Evaluación funcional del adulto mayor con enfermedad cardiovascular durante la hospitalización: Scoping Review / Funtional evaluation during hospitalization of older patients with cardiovascular disease

RESUMEN INTRODUCCIÓN: Un evento cardiovascular puede reducir o alterar la capacidad funcional de las personas y, por ende, afectar el desempeño adecuado en el ámbito físico, familiar, social y laboral. La OMS ha definido la salud de los adultos mayores por su capacidad funcional y no por sus limitaciones, discapacidades o enfermedades. Por lo tanto, la calidad de vida de los adultos mayores está estrechamente relacionada con la capacidad funcional y el conjunto de condiciones que le permiten participar en su propio autocuidado, en la vida social y familiar. OBJETIVO: El objetivo de este estudio es explorar la evidencia existente en la última década acerca de las pruebas y escalas de funcionalidad usadas en población adulta mayor con enfermedad cardiovascular durante su hospitalización y que reciben tratamiento de terapia física. MÉTODOS: Se usó la metodología Scoping Review, usando los términos DeCS/MeSH: cardiac, rehabilitation, cardiovascular disease, physical therapy, elderly, inpatient, y functionality. La revisión siguió el modelo PRISMA para ordenar y sintetizar los resultados. Las bases de datos consultadas fueron: Pubmed, Scielo, Sciencedirect y Scopus, Lilacs, PeDro. RESULTADOS: 20 artículos fueron seleccionados en los cuales se identificó que las escalas de valoración funcional más utilizadas fueron: caminata de 6 minutos, escala de independencia (FIM), Percepción de salud SF -36. CONCLUCIONES: La evidencia encontrada para guiar la rehabilitación física en paciente adulto mayor muestra cambios significativos en el incremento de la capacidad funcional.

ABSTRACT: INTRODUCTION: A cardiovascular event can reduce or alter the functional capacity of people affecting the physical capacity, and the performance in family, social and work environments. The WHO has defined the health of older adults by their functional capacity and not by their limitations, disabilities or illnesses. Therefore, the quality of life of older adults is closely related to the functional capacity and the set of conditions that allow them to participate in their own self-care, in social and family life. The aim of this study was to explore the existing evidence in the last decade about the tests and scales of functionality used in older adults with cardiovascular disease receiving physical therapy during hospitalization. METHODS: The Scoping Review methodology was used. Mesh and DeCS/MeSH terms included were cardiac, rehabilitation, cardiovascular disease, physical therapy, elderly, inpatient and functionality. The review followed the PRISMA model to sort and synthesize the results. The databases consulted were: Pubmed, Scielo, Science direct and Scopus, Lilacs, PeDro. RESULTS: 20 articles were selected in which it was identified that the most used functional assessment scales were: The 6-minute walk test, the Independence scale (FIM) and the Health Perception scale (SF-36). CONCLUSION: In older patients the functional tests identified allowed to detect significant improvements in functional capacity following cardiac rehabilitation.

Prevalence of Drugs as Triggers of Exacerbations in Chronic Urticaria.

BACKGROUND AND OBJECTIVE: Many patients with chronic spontaneous urticaria (CSU) report various drugs as triggers of their symptoms and often avoid medication unnecessarily. Objective: To estimate the clinical impact of the drugs patients most frequently suspect of inducing CSU exacerbations. METHODS: The prevalence of self-reported drug reactions was evaluated by questioning patients about their clinical history of urticaria and drug reactions and performing challenge tests with the suspect drugs. A group of healthy persons were included as controls to evaluate the prevalence of self-reported drug reactions. RESULTS: The study population comprised 245 patients with CSU and 127 healthy individuals. At least 1 adverse drug reaction was reported by 92 (37.5%) patients and 30 (23.6%) controls. Nonsteroidal anti-inflammatory drugs (NSAIDs) (27.7%) and ß-lactams (9.4%) were the most commonly reported drugs in the CSU group and the control group, respectively. Positive results in the challenge tests were less common than self-reports in the CSU group (13%) and the control group (0.7%). CONCLUSIONS: Self-reporting is generally not sufficient to confirm a drug reaction. Drug reactions to NSAIDs and ß-lactams are more frequent among patients who experience CSU than in those who do not. Drug challenge tests should be offered early during medical evaluation to avoid unnecessary restrictions.

