Serum potassium levels, CPK-MB and ECG in children suffering asthma treated with beclomethasone or beclomethasone-salmeterol.

Asthma morbidity and mortality has increased. One of the possible causes is the excessive use of beta agonists. The aim of this study is to compare the effects of six week treatment with beclomethasone alone (Ibec) or the combination of beclomethasone-salmeterol (Ibe + Isal) on serum potassium (K), CPK-MB and ECG in children suffering asthma. It was a prospective, randomised, open cross-over trial. Patients received either Ib2 (2 puff/12 hr, 100 micrograms per puff) or Ibe + Isal (B 2 puff/12 hr, 100 micrograms per puff and S 2 puff/12 hr, 25 micrograms per puff) with dose meter inhaler by 6 weeks, with a four-week wash-out period between the treatments. K, CPK-MB and ECG were assessed at baseline, and after each treatment period. There were 9 girls and 20 boys, aged 11 +/- 2.18 (mean +/- SD) years, baseline K was 4.57 +/- 0.43 mEq/l, after B K 4.38 +/- 0.39 IU and after BS K 4.38 +/- 0.40. The CPK-MB level were baseline 14.75 +/- 4.5, after B 20.10 +/- 6.9 and after BS 21 +/- 8.05 (p < 0.05). Baseline QTc was 0.416 +/- 0.02 msec, after B 0.425 +/- 0.027, and after BS 0.415 +/- 0.029. We conclude that the treatment of children with asthma with 400 micrograms per day of Ibec or concomitantly with 100 micrograms of Isal for 6 weeks does not alter the serum K+ or the QTc. However, the CPK-MB has a significant increment with both treatments but without clinical and/or ECG changes. We can't affirm that Ibec or Ibec plus Isal have a cardiotoxic side-effect by the only presence of high levels of CPK-MB. We agree that it is necessary a close follow up of these apparently asymptomatic patients not induce important cardiovascular changes although CPK-MB was increased.

Serum potassium levels, CPK-MB and ECG in children suffering asthma treated with Blecomethasone or Blecomethasone-Salmeterol

Asthma morbidity and mortality has increased. One of the possible causes is the excessive use of beta agonists. The aim of this study is to compare the effects of six week treatment with beclomethasone alone (Ibec) or the combination of beclomethasone-salmeterol (Ibe + Isal) on serum potassium (K), CPK-MB and ECG in children suffering asthma. It was a prospective, randomised, open cross-over trial. Patients received either Ib2 (2 puff/12 hr, 100 μ g per puff) or Ibe + Isal (B 2 puff/12 hr, 100 μg per puff and S 2 puff/12 hr, 25 μ g per puff) with dose meter inhaler by 6 weeks, with a four-week wash-out period between the treatments. K, CPK-MB and ECG were assessed at baseline, and after each treatment period. There were 9 girls and 20 boys, aged 11 ± 2.18 (mean ± SD) years, baseline K was 4.57 ± 0.43 mEq/l, after B K 4.38 ± 0.39 IU and after BS K 4.38 ± 0.40. The CPK-MB level were baseline 14.75 ± 4.5, after B 20.10 ± 6.9 and after BS 21 ± 8.05 (p < 0.05). Baseline QTc was 0.416 ± 0.02 msec, after B 0.425 ± 0.027, and after BS 0.415 ± 0.029. We conclude that the treatment of children with asthma with 400mg per day of Ibec or concomitantly with 100 μ g of Isal for 6 weeks does not alter the serum K + or the QTc. However, the CPK-MB has a significant increment with both treatments but without clinical and/or ECG changes. We can't affirm that Ibec or Ibec plus Isal have a cardiotoxic side-effect by the only presence of high levels of CPK-MB. We agree that it is necessary a close follow up of these apparently asymptomatic patients not induce important cardiovascular changes although CPK-MB was increased (AU)

El componente inflamatorio crónico del asma ha justificado el manejo con antiinflamatorios de tipo esteroide inhalados solos o en combinación con 2 de acción prolongada para manejo habitual del asma moderada crónica persistente (AMCP). El objetivo fue comparar los efectos de beclometasona frente a salmeterol con beclometasona en IDM sobre el potasio sérico, el intervalo QTc y en los valores de las enzimas del músculo cardíaco CPK-MB en niños asmáticos sin crisis del servicio de alergia del Hospital Infantil de México Federico Gómez. Se hizo un ensayo clínico prospectivo, longitudinal, ciego, cruzado, comparativo de dos tratamientos. administrados de forma aleatoria en diferentes tiempos en un mismo grupo de 30 pacientes de 7 a 17 años con AMCP de acuerdo a la clasificación del GINA. A los pacientes seleccionados se les determinó potasio, CPK-MB y trazo de ECG antes y después de las 6 semanas de tratamiento (salmeterol 100 g/día con beclometasona 400 g/día (Sal-Beclo) y beclometasona (Beclo) sola a la misma dosis. El inicio del tratamiento fue de tipo aleatorio quedando 14 pacientes con Sal-Beclo y 16 con Beclo, con 1 semana de lavado después del primer tratamiento para continuar el grupo que inició con Sal-Beclo con Beclo y el de Beclo con Sal-Beclo.Resultados: hubo 9 niñas y 20 hombres con una media de 11 ñ 2,18 años. Con K basal de 4,57 ñ 0,43 mEq/l con Beclo de 4,38 ñ 0,39 y con Sal-Beclo de 4,38 ñ 0,40. La CPK-MB basal fue de 14,75 ñ 8,45 después con Beclo 20,10 ñ 6,9 y con Sal-Beclo 21 ñ 8,05. Los cambios en la CPK-MB basal frente a CPK-MB con Beclo y la CPK-MB basal con Sal-Beclo se obtuvieron valores significativos (p 0,05).Conclusión: la administración de 400 g al día de beclometasona sola o en combinación con 100 g/día de salmeterol en inhalador de dosis medida por 6 semanas en el tratamiento habitual de niños con ACMP no induce cambios cardiovasculares importantes a pesar de haberse visto una elevación significativa de la CPK-MB en niños sin crisis (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.