Risk calculator of the clinical response to antihistamines in chronic urticaria: Development and internal validation.

Early detection of CSU patients with low probability of a clinical response with antihistamines could undergo prompt initiation of therapeutic alternatives. The aim of the study was to develop and internally validate a model for predicting the clinical response to antihistamines in adult patients with chronic spontaneous urticaria (CSU), who consult allergology and dermatology care centers. A cohort of CSU patients, recruited from four participating centers, were followed up for 12 months. Fifteen candidate variables were selected to be included in the multivariate model and then internal validation was done with bootstrap analysis with 1000 simulations. The outcome variable, clinical response to antihistamines, was evaluated with the UAS (Urticaria Activity Score) scale for seven days: "No response to antihistamines" was defined as UAS7 ≥7 points after at least one month with a maximum dose of antihistamines, while "Response to antiH1" was defined as UAS7 ≤6 points for at least three months with the use of antiH1. A total of 790 patients were included. Among the different models analyzed, the model that included age, angioedema, anxiety/depression, time with the disease, NSAIDs (Non-steroidal anti-inflammatory drugs) intolerance, and UAS7 baseline was considered the one with the best performance (accuracy 0.675, HL 0.87, AUC 0.727). The internal validation analyses demonstrated good consistency of the model. In conclusion, this prediction model identifies the probability of response to antihistamines in patients with chronic spontaneous urticaria. The model could be useful for a personalized therapeutic approach according to individual patient risk.

Bone involvement in non-congenital syphilis / Compromiso óseo por sífilis no congénita

We documented two stages of bone involvement due to syphilis in two adult patients infected with human immunodeficiency virus. Bony lesions of secondary versus tertiary syphilis cannot be differentiated on clinical or radiologic grounds alone. Given the rarity of this clinical presentation, there is no consensus on treatment duration and related outcomes.

Se describen dos etapas de compromiso óseo por sífilis en dos pacientes adultos infectados por el virus de la inmunodeficiencia humana. Las lesiones óseas de la sífilis secundaria y de la sífilis terciaria no se pueden diferenciar únicamente por características clínicas o radiológicas. Dada la rareza de esta presentación clínica, no hay consenso sobre la duración del tratamiento y los resultados relacionados.

Nasal Provocation Challenges with Aedes aegypti Whole-Body Extract Induces Allergic Rhinitis.

BACKGROUND: Exposure to mosquitoes in the Tropics is perennial, and their somatic and saliva antigens have shown IgE binding capacity, although it is not clear whether this is due to cross-reactivity or primary sensitization. Inhalation of these allergens could trigger an allergic response. OBJECTIVE: The aim of the study was to evaluate the clinical relevance of sensitization to Aedes aegypti in a group of patients with allergic rhinitis. METHODS: A cross-sectional study with allergic rhinitis subjects and healthy controls sensitized to mosquito extract was performed. Sensitization to mosquito and house dust mites was evaluated using skin prick test (SPT) and antibody determination by ELISA. Nasal provocation test (NPT) with whole-body extract was used to determine clinical relevance. RESULTS: Allergic rhinitis patients were more sensitized to mosquito extract than controls with (+) SPT (66.6% vs. 7.6%). From these (+) SPT patients, 44.5% had (+) NPT, and just two (11%) presented mono-sensitization to mosquito. Antibody reactivity was similar between patients and controls; however, (+) NPT patients showed a tendency to had higher levels of IgE and IgG4. DISCUSSION: Mosquitoes are perennial in most tropical areas, and their body allergens could be associated with respiratory allergies.

Preoperative respiratory therapy in patients undergoing surgery for lung cancer: A randomized controlled trial.

BACKGROUND: A preoperative respiratory therapy treatment was performed to analyze the effectiveness, with respect to postoperative air leak and pain, in patients undergoing surgery for lung cancer. OBJECTIVES: To analyze air leakage and postoperative pain. MATERIAL AND METHODS: Seventy one patients were studied, with a mean age of 62.58 years. Descriptive variables of gender, carcinogenic pathology, type of surgical incision and lung resection, use of glue and endostapler, and presence of adhesions were analyzed. Likewise, analysis of the quantitative variables of age, body mass index and forced expiratory volume in 1 s Two homogeneous groups resulted. Differentiated, experimental group (EG) that performed preoperative respiratory therapy and control group (CG). RESULTS: There were statistically significant differences in favor of the EG with respect to postoperative air leak on days 1-2 during the performance of physiotherapy techniques, the food and during the performance of the exercises autonomously. Furthermore, differences in air leakage were observed on days 2-4 during gait. The number of patients decreased to a greater extent in the EG. Regarding pain, there were statistically significant differences in the sample on days 1-4, with greater intensity of pain in the CG and after doing physiotherapy every day except the second. CONCLUSIONS: Preoperative respiratory therapy in patients undergoing surgery for lung cancer was effective in reducing the number of patients who presented postoperative air leak and reducing pain in the EG.

