) experienced 2.8 ± 1.4 (mean ± SD) ARTIs, while the patients in the placebo group (n = 20) suffered 5.2 ± 1.5 ARTIs (-2.4 [­3.3, -1.5] mean difference [95 % CI] p < 0.001 by Student's t test). Three patients with OM-85 BV had gastrointestinal events related to drug administration, as well as three placebo patients. Conclusion: This study demonstrated the clinical benefit of OM-85 BV in patients suffering from RARTIs and subnormal levels of IgG subclasses. This trial opens new perspectives in the research of the mechanism of action of OM-85 BV (AU)

Antecedentes: Las infecciones agudas del tracto respiratorio recurrentes (RARTI) en los niños se relacionan con deficiencias de subclases de IgG. El propósito del estudio fue evaluar el efecto de OM-85 BV en el número de RARTI así como en los niveles de subclases de IgG. Métodos: Este fue un estudio clínico aleatorizado, doble ciego, controlado con placebo. Fueron incluidos pacientes de edades de 3 a 6 años, con tres o más ARTI documentadas durante los últimos 6 meses y con niveles subnormales de subclases de IgG. Los pacientes tomaron una cápsula de OM-85 BV (3,5 mg) o placebo por vía oral todos los días por 10 días consecutivos por mes durante 3 meses consecutivos. Los pacientes fueron seguidos por 3 meses más sin tomar medicamento. Los niveles de subclases de IgG fueron determinados antes y después del tratamiento. Resultados: Los niveles de IgG4 diminuyeron después del tratamiento con OM-85 BV (-3 [-8,0, -1,0] diferencia mediana [IC 95 per cent] p < 0,05 por la prueba de Wilcoxon). Ningún otro cambio significativo en las subclases de IgG fue observado. Después de 6 meses los pacientes en el grupo de OM-85 BV (n = 20) experimentó 2,8 ñ 1,4 (media ñ DE) ARTI, mientras que los pacientes en el grupo del placebo (n = 20) sufrieron 5,2 ñ 1,5 ARTI (-2,4 [-3,3, -1,5] diferencia media [IC 95 per cent] p < 0,001 por t de Student). Tres pacientes con OM-85 BV tuvieron trastornos gastrointestinales relacionados a la administración del medicamento, así como tres pacientes con placebo. Conclusión: Este estudio demostró el beneficio clínico de OM-85 BV en los pacientes que sufren de RARTI y de niveles subnormales de subclases de IgG. Este estudio abre nuevas perspectivas en la búsqueda del mecanismo de acción de OM-85 BV (AU)

[Desensitization to human recombinant DNA insulin in an adolescent with insulin-dependent diabetes mellitus]. / Desensibilización a insulina DNA recombinante humana en una adolescente con diabetes mellitus insulinodependiente.

BACKGROUND: Adverse reactions to drugs have increased in the last years, about 15% of all side effects are thought to be immune mediated according to the Coombs and Gell classification they can be type I (immediate) hypersensitivity, type II (cytotoxic) type III (immune complex mediated) or type IV (delay). Allergy to insulin is defined as an immunological response type I, and type II or III to exogenous insulin solutions occurring the 0.1% and 0.2% of the patients. PATIENTS: A 13 year old female with a 4-year history of insulin-dependent diabetes mellitus who presented hypersensitivity against recombinant DNA (rDNA) insulin manifested with urticaria and itching. We used a premedication therapy without good response and impossibility to use alternative therapy for her metabolic control, so she needed desensitization with insulin. METHODS: Skin prick testing with rapid insulin preparations 1:10 W/V dilution were positive. IgE antibodies to insulin weren't presented. IgE serum values were normal. We began the desensitization with a rapid 1:1000 UI insulin solution by intradermal route, than by subcutaneous route until reaching the accumulated doses necessary per day. During the process it appeared a papular rash and itching which were treated with an intravenous antihistaminic without troubles. RESULTS: The patient tolerated the desensitization procedure very well. For the past 14 months she has been treated uneventfully by subcutaneous administration of rDNA insulin. DISCUSSION: The desensitization against drugs is not a frequently process it only has to be used when it is impossible to substitute the treatment. Our patient showed probably hypersensitivity type 1 to insulin. However, we have to take into account the cytotoxic reaction caused by IgG or IgM antibodies or by immune complex. The desensitization finally was tolerated, 14 months after our patient accepts correctly her daily dose of human recombinant insulin.