Prevalence of drugs as triggers of exacerbations in chronic urticaria

Background: Many patients with chronic spontaneous urticaria (CSU) report various drugs as triggers of their symptoms and often avoid medication unnecessarily. Objective: To estimate the clinical impact of the drugs patients most frequently suspect of inducing CSU exacerbations. Methods: The prevalence of self-reported drug reactions was evaluated by questioning patients about their clinical history of urticaria and drug reactions and performing challenge tests with the suspect drugs. A group of healthy persons were included as controls to evaluate the prevalence of self-reported drug reactions. Results: The study population comprised 245 patients with CSU and 127 healthy individuals. At least 1 adverse drug reaction was reported by 92 (37.5%) patients and 30 (23.6%) controls. Nonsteroidal anti-inflammatory drugs (NSAIDs) (27.7%) and ß-lactams (9.4%) were the most commonly reported drugs in the CSU group and the control group, respectively. Positive results in the challenge tests were less common than self-reports in the CSU group (13%) and the control group (0.7%). Conclusion: Self-reporting is generally not sufficient to confirm a drug reaction. Drug reactions to NSAIDs and ß-lactams are more frequent among patients who experience CSU than in those who do not. Drug challenge tests should be offered early during medical evaluation to avoid unnecessary restrictions

Antecedentes: Muchos pacientes con urticaria crónica espontánea (CSU, por sus siglas en inglés) informan que varios medicamentos son desencadenantes de sus síntomas y, a menudo, evitan dichos medicamentos de forma innecesaria. Objetivo: Estimar el impacto clínico en la CSU de los fármacos que los pacientes sospechan con mayor frecuencia como causantes de exacerbaciones. Métodos: Se evaluó la prevalencia de las reacciones a los fármacos autoinformadas al interrogar a los pacientes y se realizó pruebas de desafío con los fármacos sospechosos. Se incluyó un grupo de personas sanas como controles para evaluar la prevalencia de las reacciones a los fármacos autoinformadas. Resultados: La población del estudio comprendió 245 pacientes con CSU y 127 individuos sanos. 92 (37,5%) pacientes y 30 (23,6%) controles informaron al menos 1 reacción adversa al medicamento. Los fármacos antiinflamatorios no esteroideos (AINE) (27,7%) y las ß-lactámicos (9,4%) fueron los fármacos informados con mayor frecuencia en el grupo CSU y el grupo control, respectivamente. Los resultados positivos en las pruebas de desafío fueron menos comunes que los autoinformes en el grupo CSU (13%) y el grupo control (0,7%).Conclusión: La autoinformación generalmente no es suficiente para confirmar una reacción al fármaco. Las reacciones de los medicamentos a los AINE y los ß-lactámicos son más frecuentes entre los pacientes que experimentan CSU que en los que no lo hacen. Las pruebas de detección de drogas deben ofrecerse temprano durante la evaluación médica para evitar restricciones innecesarias

Adherence to pharmacotherapy improves school performance in children with rhinitis and asthma

BACKGROUND: Low levels of serum CC16 were reported in asthmatic adults, but the studies on children were scarce and conflicting. The aim of this study was to compare serum CC16 levels in pre-school children with recurrent wheezing assessed using an asthma predictive index (API). METHODS: We performed a case-control study based on API, with all enrolled pre-school children who had recurrent wheezing episodes (>3 episodes/last year confirmed by a physician) and had presented at one paediatric clinic in Santiago, Chile. The population was divided according to stringent API criteria into positive or negative. RESULTS: In a one-year period, 60 pre-schoolers were enrolled. After excluding 12, 48 pre-schoolers remained (27 males, age range from 24 to 71 months) and completed the study; 34 were API positive and 14 were API negative. There were no significant differences in demographics between groups. The level of serum CC16 levels for pre-schoolers with a positive API and negative API were (median 9.2 [7.1-11.5] and 9.4 [5.5-10], p = 0.26, respectively). The area under the curve for the serum CC16 levels to predict a positive API was 0.6, 95% CI [0.43-0.77], p = 0.3. A correlation between serum CC16 levels and age was found (r = 0.36 [0.07-0.59], p = 0.01], but not between serum CC16 levels and peripheral eosinophils blood. CONCLUSION: There was no evidence that serum CC16 levels played a role in recurrent wheezing and a positive API in pre-school children. More studies are needed to confirm this finding