Prospective analysis of clinical evolution in chronic urticaria: Persistence, remission, recurrence, and pruritus alone.

Background: Population and study's methodology heterogenicity became clinical evolution of chronic spontaneous urticaria (CSU) highly variable. Objective: In a prospective cohort, we evaluated the different pathways of clinical evolution of CSU and identified possible risk factors. Methods: A total of 685 CSU patients (>12 years) were prospectively followed over 5 years. Diagnosis and follow-up of urticaria were based on medical evaluation and photographic records. Remission was defined as at least 6 months without symptoms (hives, angioedema, or pruritus) and medication. The follow-up included at least 2 visits per year, with photographic registration and clinical evaluation. Predefined clinical and paraclinical variables were included in the regression analyses. Results: We identified four clinical evolution pathways; The cumulative prevalence of remission at 5 years was 59.1%, recurrence was 17.1%, persistence was 11.6%, and chronic pruritus without hives or angioedema was 12.2%. The probability of persistence increased with hypothyroidism diagnosis (HR 0.425, 95% CI 0.290-0.621) and each point in the UAS7 (HR 0.931 95% CI 0.918-0.945). Conclusion: Chronic urticaria has different evolutions. Disease activity and hypothyroidism predict persistence and remission. Recurrence and chronic pruritus phenotypes require further study to evaluate their causality and prognosis.

Depleción de eosinófilos: muchas implicaciones en modelos múridos, pocas estudiadas en humanos / Eosinophil depletion: many implications in murine models, few studied in humans

The eosinophil is a cell of the immune system, with an arsenal of substances that can alter the balance that exists in the different organs where they are found. With the advent of monoclonal antibodies, concern about their depletion has become an important turning point in their formulation. For this reason, it is of vital importance to investigate the consequences of the mechanism of action of biological agents, in the short and long term. This review tries to show the role of eosinophils in both homeostasis and disease, and their relationship and interaction with monoclonal drugs in diseases focused on the Th2 profile. It is expected that this article can be useful when making the decision to start treatment with monoclonals, specifically anti-interleukin-5 or against its receptor

[Urticaria associated with COVID-19 in allergic patients. A case series]. / Urticaria asociada a COVID-19 en pacientes alérgicos. Serie de casos.

INTRODUCTION: In December 2019, a new coronavirus was identified as the causal agent of the 2019 coronavirus disease (COVID-19) with a wide clinical spectrum that goes from asymptomatic cases to critical and fatal cases. Its usual manifestations are fever, cough, and fatigue; although some cases present skin lesions. CASES REPORT: The first case was a 30-year-old woman with a history of controlled solar urticaria who presented erythematous and pruritic wheals in malar and cervical regions and extremities; associated with general malaise, headaches, and nausea, in whom the presence of COVID-19 was confirmed; her condition improved with a quadruple dose of antihistamines. The second case was a 47-year-old woman with a history of wasp sting anaphylaxis, without mastocytosis, who presented nasal congestion, headaches, and hypogeusia associated with generalized, erythematous, and pruritic wheals, with confirmation of COVID-19; her condition improved with quadruple doses of antihistamines. CONCLUSIONS: Cutaneous manifestations associated with COVID-19 are frequent and can be classified as inflammatory and vascular. Among them, urticarial lesions occupy the fourth place, and although there could be some predominance of these in patients with a history of allergies, more studies are required to define an association.

