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Villarreal-González RV, Canel-Paredes A, Arias-Cruz A, Fraga-Olvera A, Delgado-Bañuelos A, Rico-Solís GA, Ochoa-García IV, Jiménez-Sandoval JO, Ramírez-Heredia J, Flores-González JV, Cortés-Grimaldo RM, Zecua-Nájera Y, Ortega-Cisneros M. [Drug allergy: Fundamental aspects in diagnosis and treatment.]. Rev Alerg Mex 2023; 69:195-213. [PMID: 37218047 DOI: 10.29262/ram.v69i4.1181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/14/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Any substance used as a treatment for any disease can produce harmful or unpleasant events called adverse drug reactions (ADRs). They are due to inherent biological effects of the drug and are caused by immunological and non-immunological mechanisms. OBJECTIVES To describe the immunological mechanisms of hypersensitivity reactions (HSR) to drugs, their epidemiology, risk factors, classification, clinical manifestations, diagnosis, treatment, and prognosis. METHODS A review of the most current literature in English and Spanish was carried out, in the main databases, related to the HSR of various drug groups. RESULTS This study describes the terms used to define ADRs and HSRs, their classification and clinical manifestations, current diagnostic tools, treatment algorithms and prognosis of the most frequently used medications and with the highest prevalence of reported adverse events. CONCLUSION ADRs are a challenging entity, with a complex pathophysiology that has not been fully understood. Its approach requires a careful consideration since not all drugs have validated tests for their diagnosis nor a specific treatment. When indicating the use of any drug, the severity of the disease, the availability of other treatments and the potential risks of developing future adverse events should always be taken into consideration.
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Affiliation(s)
- Rosalaura Virginia Villarreal-González
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Alergia e Inmunología Clínica, Hospital Universitario Dr. José Eleuterio González, Nuevo León, México
| | - Alejandra Canel-Paredes
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Alergia e Inmunología Clínica, Hospital Universitario Dr. José Eleuterio González, Nuevo León, México
| | - Alfredo Arias-Cruz
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Alergia e Inmunología Clínica, Hospital Universitario Dr. José Eleuterio González, Nuevo León, México
| | - Alira Fraga-Olvera
- Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México; Hospital Amerimed, Quintana Roo, México
| | - Angélica Delgado-Bañuelos
- Servicio de Alergia e Inmunología Clínica, Hospital General Regional 58, Instituto Mexicano del Seguro Social, Guanajuato, México
| | | | - Itzel Vianey Ochoa-García
- Departamento de Inmunología clínica y Alergia, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Jalisco, México
| | - Jaime Omar Jiménez-Sandoval
- Departamento de Alergia e Inmunología Clínica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México; Hospital Regional Río Blanco, SESVER, Veracruz, México
| | - Jennifer Ramírez-Heredia
- Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México; Hospital MAC, Irapuato, Guanajuato, México
| | | | - Rosa María Cortés-Grimaldo
- Departamento de Alergia e Inmunología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Jalisco, México
| | - Yahvéh Zecua-Nájera
- Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México; Centro Médico San Carlos, Tlaxcala, México
| | - Margarita Ortega-Cisneros
- Departamento de Inmunología Clínica y Alergia, Unidad Médica de Alta Especialidad, Hospital de especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social.