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Adherence to pharmacotherapy improves school performance in children with rhinitis and asthma.

BACKGROUND: Adherence to pharmacotherapy reduces symptoms of asthma and rhinitis, however, little is known of its impact on school performance. OBJECTIVE: To evaluate the impact of pharmacotherapy in absenteeism and school performance in a child population. METHODS: A cross-sectional study, carried out in eight schools. All participants and their parents were given a questionnaire assessing parameters related to respiratory diseases and pharmacotherapy. Data on school performance was obtained from the academic history of each child who participated in the study. Adherence to pharmacotherapy was classified as a correct use of therapy for more than five days per week. RESULTS: 1109 children agreed to participate. Students were divided into two groups: symptomatic (36%) and asymptomatic (63%). The symptomatic group had a higher frequency of school absenteeism (1 vs. 3.1days/year/patient p<0.01) and lower academic performance (failed: 20% vs. 33% p<0.01). After dividing the symptomatic group between adherents and non-adherents to the pharmacotherapy, the group of adherents had a similar school performance to the asymptomatic group and it was significantly different from the no-adherent group. CONCLUSION: Respiratory symptoms are associated with poor school performance and with an increase in school absenteeism, but adherence to pharmacotherapy can reduce these negative impacts in children.

Pythiosis with atypical location in the soft palate in a horse in Southern Brazil / Pitiose com localização atípica no palato mole em um equino na região Sul do Brasil

A pitiose é uma enfermidade piogranulomatosa causada pelo oomiceto aquático Pythium insidiosum, que acomete várias espécies domésticas, assim como a humana. O presente relato refere-se à descrição de um caso de pitiose em um equino, fêmea, da raça Crioula, criado na região Sul do Brasil com história clínica de emagrecimento progressivo, disfagia e dificuldade respiratória. Macroscopicamente, o palato mole estava aumentado de tamanho e deslocado caudalmente, resultando em obstrução física da nasofaringe. Ao corte, essa massa era branca-amarelada, fibrosa e com áreas de ulceração. Na análise histopatológica, havia inflamação piogranulomatosa, com focos necróticos associados a imagens negativas tubuliformes de hifas fúngicas. A coloração de Grocott demonstrou inúmeras hifas septadas e ramificadas, as quais foram marcadas positivamente para anticorpos contra P. insidiosum na imuno-histoquímica. O diagnóstico de pitiose foi baseado nos achados macro e microscópicos e confirmado pela técnica de imuno-histoquímica.(AU)

Divertículo rectal. reporte de un caso / Rectal diverticulum. clinical case report

RESUMEN Introducción: La enfermedad diverticular del colon es frecuente en la población general, afectando al 50% de las personas mayores de 50 años, sin embargo, los divertículos ubicados en el recto son excepcionalmente raros. El objetivo de este estudio es informar el caso de un hombre de 67 años con enfermedad diverticular de colon sigmoides y colon transverso, con un divertículo rectal que se diagnosticó durante una colonoscopia ambulatoria. Caso clínico: Hombre de 67 años quien consultó al servicio de gastroenterología por cuadro de diarrea crónica. Se le realizó una colonoscopia y se evidenció un agujero diverticular de 3 cm de diámetro, a 6 cm del margen anal. Se concluyó que la enfermedad diverticular no era la causa de su cuadro diarreico. Discusión: Hay diversas teorías que tratan de explicar la etiología y el porqué de la baja frecuencia de los divertículos rectales, incluyendo los procedimientos quirúrgicos en esta zona; las presentaciones asintomáticas no ameritan cirugía, aunque debe realizarse evaluación periódica de estos pacientes.