Introducción: En diciembre de 2019 fue identificado un nuevo coronavirus como agente causal de la enfermedad por coronavirus del 2019 con un amplio espectro clínico, desde casos asintomáticos hasta críticos y fatales. Generalmente se manifiesta con fiebre, tos y fatiga, aunque algunos casos se presentan con lesiones cutáneas. Reporte de casos: El primer caso es una mujer de 30 años con antecedente de urticaria solar controlada quien presentó habones eritematosos y pruriginosos en región malar, cervical y extremidades, asociado a malestar general, cefalea y náuseas, en quien se confirmó la presencia de COVID-19, y mejoró con antihistamínicos a dosis cuádruple. El segundo caso es una mujer de 47 años con antecedente de anafilaxia por picadura de avispa, sin mastocitosis, quien presentó congestión nasal, cefalea e hipogeusia asociado a habones generalizados, eritematosos y pruriginosos, con confirmación de COVID-19, y mejoría con dosis cuadruple de antihistamínicos. Conclusiones: Las manifestaciones cutáneas asociadas a COVID-19 son frecuentes y se pueden clasificar en inflamatorias y vasculares. Dentro de ellas, las lesiones urticariales ocupan el cuarto lugar, y aunque podría existir algún predominio de estas en pacientes con antecedentes de alergias, se necesitan más estudios para definir una asociación.

Presence of IgE Autoantibodies Against Eosinophil Peroxidase and Eosinophil Cationic Protein in Severe Chronic Spontaneous Urticaria and Atopic Dermatitis.

PURPOSE: Eosinophils are frequently found in atopic dermatitis (AD) and chronic spontaneous urticaria (CSU) that release eosinophil peroxidase (EPX) and eosinophil cationic protein (ECP). Continuous exposure to these proteins could trigger an autoimmune response which may contribute to the pathogenesis and severity of skin inflammation. In this study, we investigate the immunoglobulin E (IgE) response against eosinophil proteins in CSU and AD. METHODS: We recruited patients with severe AD, severe CSU and healthy subjects to explore the presence of IgE autoantibodies and cross-reactivity against EPX, ECP and thyroid peroxidase (TPO). The potential cross-reactive epitopes among the peroxidase family were determined using in silico tools. RESULTS: The frequencies of anti-EPX IgE (28.8%) and anti-ECP IgE (26.6%) were higher in the AD group, and anti-TPO IgE was higher in the CSU group (27.2%). In the CSU group, there was a correlation between the anti-EPX IgE and anti-TPO IgE levels (r = 0.542, P < 0.001); TPO inhibited 42% of IgE binding to EPX, while EPX inhibited 59% of IgE binding to TPO, suggesting a cross-reactivity with EPX as a primary sensitizer. There was greater inhibition when we used a pool of sera CSU and AD, TPO inhibited 52% of IgE binding to EPX, while EPX inhibited 78% of IgE binding to TPO. In silico analysis showed a possible shared epitope in the peroxidase protein family. CONCLUSIONS: IgE against eosinophil proteins may contribute to chronic inflammation in patients with AD and CSU. Cross-reactivity between EPX and TPO could explain thyroid problems in CSU patients.

Impact of the allergen-specific immunotherapy in pediatric patients with asthma treated at a health institution in Colombia / Efecto de la inmunoterapia con alérgenos específicos en pacientes pediátricos con asma atendidos en una institución de salud de Colombia

Introduction: Asthma is a chronic and potentially serious disease and 80% of the cases have an allergic etiology. In this sense, allergen-specific immunotherapy is an alternative that modulates the natural course of the disease. Objective: To evaluate the impact of immunotherapy in pediatric asthma patients treated at a health institution in Colombia. Materials and methods: We conducted an observational descriptive study with an analytical cross-sectional component. Sixty-two patients diagnosed with allergic asthma sensitized to dust mites and treated with at least 6 doses of mite immunotherapy were included. We assessed the impact of immunotherapy using the Asthma Control Test (ACT), the Global Initiative for Asthma (GINA) treatment scale, and spirometry values. Results: The ACT score before the start reported 30% of patients with uncontrolled asthma, 28% with good control, and 4% with totally controlled asthma. Of the patients with uncontrolled asthma, 46.7% achieved good control and 23.3% total control. Regarding patients' perception of improvement with the immunotherapy, 9.75% perceived a response of less than 50%, 45.2% one between 50% -90%, and 41.9% reported response equal to or greater than 90%. No significant changes in FEV1 values were found in spirometry. Conclusions: Significant changes in the ACT scores and the perception of disease improvement were observed in the population evaluated with specific mite immunotherapy, i.e., it had a positive impact on the natural course of the disease.