[Procedure for bronchodynamic tests with inhaled allergens]. / Procedimiento para realizar pruebas broncodinámicas con alergenos inhalados.

The asthma is one of the most frequent chronic illnesses in the children. It is characterized by hyperreactivity from the air roads to inspecific stimuli (metacholin and histamin) and specific (allergens). The broncodynamics tests determines the broncolability asthmatic boy's and they help to settle down the I diagnose functional. They should be carried out with antigenic extracts of high quality, lyophilized watery and standardized; you can use an open or closed circuit and a dosimeter, the initial dose of the allergen it is lower than with the one that the positive cutaneous reactivity was obtained, carrying out successive increments until the VEF-1 descend 15% or more. The patient's security is fundamental, they should be carried out for specialized personnel.

[Effect of heating on FEV-1 in children with asthma challenged with exercise]. / Efecto del calentamiento sobre el VEF-1 en niños con asma sometidos a reto por ejercicio.

AIMS: The exercise-induced bronchoespasm, also called asthma for exercise, it corresponds to a frequent clinical entity that commonly accompanies the asthmatic patient. Their frequency is of around the 80 to 90% for the patients with asthma; it is presented among 40 to 50% of the children with allergic rhinitis, in the athletes 14% and in the population's 12% in general. OBJECTIVE: To determine the effectiveness of a heating routine like preventive agent of the exercise-induced bronchoespasm. METHOD: 30 patients were included of between 10 and 16 years of age, asthmatic and with exercise-induced bronchoespasm by diagnosed by means of challenge test to the exercise. All the patients carried out an exercise routine with duration of 20 minutes during which movements of elasticity, calisthenics and light activity were made directed to the exercise to develop, taking as objective parameter 60% of the frequency heart submax. Did all the patients carry out challenge at once, again to the exercise, in which a band numberless was used, with speeds that were increased progressively from 1 to 8 km/h and with inclination of 0? 10 0. The spirometrics registrations was made before the challenge and at the 2, 5, 10, 15, 20, 25, 30 and 60 minutes after the same one. RESULTS: The average of the patient's age was of 12.8 +/- 2 years with size of 157 +/- 10 cm. CONCLUSION: The heating in children with broncoespasmo induced by exercise acts as a protective agent against the decrement of the VEF-1. Although the heating can be a good control method in the asthmatic patient, it is necessary to keep in mind that not all the patients have a benefit of this protection. This can only be used in patient with programmed physical activity, since in the preschoolers it is not possible to implant a heating routine for the characteristics characteristic of their activity.

[Determination of immediate hypersensitivity to pollen in allergic patients in the Federal District]. / Determinación de hipersensibilidad inmediata a pólenes en pacientes alérgicos del Distrito Federal.

AIMS: The immediate hypersensibility immediate mediated by IgE represents the damage mechanism type 1 according to the original classification of Gell & Coombs. MATERIAL AND METHOD: Observational study, descriptive, transverse in the one which were checked the files of 1250 patient of the Allergy Service of the Hospital Infantil de Mexico Federico Gomez with diagnostic of rhinitis allergic; asthma; asthma and rhinitis allergic. RESULTS: 1250 patient studied 468 were of the feminine sex (37.44%) and 782 (62.58%) of the masculine with a mean age in either case of 7.9 +/- 3.5 SD. With respect to result of cutaneous test 154 (12.32%) were negative and 1096 (87.68%) were positive to one or more antigens. CONCLUSIONS: The obtained results indicate the importance of accomplishing greater number of studies that relate not only the percentages of positive in the determination of immediate hypersensitive, but also to the frequency of pollens in the means to the one which is unfolded the patient, together with the stages of pollination throughout the Mexican Republic, in pediatric population as well as in adult, to effect cutaneous tests selects according to the zone and to stablish a specific treatment and adapted for each patient.

[Wheezing in infants]. / Sibilancias en el lactante.

The wheeze are a common symptom in nursing, especially when suffer infections of the respiratory tract. They are common in 75 to 85% of the children, who have wheezes during some stage of their development between 2 to 5 years old. They can be related to smoking motherly during the pregnancy, exposition to the smoke of the tobacco to the subsequent stage to the birth, exposition to environmental and certain factor infections veers them. The wheezes in patient with atopy maybe they are related to a IgE two standard deviations up above of what is normal and persist as asthma in late stages. The wheeze is an affection syndromatic therefore it is obligatory to seek the factor unfetter you to arrive to a definitive diagnosis.