ABSTRACT Introduction: Diverticular colon disease is common in the general population affecting 50% of people over the age of 50. However, diverticula located in the rectum are exceptionally rare. This study aims to report the case of a 67 years old man with diverticular disease of the sigmoid colon and transverse colon with a rectal diverticulum diagnosed during an ambulatory colonoscopy. Case report: A 67-year-old man who consulted the gastroenterology service for chronic diarrhea. A colonoscopy was performed, and a 3 cm in diameter diverticular hole was evident, 6 cm from the anal margin. It was concluded that diverticular disease was not the cause of diarrhea. Discussion: There are several theories to explain the etiology and the reason for the low frequency of rectal diverticula, including surgical procedures in this area. Asymptomatic presentations do not need surgery, although periodic evaluation of these patients should be performed.

Fisioterapia en Unidades de Cuidados Intensivos / No disponible

Introducción: La Fisioterapia en las Unidades de Cuidados Intensivos se aplica desde hace años en diversas partes del mundo. El papel del fisioterapeuta dentro de estas Unidades está reconocido para desempeñar funciones propias de nuestra profesión. Cada vez más se nos incluye en estas áreas para tratamiento respiratorio, cardiopulmonar, musculoesquelético y neuromuscular, formando parte de los equipos multidisciplinares que trabajan en estas Unidades. Objetivos: Esta revisión bibliográfica pretende describir la evidencia disponible relacionada con el tratamiento de Fisioterapia en la UCI de adultos y describir los tipos de tratamientos de Fisioterapia que se realizan habitualmente en los pacientes ingresados en UCI. Material y método. La revisión bibliográfica se realizó utilizando las siguientes bases de datos: PEDro, PubMed y Dialnet. Se incluyeron Ensayos Clínicos Aleatorizados, Estudios Clínicos, Estudios Comparativos, Ensayos Clínicos Controlados y Ensayos Controlados Aleatorizados, desarrollados en pacientes adultos ingresados en Unidades de Cuidados Intensivos y que han recibido fisioterapia o tratamiento rehabilitador, publicados en los últimos 5 años, tanto en lengua inglesa como española, con un valor superior 5/10 en la escala PEDro. Resultados: Tras realizar una lectura crítica de 48 artículos, ser analizados con la escala PEDro, cumplir los criterios de selección y quedando eliminados los duplicados, quedaron un total de 11 artículos. Conclusiones: Observamos que la Fisioterapia en UCI puede llegar a ser de gran utilidad para los pacientes en estas Unidades y que colabora en su recuperación. Se necesitan más estudios, con mejor metodología, para estudiar los beneficios de la Fisioterapia en UCI

Introduction: Physiotherapy has been used in Intensive Care Units (ICU) for some years in many parts of the world. The importance of the role of the physiotherapist in these units is generally accepted. It is also included ever more widely in units for respiratory, cardio-pulmonary, musculoskeletal and neuromuscular therapies, where it forms part of the multidisciplinary teams working there. Objectives:. This bibliographical review sets out to describe the available evidence relating to Physiotherapy treatment in adult ICUs, and to describe the types of Physiotherapy treatments that are commonly performed on patients admitted to an ICU. Materials and methods: The bibliographical revision was conducted using the following data bases: PEDro, PubMed and Dialnet. The material included randomized clinical trials, clinical trials, comparative studies, controlled clinical trials carried and randomized controlled trials, out on adult patients admitted to Intensive Care Units who received physiotherapy or rehabilitation treatment, which were published in the last 5 years in English or in Spanish, with a value above 5/10 in the PEDro scale. Results. After conducting a critical appraisal of 48 articles, analysis using the PEDro scale, complying with the selection criteria and eliminating any duplicates, a total of 11 articles remained. Conclusions: We found that physiotherapy in ICUs can be extremely useful for ICU patients and contribute to their recovery. More trials are required, with better methodology, to study the benefits of Physiotherapy in ICUs