Introducción. El asma es una enfermedad crónica y potencialmente grave. El 80 % de los casos es de origen alérgico, por lo cual la inmunoterapia específica con alérgenos es una alternativa terapéutica que modula el curso natural de la enfermedad. Objetivo. Evaluar el impacto de la inmunoterapia en pacientes pediátricos con asma atendidos en una institución de salud de Colombia. Materiales y métodos. Se hizo un estudio observacional descriptivo con componente analítico de corte transversal. Se incluyeron 62 pacientes con diagnóstico de asma alérgica sensibilizados a ácaros del polvo y en tratamiento, mínimo, con seis dosis de inmunoterapia contra ácaros. El efecto del tratamiento se evaluó mediante la escala de puntuación del ACT (Asthma Control Test), la escala de tratamiento de la GINA (Global Initiative for Asthma) y la espirometría. Resultados. La puntuación de la prueba ACT antes del inicio de la inmunoterapia, correspondía a 30 % de pacientes con asma no controlada, 28 % con buen control y 4 % con asma totalmente controlada. Entre los pacientes con asma no controlada, el 46,7 % logró un buen control y el 23,3 % alcanzó un control total. En cuanto a la percepción de los pacientes sobre la mejoría con la inmunoterapia, el 9,75 % percibió una mejoría menor del 50 %, el 45,2 %, una entre el 50 y el 90 %, en tanto que el 41,9 % refirió una igual o mayor del 90 %. No se encontraron cambios significativos en los valores del volumen espiratorio forzado en un segundo (VEF1) en las espirometrías. Conclusiones. Se observaron cambios significativos en los puntajes del ACT y en la percepción de mejoría de la enfermedad en la población tratada con inmunoterapia específica para ácaros, es decir, que esta tendría un efecto beneficioso en el curso natural de la enfermedad.

Efecto de la inmunoterapia con alérgenos específicos en pacientes pediátricos con asma atendidos en una institución de salud de Colombia / Impact of the allergen-specific immunotherapy in pediatric patients with asthma treated at a health institution in Colombia

Resumen Introducción. El asma es una enfermedad crónica y potencialmente grave. El 80 % de los casos es de origen alérgico, por lo cual la inmunoterapia específica con alérgenos es una alternativa terapéutica que modula el curso natural de la enfermedad. Objetivo. Evaluar el impacto de la inmunoterapia en pacientes pediátricos con asma atendidos en una institución de salud de Colombia. Materiales y métodos. Se hizo un estudio observacional descriptivo con componente analítico de corte transversal. Se incluyeron 62 pacientes con diagnóstico de asma alérgica sensibilizados a ácaros del polvo y en tratamiento, mínimo, con seis dosis de inmunoterapia contra ácaros. El efecto del tratamiento se evaluó mediante la escala de puntuación del ACT (Asthma Control Test), la escala de tratamiento de la GINA (Global Initiative for Asthma) y la espirometría. Resultados. La puntuación de la prueba ACT antes del inicio de la inmunoterapia, correspondía a 30 % de pacientes con asma no controlada, 28 % con buen control y 4 % con asma totalmente controlada. Entre los pacientes con asma no controlada, el 46,7 % logró un buen control y el 23,3 % alcanzó un control total. En cuanto a la percepción de los pacientes sobre la mejoría con la inmunoterapia, el 9,75 % percibió una mejoría menor del 50 %, el 45,2 %, una entre el 50 y el 90 %, en tanto que el 41,9 % refirió una igual o mayor del 90 %. No se encontraron cambios significativos en los valores del volumen espiratorio forzado en un segundo (VEF1) en las espirometrías. Conclusiones. Se observaron cambios significativos en los puntajes del ACT y en la percepción de mejoría de la enfermedad en la población tratada con inmunoterapia específica para ácaros, es decir, que esta tendría un efecto beneficioso en el curso natural de la enfermedad

