Triggers of Exacerbation in Chronic Urticaria and Recurrent Angioedema-Prevalence and Relevance.

Patients with urticaria and angioedema often have triggers that cause an outbreak or a swelling episode or worsen their chronic condition. Exploring these factors with each patient may result in better understanding and control of their disease. Patients should be advised to avoid known triggers, if feasible, or prepare to prevent or control an exacerbation with appropriate pretreatment if avoidance is not possible. In this review, we describe and discuss a variety of factors for which there is evidence that they cause or exacerbate chronic spontaneous urticaria and angioedema. These potentially exacerbating factors include drugs, food additives, and naturally occurring pseudoallergens, mental stress, and trauma.

[Mast cell activation syndrome. About a clinical case]. / Síndrome de activación mastocitaria. A propósito de un caso clínico.

BACKGROUND: Monoclonal mast cell activation syndrome is included in mast cell activation disorders in which, after a diagnostic process, it is not possible to meet the required criteria for a diagnosis of systemic mastocytosis. CLINICAL CASE: A 73-year-old woman who presented two events of anaphylaxis 15 minutes after the intake of yucca; with a positive skin test, elevated tryptase, and mast cells with abnormal phenotype in the bone marrow biopsy, and without criteria for systemic mastocytosis. CONCLUSION: The diagnosis of monoclonal mast cell activation syndrome requires high clinical suspicion for patients with recurrent anaphylaxis and elevated tryptase, for whom joint management with hematology is essential.

Antecedentes: Entre los desórdenes de activación mastocitaria se incluye el síndrome de activación monoclonal de mastocitos, que no cumple con los criterios requeridos para hacer el diagnóstico de mastocitosis sistémica. Caso clínico: Mujer de 73 años que presentó dos cuadros de anafilaxia 15 minutos después del consumo de yuca, con prueba cutánea positiva, triptasa elevada y mastocitos con fenotipo anormal en la biopsia de médula ósea, sin criterios de mastocitosis sistémica. Conclusiones: El diagnóstico de síndrome de activación monoclonal de mastocitos requiere alta sospecha clínica ante pacientes con anafilaxia recurrente y triptasa elevada, en quienes es indispensable el manejo conjunto con hematología.

[Sensitization to aeroallergens in allergic patients from Medellin, Colombia]. / Sensibilización a aeroalergenos en pacientes alérgicos de Medellín, Colombia.

BACKGROUND: Allergen sensitization is the first step in the onset of allergic diseases. Sensitizing sources may vary among geographic region but identification is needed to develop effective treatment as specific avoidance measures and immunotherapy. OBJECTIVE: To determine the prevalence of sensitization to several sources of aeroallergens by prick skin tests, in a group of patients with rhinitis, conjunctivitis, asthma or atopic dermatitis in a tropical city. METHODS: We reviewed the medical records of patients and their results of skin prick tests with aeroallergens, including Dermatophagoides pteronyssinus and Dermatophagoides farina, during the period of January 2008 to December 2011. RESULTS: Three hundred allergic patients with sensitization to 30 different allergens were included. House dust mites (78%), dog dander (47%) and cockroach (21.5%) were the most frequent positive allergens. We observed a significative sensitization pattern with house dust mites, dog dander, molds and piggeon droppings, associated with systemic allergic sensitization. CONCLUSIONS: As we expect, mites are the main source of sensitization in Medellin. However, other sources common in other regions such as the pollen grains are rare. The identification of the sources could help to predict in young children allergic phenotypes.