[Clinical symptom relief in obese patients with persistent moderate asthma secondary to decreased obesity]. / Alivio de síntomas clínicos en pacientes obesos con asma moderada persistente secundario a la disminución de obesidad.

BACKGROUND: The prevalence of asthma and obesity has increased last years implying important economical and social consequences. A relationship between asthma severity and obesity grade has been found. Therefore, it is necessary to evaluate if obesity decline has a beneficial impact on asthma severity. OBJECTIVE: To evaluate the effect of obesity decline on control symptoms and asthma severity. PATIENTS AND METHODS: Ninety-six patients with obesity and moderate chronic asthma were randomized to group A or B and were maintained for 40 days on a low calorie diet. At baseline and at the end of the study, symptoms, measurement of obesity, spirometry, inflammatory cytokines and immunoglobulin's levels were assessed. Diets' safety was evaluated based on laboratory test. Data were analyzed with Student's t test. RESULTS: After 40 days on a low calorie diet, in group A, there were significant decreases of obesity (p < 0.001) and IgE, symptoms almost disappeared (cough persisted in 20%) and medication was suspended in 80%. Group B had obesity decline but IgE levels remained (> 100 UI/mL), symptoms and drug regimen remained unchanged. Both diets were not harmful for patients. CONCLUSION: These results show that asthmatic obese patients maintained for 40 days on low calorie diet A, had obesity and IgE levels decrease and symptoms and asthma severity relief.

[Drug allergy assessed by modified Shelley's test. A case series]. / Alergia a medicamentos evaluada con la prueba de Shelley modificada. Serie de casos.

BACKGROUND: The frequency of allergy to drugs is 5-10% in the general population, The Shelley's test is a method in vitro for its diagnosis and it is considered positive when it is equal o greater than 20%. OBJECTIVE: To show the allergy to drugs frequency evaluated by the Shelley's Modified Test. MATERIAL AND METHODS: We included 165 patients with clinical diagnosis of allergy to drugs to those who the test of Shelley's was applied modified test for one or several medicines. The study was made in the period of January 1st to December 3st 2002. RESULTS: 88% (145 patients) were positive, and 12% (20 patients) were negative in correlation with clinical findings. The female was more determinant (2:1 relation), with an average age of 45 years. The drugs that caused reactions of allergy in were the antibiotics (sulfas, penicillin, quinolones), analgesic (ASA, naproxen, diclofenac), antihypertensive (enalapril, captopril, verapamil) and others with 95, 170, 48 and 97 cases respectively. The most frequent clinical features were urticaria, angioedema, anaphylactic shock and erythema. CONCLUSION: The Shelley's test is useful to support the diagnosis of allergy to drugs, although does not exclude it. The antibiotics intake is the most common cause and the most common clinical manifestation was urticaria.

[Asthma or laryngeal amyloidosis? A report of a case and literature review]. / Asma o amiloidosis laríngea? Comunicación de un caso y revisión de la literatura.

The laryngeal amyloidosis is an uncommon disease accounting for 1% of all benign lesions of larynx. The commonest symptom is the dysphonia, sometimes accompanied by stridor, laryngeal globus sensation, dysphagia and, in rare occasions, cough, dyspnea and hemoptysis, specially when the tracheobronchial tree is also affected. This paper describes the case of a 30-year-old female patient, whose main symptoms were progressive dysphonia and dyspnea, admitted at allergy service to rule out asthma. The respiratory function tests showed obstruction in the medium and small caliber ways without reversibility with salbutamol. Biopsies of ventricular band, vocal cord and arytenoid stained with positive Congo red for amyloid tissue, established the laryngeal amyloidosis diagnosis. The complementary studies to rule out amyloid tissue in the remaining tracheobronchial tree were negative. Dyspnea had characteristics of laryngeal origin, caused by a pulmonary ventilation disorder provoked by the difficult arrival of air to alveoli, which caused the decreased partial pressure of oxygen and CO2.

[Nasal budesonide plus zafirlukast vs nasal budesonide plus loratadine-pseudoephedrine for controlling the symptoms of rhinitis and asthma]. / Budesonida nasal más zafirlukast vs budesonida nasal más loratadina- pseudoefedrina en el control de los síntomas de la rinitis y el asma.

OBJECTIVE: To compare the efficacy of nasal budesonide plus oral zafirlukast against nasal budesonide plus oral loratadine/pseudoephedrine combination in the control of symptoms of rhinitis and asthma. PATIENTS AND METHODS: A controlled, clinical, randomized, double blind and crossover study was made in 36 patients with allergic rhinitis and asthma following one of the next treatment regimes: group a) nasal budesonide plus oral zafirlukast twice a day or group b) nasal budesonide plus oral loratadine/pseudoephedrine twice a day, both of them during six weeks, and two weeks of washing and crossover of the treatments during six more weeks. Changes in the rhinitis and asthma symptoms, blood eosinophils, pulmonary function testing, and nasal cytology were evaluated before and after the treatment. RESULTS: 19 patients were assigned to group a, whereas 17 patients to group b. The age ranged between 16 to 45 years, and it predominated the female group, 70 and 89%, respectively (statistically no significant). During the first six weeks of the treatment, V0 to V3, both groups of patients got better nasal symptoms but group a was superior to group b. However, in bronchial symptoms, cough, wheezing and breathlessness, group a showed efficacy in comparison with group b, where no significant improvement was shown. Once the crossover was made, from V5 to V7, there was no difference between both groups. The other evaluated indicators, such as eosinophilia, VEF1 and nasal eosinophils, had a significant improvement before and at the end of the study. CONCLUSIONS: The association of a nasal steroid with a leukotriene modifier (zafirlukast) was more effective for controlling nasal symptoms and especially bronchial symptoms than the association of a nasal steroid with antihistamines (loratadine) with pseudoephedrine. Other inflammation indicators, such as eosinophilia and nasal eosinophilia, were diminished; the VEF1 increased significantly in both treatment groups. All the above may be due to the nasal steroid use associated to a leukotriene modifier.