Abstract Introduction: Asthma is a chronic and potentially serious disease and 80% of the cases have an allergic etiology. In this sense, allergen-specific immunotherapy is an alternative that modulates the natural course of the disease. Objective: To evaluate the impact of immunotherapy in pediatric asthma patients treated at a health institution in Colombia. Materials and methods: We conducted an observational descriptive study with an analytical cross-sectional component. Sixty-two patients diagnosed with allergic asthma sensitized to dust mites and treated with at least 6 doses of mite immunotherapy were included. We assessed the impact of immunotherapy using the Asthma Control Test (ACT), the Global Initiative for Asthma (GINA) treatment scale, and spirometry values. Results: The ACT score before the start reported 30% of patients with uncontrolled asthma, 28% with good control, and 4% with totally controlled asthma. Of the patients with uncontrolled asthma, 46.7% achieved good control and 23.3% total control. Regarding patients' perception of improvement with the immunotherapy, 9.75% perceived a response of less than 50%, 45.2% one between 50% -90%, and 41.9% reported response equal to or greater than 90%. No significant changes in FEV1 values were found in spirometry. Conclusions: Significant changes in the ACT scores and the perception of disease improvement were observed in the population evaluated with specific mite immunotherapy, i.e., it had a positive impact on the natural course of the disease.

Current situation of allergy education in Mexico and other parts of Latin America.

Allergic diseases are one of the most frequent chronic diseases in the world. It has been established that there is a worldwide epidemic of allergic diseases; therefore, the treatment of allergies should be acknowledged as a worldwide priority and the specialty of allergy should be considered an important field in medicine. Due to the fact that allergic diseases involve many organs, and Allergy and Clinical Immunology is one of the specialties in which physicians may be trained to treat patients of all ages, the subject in medical schools is not always taught as an individual specialty but often as part of another subject such as internal medicine or pediatrics. Certified allergists are an important contribution to health systems, providing the necessary care for patients who have allergic diseases. Undergraduate programs in many universities do not include allergy as a subject, contributing to a lack of knowledge regarding the correct management of allergic diseases. World Health Organization (WHO) recommends 1 allergist per 50,000 people; however, there is an uneven distribution of allergy and clinical immunology specialists. Most practitioners are localized mainly in larger cities and state capitals, while in other regions, specialists are still greatly needed. Support and training systems are required for allergy and clinical immunology specialists to promote continuing education and keep their clinical competence up to date, which will lead to better care for their patients. Increased exposure to the concepts of allergy and clinical immunology diagnosis and treatment in undergraduate education may also potentially lead to an increase in interest in the field of allergy and clinical immunology among physicians in training. This review will approach allergy education in Mexico and other parts of Latin America.

[Hypersensitivity to ß-lactam antibiotics: algorithms of management and desensitization as a vital therapeutic alternative]. / Hipersensibilidad a antibióticos betalactámicos: algoritmos de manejo y desensibilización como alternativa terapéutica vital.

Hypersensitivity reactions can be complex and life-threatening to patients, especially when drugs such as ß-lactam antibiotics are involved. To this day, there are diagnostic algorithms and mobile applications that improve the clinical approach, as well as laboratory tests and more specialized procedures, such as skin tests and controlled exposure tests; which are useful for identifying the drug involved and for selecting safe and effective therapeutic alternatives. For several years, the desensitization procedure has been positioned as a vital tool for clinical allergists and for their patients, and it is key to improving clinical outcomes such as survival and quality of life.

Las reacciones de hipersensibilidad pueden ser complejas y poner en peligro la vida de los pacientes, más cuando se involucran medicamentos como los antibióticos betalactámicos. A la fecha, se dispone de algoritmos diagnósticos y aplicaciones móviles que facilitan el abordaje clínico, así como pruebas de laboratorio y procedimientos más especializados, como las pruebas cutáneas y de exposición controlada, útiles para la identificación de la sustancia implicada y para la selección de alternativas terapéuticas seguras y efectivas. Desde hace varios años, el procedimiento de desensibilización se ha posicionado como una herramienta vital para el alergólogo clínico y los pacientes, y es clave para mejorar los desenlaces clínicos, tanto la supervivencia como la calidad de vida.