Apendicitis atípica diagnosticada durante una colonoscopia: reporte de caso clínico / Atypical Appendicitis Diagnosed During a Colonoscopy

Resumen Se presenta el caso clínico de una apendicitis atípica diagnosticada durante una colonoscopia en un paciente masculino de 85 años, en estudio por síndrome anémico y hospitalizado por un cuadro de infección neumónica en la Clínica Versalles de Manizales (Caldas). Durante la exploración del ciego, se observa un orificio apendicular prominente, con salida de material purulento hacia la luz del colon. La apendicitis atípica es un cuadro que puede presentarse en ancianos y, en ocasiones, se diagnostica durante una colonoscopia. El manejo de estos pacientes es poco claro y suele ser determinado por el médico tratante.

Abstract We present a case of atypical appendicitis diagnosed during a colonoscopy in a 85 year old male patient under study for anemic syndrome while hospitalized because of pneumonia at Clínica Versalles in Manizales, Caldas, Colombia. During the exploration of the cecum, a prominent appendicular orifice discharge purulent material into the lumen of the colon was found. Atypical appendicitis can occur in the elderly and is sometimes diagnosed during a colonoscopy. The management of these patients is unclear and is usually determined by the treating physician.

Prediction of the Efficacy of Antihistamines in Chronic Spontaneous Urticaria Based on Initial Suppression of the Histamine- Induced Wheal.

BACKGROUND: Antihistamines are the first line of treatment for chronic spontaneous urticaria. However, there is no effective method to predict whether an antihistamine will have a beneficial clinical effect or not. OBJECTIVE: To assess whether the change in histamine-induced wheal and flare measurements 24 hours after administration of antihistamine can predict the efficacy of treatment. METHODS: We performed a multicenter, triple-blind, randomized study. Patients received a daily oral dose of cetirizine, fexofenadine, bilastine, desloratadine, or ebastine over 8 weeks. After 4 weeks, a higher dose of antihistamine was administered to patients who did not experience a clinical response. A histamine skin prick test was carried out at baseline and 24 hours after the first dose of antihistamine. Disease severity (Urticaria Activity Score [UAS]), response to the histamine skin prick test, and impact on the patient's quality of life (Dermatology Life Quality Index [DLQI]) were determined every 2 weeks. RESULTS: The study population comprised 150 patients (30 per group) and 30 controls. Twenty-four hours after administration of antihistamine, inhibition of the histamine wheal by >75% was significantly associated with better UAS and DLQI scores. The safety and efficacy of the 5 antihistamines were similar. After updosing, rates of disease control (DLQI score <5) increased from 58.7% to 76.7%. CONCLUSIONS: Measurement of the histamine-induced wheal can predict which patients will have a strong clinical response to antihistamines but has limited utility for identifying nonresponders. The clinical significance of these data could be relevant in the search for new urticaria treatment regimens.

Prediction of the efficacy of antihistamines in chronic spontaneous urticaria based on initial suppression of the histamine-induced wheal

Background: Antihistamines are the first line of treatment for chronic spontaneous urticaria. However, there is no effective method to predict whether an antihistamine will have a beneficial clinical effect or not. Objective: To assess whether the change in histamine-induced wheal and flare measurements 24 hours after administration of antihistamine can predict the efficacy of treatment. Methods: We performed a multicenter, triple-blind, randomized study. Patients received a daily oral dose of cetirizine, fexofenadine, bilastine, desloratadine, or ebastine over 8 weeks. After 4 weeks, a higher dose of antihistamine was administered to patients who did not experience a clinical response. A histamine skin prick test was carried out at baseline and 24 hours after the first dose of antihistamine. Disease severity (Urticaria Activity Score [UAS]), response to the histamine skin prick test, and impact on the patient’s quality of life (Dermatology Life Quality Index [DLQI]) were determined every 2 weeks. Results: The study population comprised 150 patients (30 per group) and 30 controls. Twenty-four hours after administration of antihistamine, inhibition of the histamine wheal by >75% was significantly associated with better UAS and DLQI scores. The safety and efficacy of the 5 antihistamines were similar. After updosing, rates of disease control (DLQI score <5) increased from 58.7% to 76.7%. Conclusions: Measurement of the histamine-induced wheal can predict which patients will have a strong clinical response to antihistamines but has limited utility for identifying nonresponders. The clinical significance of these data could be relevant in the search for new urticaria treatment regimens (AU)

