Clinical and immunological features of common variable immunodeficiency in Mexican patients.

BACKGROUND: Common variable immunodeficiency (CVID) is characterised by hypogammaglobulinaemia and a broad clinical spectrum, mainly showing recurrent bacterial infections accompanied sometimes by increased susceptibility to chronic lung disease, autoimmunity, and neoplastic diseases. OBJECTIVES: To evaluate the clinical and immunological characteristics of patients with CVID in Mexico. METHODS: This is a retrospective analysis of 43 patients with CVID from the Immunology Division of seven different reference centres in Mexico. Patients were diagnosed according to the diagnostic criteria of the European Society for Immunodeficiency Diseases. We collected demographics, clinical and immunological data from each patient and a statistical analysis was performed. RESULTS: There were 23 (53.5%) male and 20 (46.5%) female patients. Median age at onset of disease was 13.7 years, and median age at diagnosis was 19 years. Average delay in diagnosis was 12.5 years. The median total serum levels of IgG, IgM, and IgA at diagnosis were 175, 18, and 17.8mg/dL, respectively. The mean percentage of CD19+ B cells was 8.15%. Sinusitis (83%), pneumonia (83%), gastrointestinal infection (70%), and acute otitis media (49%) were the most common manifestations. Bronchiectasis was present in 51% of the patients, 44% manifested non-infectious chronic diarrhoea, and 70% experienced weight loss. Autoimmunity was present in 23% of the patients; haemolytic anaemia and autoimmune thrombocytopenic purpura were the most common presentations. Allergy was present in 30.2% of patients, with allergic rhinitis and asthma being the most frequent types. Two patients developed malignancy. All the patients received Intravenous immunoglobulin (IVIG) as a fundamental part of the treatment at a mean dose of 408mg/kg. CONCLUSION: This is the first cohort of CVID reported in Mexico We found that infection diseases were the most frequent presentations at onset. Moreover, patients had an average diagnosis delay of twelve years and thus a major prevalence of bronchiectasis. We suggest performing an extended analysis of patients with CVID patients in other Latin American countries.

[Asthma physiopathology]. / Fisiopatología del asma.

Bronchial asthma is a very common disease but often the diagnosis and treatment is not done correctly. The physiopathology is very complex in which are involved neuroimmune mechanism with imbalance between sympatic-parasympatic system, and the other pathways including non adrenergic non colinergic and neuropeptide factors. The immunologic participation with a high level of IgE and the activation of the interleukins, all these together with very active participation of the adhesives, are the responsible for the activations and action of the chemical substances who are the origin of the bronchospasm and inflammation.

[Cutaneous reactivity to foods among patients with allergic rhinoconjunctivitis]. / Reactividad cutánea a alimentos en pacientes con rinoconjuntivitis alérgica.

Ocular allergy could be induced by food allergy or inhaled allergens. However there are few pediatric studies about it. Our objective was to know the frequency in children who have food allergy as cause of their ocular allergy. We perform a prospective and descriptive study in 50 patients within 6 to 16 years of age during June 1996 to January 1997. Skin prick tests to food allergens and inhalants, serum IgE levels by ELISA (enzyme immunoassay), nasal and conjunctival cytology were done. Not paired student T-test, Mann-Whitney U, and Kruskall-Wallis test were used for statistical analysis. We found mean of age 9.1 years +/- 2.5. Prick tests were positives to foods in 20%, 50% to inhalants and 30% to both. Food allergens seen more frequently were shellfish, tomato, rice, peanut and inhaled allergen Dermatophagoides pteronissinus. Serum IgE was elevated and ocular cytology was positive in food hypersensitivity group with significance difference (p = 0.023). In conclusion, we found a high frequency (50%) of food hypersensitivity in patients with allergic rhinoconjunctivitis.

[Comparison of 4 skin prick tests to detect immediate hypersensitivity]. / Comparación de cuatro aditamentos epicutáneos para detectar hipersensibilidad inmediata.

AIMS: To diagnostic allergic diseases it's necessary an adequate history, and in vivo or in vitro test, to determine specific IgE. The skin prick test are the best for this, because are more sensitive, economic and quick to do. However there are variability in results with the different instruments to do it (the Morrow-Brown (MB), needle, Prick lancet (L)t Multi-Test (MT), and the Doutip-Test). To consider this instruments how adequate diagnostic proceedings, we should evaluate some characteristics. Because it, our objective was to evaluate precision, sensitivity, specificity and patient preference by each one. METHOD: Prospective study in 20 patients with asthma or allergic rhinitis who comes to the allergy service of Hospital Infantil de México Federico Gómez. We analyzed skin prick test with DT, MB, MT and L on the back surface with histamine in five times and glicerosaline in one. We measured wheel and flare diameters 15 minutes after applications. We consider positive results if medium diameter of wheel was 3 mm or flare 10 mm. Precision was measured by coefficient of variation of wheel with histamine with each instrument. Patient preference was considered in relation to low grade of discomfort with each one. Precision was compared by two- vias varianza analysis. No parametric Friedman test was used to compared patient preference. RESULTS: We studied 20 patients, 40% was females and 60% males. The ages were 10 to 16 years old Promedio wheal histamine diameter was to MB = 5.1 +/- 1.1, L = 6.1 +/- 0.8, DT = 6.7 +/- 0.9, MT = 6.3 +/- 1.5; promedio flare diameter with histamine was to MB: 15.9 +/- 4.2, L: 19.0 +/- 4.8, DT = 21.9 +/- 4.8, MT = 18 +/- 6.9. Sensibility of DT was 100%, L = 99%, MT = 97% and MB 95%. The specificity of MB was 90%, L = 70%, MT = 41.6% and DT 30%. DT coefficient of variation was 15.6%, L: 17.3%, MT = 24.4% and MB 24.6%. CONCLUSIONS: In our study more sensitive device was DT, more specific was MB and more precise was DT. Patients preferred the lancet, because they had less discomfort when used it.