Rendimiento diagnóstico de las punciones de lesiones biliopancreáticas guiadas por ultrasonido endoscópico con patólogo en sala / Diagnostic performance of endoscopic ultrasound-guided fine needle aspiration of pancreatobiliary lesions with rapid on-site evaluation

Resumen Introducción y objetivos: El ultrasonido endoscópico con punción-aspiración con aguja fina (USE-PAAF) en lesiones neoplásicas biliopancreáticas suele tener un rendimiento alto, que depende de características de la lesión; aspectos técnicos de la USE-PAAF y la experiencia del endoscopista. De los factores menos estudiados es la presencia de patólogo en sala. Se plantea la realización de USE-PAAF con patólogo en sala para disminuir el número de pases, la tasa de muestras inadecuadas y la necesidad de repetir el procedimiento. Material y métodos: Estudio observacional, retrospectivo, con recolección prospectiva de enero de 2018 a junio de 2019, en pacientes adultos sometidos a USE-PAAF. Las muestras obtenidas fueron extendidas y evaluadas en salas de endoscopia por médico patólogo con coloración Diff-Quick y cuando se obtenía una muestra suficiente se enviaba en frasco con formol para bloque celular o biopsias. Resultados: Se realizaron 48 USE-PAAF biliopancreáticas en individuos con una edad mediana de 64 años. Las indicaciones más frecuentes fueron punciones por masa o pseudomasa pancreática (71 % de casos); Se diagnosticaron 35 malignidades (77 % correspondientes a adenocarcinoma, y 14 % a tumores neuroendocrinos). La mediana de tamaño de lesiones fue de 28 mm; el número de pases promedio fue de 3. Se obtuvieron resultados diagnósticos en 89 % frente a 11 % de falsos negativos. Se presentó 1 complicación menor (2,1 %), que fue dolor abdominal. Conclusiones: La USE-PAAF con patólogo en sala tiene alto rendimiento diagnóstico, con escasos resultados falsos negativos. Se requiere una mediana de pases menor, que podría minimizar los riesgos del procedimiento y la necesidad de repetir la prueba.

Abstract Introduction: Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) of pancreatobiliary neoplastic lesions usually has a high performance that depends on the characteristics of the lesion, technical aspects, and expertise of the endoscopist. One of the least studied factors is rapid on-site evaluation with a pathologist in the room. Objective: To perform EUS-FNA with a pathologist in the endoscopy room to reduce the number of passes, the rate of inadequate samples and the need to repeat the procedure. Material and methods: Observational retrospective study with a prospective data collection approach from January 2018 to June 2019 of adult patients undergoing EUS-FNA. The samples obtained were spread and evaluated in endoscopy rooms by a pathologist with Diff-Quick stain, and when a sufficient sample was obtained, it was sent in a vial with formalin for cell block and/or biopsy. Results: 48 pancreatobiliary EUS-FNA were performed in individuals with a median age of 64 years. The most frequent indication was aspiration due to pancreatic mass (71%); 35 malignancies were diagnosed (77% were adenocarcinomas and 14% were neuroendocrine tumors). The median size of the lesions was 28mm, and the average number of passes was 3. Diagnostic results were obtained in 89% vs. 11% of false negatives. There was 1 minor complication (2.1%), which was abdominal pain. Conclusions: EUS-FNA with an in-room pathologist has a high diagnostic performance, with few false negative results. Also, a lower median number of passes is required, minimizing the risks of the procedure and the need for repeating it.

IgE, blood eosinophils and FeNO are not enough for choosing a monoclonal therapy among the approved options in patients with type 2 severe asthma.

Type-2 inflammation is the most frequent endophenotype of asthma. Different biomarkers have been proposed to identify this inflammation because highly effective therapies have improved type-2 severe asthma control. We investigated the frequency of some biomarkers of type-2 inflammation (total IgE, sIgE, blood eosinophil, and FeNO) in the framework of severe asthma and assessed its ability to help us to choose the best biological therapy for each patient. Different scenarios (sensitivity analysis) were evaluated according to the biomarkers proposed for each biological therapy in 72 patients with type-2 severe asthma. Between 54.1% and 68% of patients could receive at least 2 different biological therapies and 34.7%-40.2% could receive any of the 3 types of therapies (anti-IgE, anti-eosinophil, anti-IL4). Biomarkers help to identify type-2 severe asthma but total IgE, sIgE, blood eosinophil, and FeNO are not enough to select 1 specific therapy. With the increasing arrival of new biological therapies, it is necessary to identify new biomarkers that allow us to improve our selection criteria for the best therapy for each patient or to construct a prediction rule.

Nasal specific IgE to Der p is not an acceptable screening test to predict the outcome of the nasal challenge test in patients with non-allergic rhinitis.