Antecedentes: Los antihistamínicos son la primera línea de tratamiento en la urticaria crónica espontanea (UCS) pero actualmente no hay un método eficaz para predecir si un antihistamínico tendrá un efecto clínico beneficioso o no. Objetivo: Evaluar si la prueba cutánea con histamina puede predecir la efectividad del tratamiento con antihistamínicos. Métodos: Se realizó un estudio multicéntrico, triple ciego, aleatorizado. Los pacientes recibieron una dosis oral diaria de cetirizina, fexofenadina, bilastina, desloratadina o ebastina durante 8 semanas. Después de 4 semanas, en los pacientes sin respuesta clínica, se administró una dosis más alta de antihistamínico. Al inicio del estudio, después de 24 horas y cada dos semanas tras la primera administración de los antihistamínicos, se llevó a cabo una prueba intraepidérmica con histamina. La severidad de la enfermedad (escala UAS) y el impacto en la calidad de vida de los pacientes (escala DLQI) fueron evaluados cada dos semanas. Resultados: 150 pacientes (n = 30, en cada grupo) y 30 sujetos control participaron en este estudio. Después de 24 horas de la administración de antihistamínicos, una inhibición de histamina mayor al 75% del basal, se asoció significativamente con mejores resultados en el UAS y el DLQI. La seguridad y eficacia de los cinco antihistamínicos fueron similares. Después de aumentar la dosis, las tasas de control de la enfermedad (puntuación DLQI <5) paso de 58,7% a 76,7%. Conclusiones: La prueba intraepidérmica con histamina es útil para predecir a los pacientes que tendrán una importante respuesta clínica a los antihistamínicos, pero tiene una utilidad limitada para la identificación de los no respondedores. Estos datos pueden ser relevantes en el momento de establecer nuevos esquemas para el tratamiento de la urticaria (AU)

Life-threatening reaction to iron dextran: protocol for induction of tolerance

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Reply to "Hevea Brasiliensis rather than latex"

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Closed reduction of humeral condylar fracture and elbow luxation in a dog / Reducción cerrada de fractura condilar de húmero y luxación de codo en un canino

Fractures of the distal humerus that involving the condyles often requires extensive surgical approach for treatment, leading to a prolonged recovery time. In a West Highland White Terrier dog two years old, with a fracture of the lateral humeral condyle portion and elbow luxation, was performed a closed technique for luxation reduction, fracture reduction was performed by digital pressure and percutaneous osteosynthesis by introduction of a Kirschner wire of 2 mm diameter, accompanied by Robert-Jones bandage modified for 6 weeks. Limb function was recovered in the immediate postoperative, the wire was removed six weeks after, non-was observed postoperative complications, and full functional recovery of the limb was clinically evident. This suggests that this technique could be an option in cases of condylar fractures in small-sized dogs.

Las fracturas de la porción distal del húmero que involucran los cóndilos, frecuentemente exigen para su reparación un amplio abordaje quirúrgico, que conlleva un tiempo de recuperación prolongado. En un canino West Highland White Terrier de dos años de edad, con una fractura de la porción lateral del cóndilo humeral y luxación de codo, se realizó una técnica cerrada de reducción de la luxación, reducción de la fractura mediante presión digital, y osteosíntesis percutánea mediante la introducción de un clavo de kirschner de 2 mm de diámetro, acompañado de vendaje de Robert-Jones modificado durante 6 semanas. El paciente recuperó la función del miembro en el posquirúrgico inmediato, no se evidenciaron complicaciones posquirúrgicas, seis semanas después se retiro el clavo y se evidenció clínicamente recuperación total de la funcionalidad del miembro. Lo anterior sugiere que esta técnica podría ser una opción en casos de fracturas condilares en perros de pequeño porte.