OBJECTIVES: Nasal specific IgE (NsIgE) is the most common marker to identify type-2 inflammation in local allergic rhinitis (LAR). However, the comparison of NsIgE in different types of rhinitis, its frequency in tropical countries, and its diagnostic performance for predicting the outcome of a nasal challenge test (NCT) has had limited study. The main objective of this study was to explore the diagnostic performance of NsIgE to Dermatophagoides pteronyssinus (Der p) among different types of rhinitis and control subjects in a tropical population. METHODS: We evaluated the frequency of NsIgE, systemic atopy (serum sIgE and Skin Prick Test), and nasal eosinophils, and we performed nasal challenge tests (NCTs) with Der p in 3 groups of patients; rhinitis without atopy (RWoA) (n = 25), rhinitis with atopy (RWA) (n = 25), and control subjects (n = 18). RESULTS: NsIgE had a low sensitivity and specificity to predict a positive NCT in the RWoA group: 48% had NsIgE, but only 28% had a positive NCT. Among the RWA group 84% had NsIgE and 80% had a positive NCT; the association of NsIgE and positive NCT was high (>80%). In the control group 27.8% had NsIgE, but none had a positive NCT. CONCLUSIONS: NsIgE performs poorly in predicting NCT results in patients with non-allergic rhinitis. More methodical investigations are needed in this complex area of rhinitis. In patients with allergic rhinitis, NsIgE was useful in predicting a positive nasal challenge, but not superior to the systemic atopic test.

[Emollients: benefits, key elements, and clinical application]. / Emolientes: beneficios, elementos clave y aplicación clínica.

The skin is the largest organ in the human body. Among other components, it contains epidermal cells, which are modified epithelial cells that rest on a basal membrane that separates them from the dermis. When the epidermis presents variations in its structural composition and the distribution of its elements, the result is the loss of large amounts of water, which perpetuates these variations and leads to permanent dehydration. Emollients are the first line of treatment for pathologies that affect the hydration of the skin, such as atopic dermatitis, which is one of the most important ones. This document entails the description of the epidermal barrier with its main components and functions, the characteristics of an altered skin barrier, and the mechanisms for its repair. Subsequently, this paper includes the definition of emollient, hydration mechanisms for the recovery of the barrier, types of emollients, the situations that must be taken into account when the use of emollients is prescribed, evidence with or without connection with their advantages, and the key points at the time of its formulation.

La piel es el órgano más extenso del cuerpo humano; entre otros componentes comprende las células epidérmicas, la cuales son células epiteliales modificadas que descansan sobre una membrana basal separadas de la dermis. Al presentar modificaciones en su composición estructural y la distribución de sus elementos, la epidermis pierde grandes cantidades de agua, lo que perpetúa estas variaciones y llevan a deshidratación permanente. Los emolientes constituyen la primera línea de manejo para las patologías que afectan la hidratación de la piel, entre ellas una de las más importantes es la dermatitis atópica. En este documento se describe la barrera epidérmica con sus principales componentes y funciones, las características de una barrera cutánea alterada y los mecanismos para su reparación. Posteriormente se continúa con la definición de emoliente, mecanismos de hidratación para la recuperación de la barrera, tipos de emolientes, situaciones que deben considerarse al indicar su uso, la evidencia en relación con sus ventajas o no y los puntos clave al realizar su formulación.

[Drug provocation tests to identify analgesic alternatives for an infant with Stevens-Johnson syndrome caused by ibuprofen-acetaminophen]. / Provocación farmacológica para identificar alternativas analgésicas en infante con síndrome de Stevens-Johnson por ibuprofeno-acetaminofén.

BACKGROUND: The Stevens-Johnson syndrome is a serious skin reaction to drugs, and it is potentially life-threatening. Its handling involves the strict restriction of the drug involved, as well as of the drugs that are similar or structurally related. CASE REPORT: A two-year and eight-month old girl with Stevens-Jonson syndrome that was caused by acetaminophen and ibuprofen. Due to the total restriction of non-steroidal anti-inflammatory drugs, and with the purpose of establishing antipyretic alternatives, an oral provocation test was carried out with the usual dose of oral nimesulide, which was negative for both immediate and late reactions. In order to offer a parenteral alternative, a provocation test was carried out with intravenous dipyrone, with in-hospital monitoring for 48 hours in an administration protocol of 10, 30 and 60 %; one dose per hour, for a total of 400 mg. The provocation test was negative for both immediate and late reactions. Oral nimesulide or parenteral dipyrone were prescribed upon requiring analgesic, anti-inflammatory, or antipyretic medication. CONCLUSION: At a pediatric age, febrile symptoms are common and controlling them is fundamental; such that if an allergy to non-steroidal anti-inflammatory drugs and acetaminophen is identified in an infant, an affectation on the quality of life will be entailed.

Antecedentes: El síndrome de Stevens-Johnson es una reacción farmacológica cutánea grave, potencialmente mortal. Su manejo incluye estricta restricción del medicamento implicado y de los fármacos estructuralmente relacionados o similares. Caso clínico: Niña de dos años y ocho meses quien presentó síndrome de Stevens-Johnson desencadenado por acetaminofén e ibuprofeno. Debido a la restricción total de antiinflamatorios no esteroideos y con el fin de establecer alternativas antipiréticas, se realizó provocación oral con dosis usual de nimesulida oral, la cual fue negativa para reacciones inmediatas y tardías. Para ofrecer una alternativa parenteral, se efectuó prueba de provocación con dipirona intravenosa, con vigilancia intrahospitalaria por 48 horas en un protocolo de administración de 10, 30 y 60 %, una dosis cada hora, para un total de 400 mg. La prueba de provocación fue negativa para reacciones inmediatas y tardías. Se indicó nimesulida oral o dipirona oral o parenteral en caso de requerir medicación analgésica, antiinflamatoria o antipirética. Conclusión: En la infancia, los cuadros febriles son comunes y el control de este síntoma es fundamental, de tal forma que si en un infante se identifica alergia a los antiinflamatorios no esteroideos y al acetaminofén, eso supondrá afectación en la calidad de vida.

Clinical Control of CSU with Antihistamines Allows for Tolerance of NSAID-Exacerbated Cutaneous Disease.

BACKGROUND: Many patients with chronic spontaneous urticaria (CSU) experience exacerbations after the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), with clinical implications for the selection of therapeutic options for pain management. Case reports suggest that antihistamines could prevent these reactions. OBJECTIVE: To determine whether antihistamines can prevent NSAID-exacerbated reactions in patients with CSU. METHODS: Data on 121 patients with CSU and a history of NSAID exacerbations were evaluated. Two types of challenge with NSAIDs were performed using the NSAIDs reported in the medical record (a diagnostic challenge test without the use of antihistamines and a challenge test using antihistamines). The order in which the tests were performed in each patient was dependent on the treating physician. Patients with a positive first diagnostic challenge underwent a second challenge using H1-antihistamines (anti-H1), patients with a negative first challenge using anti-H1 underwent a second diagnostic challenge without the use of anti-H1, and patients with a negative first diagnostic challenge or a positive first challenge using anti-H1 did not undergo a second challenge. In some patients, additional challenges were performed with an alternative NSAID before performing the diagnostic challenge test or the challenge test using anti-H1. RESULTS: In the diagnostic challenge test, 96 patients tested positive. Seventy-two (75%) of these patients tolerated the NSAIDs involved in the reaction when they used antihistamines. CONCLUSIONS: NSAID restrictions create many inconveniences for patients with CSU. Clinical control of CSU with the use of antihistamines can prevent further exacerbations due to NSAID intake in many patients to help them avoid unnecessary restrictions.

The current state of the knowledge about local allergic rhinitis.

In recent years, a new phenotype of rhinitis has been described; it is characterized by the local production of specific IgE. There isn't any evidence of systemic atopy and it has been called local allergic rhinitis. Understanding the involved physiopathological mechanisms and the behavior of this phenotype translates into the development of strategies and treatments that improve the quality of life of patients with this disease. Below, we present an updated review of the available information regarding this disease and also of the aspects that are yet unresolved.

En los últimos años se ha descrito un nuevo fenotipo de rinitis, caracterizado por la producción local de IgE específica, sin evidencia de atopia sistémica, el cual se ha denominado rinitis alérgica local. Entender los mecanismos fisiopatológicos implicados y el comportamiento de este fenotipo se traducen en el desarrollo de estrategias y tratamientos que mejoran la calidad de vida de los pacientes con esta enfermedad. En este documento se presenta una revisión actualizada de la información disponible relativa a esta enfermedad y de los aspectos pendientes por resolver.