Cross-reactivity between cassava and latex in a colombian patient with an anaphylactic reaction

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Safety of immunotherapy in patients with rhinitis, asthma or atopic dermatitis using an ultra-rush buildup. A retrospective study

BACKGROUND: Allergen-specific immunotherapy is a proven, highly effective treatment for IgE-mediated diseases. However, ultra-rush immunotherapy is prescribed infrequently because of the perception that accelerated immunotherapy buildup leads to a higher rate of systemic reactions. OBJECTIVE: To evaluate the frequency of adverse reactions in patients with IgE-mediated diseases receiving house dust mite (HDM) ultra-rush immunotherapy. METHODS: A retrospective, observational study was conducted for patients with IgE-mediated diseases receiving allergen-specific immunotherapy. Subcutaneous immunotherapy with depigmented polymerized mites extract was administered in two refracted doses of 0.2 and 0.3 ml at first injection, and in single 0.5 ml doses in subsequent monthly injections. A 30 min observation time was required after each injection. Systemic reactions were graded using the World Allergy Organisation grading system.Results575 patients were included. The age range was 1-83 years. Most patients had respiratory diseases (544) and 101 patients had atopic dermatitis. A total of 27 patients (4.6%) experienced 139 reactions (reactions/injections: 1.9%); 22 patients (3.8%) experienced 134 local reactions (local reactions/injections: 1.8%). Eight patients (1.3%) experienced eight systemic reactions (systemic reactions/injections: 0.1%). Five systemic reactions were grade 2 and three grade 1. Two systemic reactions were reported during buildup. There were no fatalities. CONCLUSION: Taking into account the possible bias for the retrospective design of this study we observed that immunotherapy for patients with IgE-mediated diseases using a depigmented polymerized mites extract, with an ultra-rush buildup, has similar frequency of systemic reactions than that seen in slower buildup immunotherapy in other studies. Accelerated buildup could improve patients' adherence and reduce dropout rates

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Safety of immunotherapy in patients with rhinitis, asthma or atopic dermatitis using an ultra-rush buildup. A retrospective study.

BACKGROUND: Allergen-specific immunotherapy is a proven, highly effective treatment for IgE-mediated diseases. However, ultra-rush immunotherapy is prescribed infrequently because of the perception that accelerated immunotherapy buildup leads to a higher rate of systemic reactions. OBJECTIVE: To evaluate the frequency of adverse reactions in patients with IgE-mediated diseases receiving house dust mite (HDM) ultra-rush immunotherapy. METHODS: A retrospective, observational study was conducted for patients with IgE-mediated diseases receiving allergen-specific immunotherapy. Subcutaneous immunotherapy with depigmented polymerized mites extract was administered in two refracted doses of 0.2 and 0.3 ml at first injection, and in single 0.5 ml doses in subsequent monthly injections. A 30 min observation time was required after each injection. Systemic reactions were graded using the World Allergy Organisation grading system. RESULTS: 575 patients were included. The age range was 1-83 years. Most patients had respiratory diseases (544) and 101 patients had atopic dermatitis. A total of 27 patients (4.6%) experienced 139 reactions (reactions/injections: 1.9%); 22 patients (3.8%) experienced 134 local reactions (local reactions/injections: 1.8%). Eight patients (1.3%) experienced eight systemic reactions (systemic reactions/injections: 0.1%). Five systemic reactions were grade 2 and three grade 1. Two systemic reactions were reported during buildup. There were no fatalities. CONCLUSION: Taking into account the possible bias for the retrospective design of this study we observed that immunotherapy for patients with IgE-mediated diseases using a depigmented polymerized mites extract, with an ultra-rush buildup, has similar frequency of systemic reactions than that seen in slower buildup immunotherapy in other studies. Accelerated buildup could improve patients' adherence and reduce dropout rates.