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García-Marcos L, Chiang CY, Asher MI, Marks GB, El Sony A, Masekela R, Bissell K, Ellwood E, Ellwood P, Pearce N, Strachan DP, Mortimer K, Morales E, Ajeagah GA, Alkhayer G, Alomary SA, Ambriz-Moreno MJ, Arias-Cruz A, Awasthi S, Badellino H, Behniafard N, Bercedo-Sanz A, Brożek G, Bucaliu-Ismajli I, Cabrera-Aguilar A, Chinratanapisit S, Del-Río-Navarro BE, Douros K, El Sadig H, Escalante-Dominguez AJ, Falade AG, Gacaferri-Lumezi B, García-Almaráz R, Garcia-Muñoz R, Ghashi V, Ghoshal AG, González-Díaz C, Hana-Lleshi L, Hernández-Mondragón LO, Huang JL, Jiménez-González CA, Juan-Pineda MÁ, Kochar SK, Kuzmicheva K, Linares-Zapien FJ, Lokaj-Berisha V, López-Silvarrey A, Lozano-Sáenz JS, Mahesh PA, Mallol J, Martinez-Torres AE, Masekela R, Mérida-Palacio JV, Mohammad Y, Moreno-Gardea HL, Navarrete-Rodriguez EM, Ndikum AE, Noor M, Ochoa-Lopez G, Pajaziti L, Pellegrini-Belinchon J, Perez-Fernández V, Priftis K, Ramos-García BC, Ranasinghe JC, Robertson S, Rodriguez-Perez N, Rutter CE, Sacre-Hazouri JA, Salvi S, Sanchez JF, Sánchez JF, Sanchez-Coronel MG, Saucedo-Ramirez OJ, Singh M, Singh N, Singh V, Sinha S, Sit N, Sosa-Ferrari SM, Soto-Martínez ME, Urrutia-Pereira M, Yeh KW, Zar HJ, Zhjeqi V. Asthma management and control in children, adolescents, and adults in 25 countries: a Global Asthma Network Phase I cross-sectional study. Lancet Glob Health 2023; 11:e218-e228. [PMID: 36669806 PMCID: PMC9885426 DOI: 10.1016/s2214-109x(22)00506-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Asthma is one of the most common non-communicable diseases globally. This study aimed to assess asthma medicine use, management plan availability, and disease control in childhood, adolescence, and adulthood across different country settings. METHODS We used data from the Global Asthma Network Phase I cross-sectional epidemiological study (2015-20). A validated, written questionnaire was distributed via schools to three age groups (children, 6-7 years; adolescents, 13-14 years; and adults, ≥19 years). Eligible adults were the parents or guardians of children and adolescents included in the surveys. In individuals with asthma diagnosed by a doctor, we collated responses on past-year asthma medicines use (type of inhaled or oral medicine, and frequency of use). Questions on asthma symptoms and health visits were used to define past-year symptom severity and extent of asthma control. Income categories for countries based on gross national income per capita followed the 2020 World Bank classification. Proportions (and 95% CI clustered by centre) were used to describe results. Generalised structural equation multilevel models were used to assess factors associated with receiving medicines and having poorly controlled asthma in each age group. FINDINGS Overall, 453 473 individuals from 63 centres in 25 countries were included, comprising 101 777 children (6445 [6·3%] with asthma diagnosed by a doctor), 157 784 adolescents (12 532 [7·9%]), and 193 912 adults (6677 [3·4%]). Use of asthma medicines varied by symptom severity and country income category. The most used medicines in the previous year were inhaled short-acting β2 agonists (SABA; range across age groups, 29·3-85·3% participants) and inhaled corticosteroids (12·6-51·9%). The proportion of individuals with severe asthma symptoms not taking inhaled corticosteroids (inhaled corticosteroids alone or with long-acting β2 agonists) was high in all age groups (934 [44·8%] of 2085 children, 2011 [60·1%] of 3345 adolescents, and 1142 [55·5%] of 2058 adults), and was significantly higher in middle-to-low-income countries. Oral SABA and theophylline were used across age groups and country income categories, contrary to current guidelines. Asthma management plans were used by 4049 (62·8%) children, 6694 (53·4%) adolescents, and 3168 (47·4%) adults; and 2840 (44·1%) children, 6942 (55·4%) adolescents, and 4081 (61·1%) adults had well controlled asthma. Independently of country income and asthma severity, having an asthma management plan was significantly associated with the use of any type of inhaled medicine (adjusted odds ratio [OR] 2·75 [95% CI 2·40-3·15] for children; 2·45 [2·25-2·67] for adolescents; and 2·75 [2·38-3·16] for adults) or any type of oral medicine (1·86 [1·63-2·12] for children; 1·53 [1·40-1·68] for adolescents; and 1·78 [1·55-2·04] for adults). Poor asthma control was associated with low country income (lower-middle-income and low-income countries vs high-income countries, adjusted OR 2·33 [95% CI 1·32-4·14] for children; 3·46 [1·83-6·54] for adolescents; and 4·86 [2·55-9·26] for adults). INTERPRETATION Asthma management and control is frequently inadequate, particularly in low-resource settings. Strategies should be implemented to improve adherence to asthma treatment guidelines worldwide, with emphasis on access to affordable and quality-assured essential asthma medicines especially in low-income and middle-income countries. FUNDING International Union Against Tuberculosis and Lung Disease, Boehringer Ingelheim New Zealand, AstraZeneca, UK National Institute for Health Research, UK Medical Research Council, European Research Council, the Spanish Instituto de Salud Carlos III. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Luis García-Marcos
- Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children‘s Hospital, University of Murcia and IMIB Bio-medical Research Institute, Murcia, Spain,ARADyAL Allergy Network, Murcia, Spain,Correspondence to: Prof Luis García-Marcos, Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children‘s Hospital, University of Murcia and IMIB Bio-medical Research Institute, 30120 Murcia, Spain
| | - Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France,Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, and Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - M Innes Asher
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Guy B Marks
- Respiratory and Environmental Epidemiology, University of New South Wales, Sydney, NSW, Australia
| | - Asma El Sony
- Epidemiological Laboratory for Public Health, Research and Development, Khartoum, Sudan
| | - Refiloe Masekela
- Inkosi Albert Luthuli Central Hospital, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Karen Bissell
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eamon Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - David P Strachan
- Population Health Research Institute, St George's, University of London, London, UK
| | - Kevin Mortimer
- Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK,Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Eva Morales
- Department of Public Health Sciences, University of Murcia and IMIB Bio-medical Research Institute, Murcia, Spain
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Larenas-Linnemann DE, Ortega-Martell JA, Blandón-Vijil MV, Rodríguez-Pérez N, Luna-Pech JA, Estrada-Cardona A, Arias-Cruz A, Del Rio-Navarro BE, Rodríguez EMN, Pozo-Beltrán CF, Takane EO, Rojo-Gutiérrez MI, Espinosa-Rosales FJ, Martínez-Infante EA. Coronavirus disease 2019, allergic diseases, and allergen immunotherapy: Possible favorable mechanisms of interaction. Allergy Asthma Proc 2021; 42:187-197. [PMID: 33980331 DOI: 10.2500/aap.2021.42.210013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Both, allergen immunotherapy (AIT) and SARS-COV-2 infection cause a set of immunologic changes that respectively vary during the course of the treatment or the disease. Objective: To review immune changes brought along by each of these entities and how they might interrelate. Methods: We start presenting a brief review of the structure of the new coronavirus and how it alters the functioning of the human immune system. Subsequently, we describe the immune changes induced by AIT and how these changes could be favorable or unfavorable in the allergic patient infected with SARS-CoV-2 at a particular point of time during the evolving infection. Results: We describe how a healthy immune response against SARS-CoV-2 develops, versus an immune response that is initially suppressed by the virus, but ultimately overactivated, leading to an excessive production of cytokines (cytokine-storm-like). These changes are then linked to the clinical manifestations and outcomes of the patient. Reviewing the immune changes secondary to AIT, it becomes clear how AIT is capable of restoring a healthy innate immunity. Investigators have previously shown that the frequency of respiratory infections is reduced in allergic patients treated with AIT. On the other hand it also increases immunoregulation. Conclusion: As there are many variables involved, it is hard to predict how AIT could influence the allergic patient's reaction to a SARS-CoV-2 infection. In any case, AIT is likely to be beneficial for the patient with allergic rhinitis and/or allergic asthma in the context of the SARS-CoV-2 pandemic as controlling allergic diseases leads to a reduced need for contact with healthcare professionals. The authors remind the reader that everything in this article is still theoretical, since at the moment, there are no published clinical trials on the outcome of COVID-19 in allergic patients under AIT.
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Affiliation(s)
| | - José A. Ortega-Martell
- Centro Universitario de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Mexico
| | | | | | - Jorge A. Luna-Pech
- Departamento de Disciplinas Filosóficas Metodoloógicas e Instrumentales, Universidad de Guadalajara, Jalisco, Mexico
| | | | - Alfredo Arias-Cruz
- Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Blanca E. Del Rio-Navarro
- Servicio de Alegia e Inmunología Clínica, Hospital Infantil de Mexico Federico Gómez, Mexico City, Mexico
| | | | - Cesar F. Pozo-Beltrán
- Subdirección de Enseñanza e Investigación, Hospital General de Especialidades Juan María Salvatierra, Baja California Sur, Mexico
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Larenas-Linnemann D, Luna-Pech J, Navarrete-Rodríguez EM, Rodríguez-Pérez N, Arias-Cruz A, Blandón-Vijil MV, Del Rio-Navarro BE, Estrada-Cardona A, Onuma-Takane E, Pozo-Beltrán CF, Valencia-Herrera AM, Ortiz-Aldana FI, Toledo-Bahena ME. Cutaneous Manifestations Related to COVID-19 Immune Dysregulation in the Pediatric Age Group. Curr Allergy Asthma Rep 2021; 21:13. [PMID: 33630167 PMCID: PMC7905763 DOI: 10.1007/s11882-020-00986-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 01/04/2023]
Abstract
Purpose of Review At the juncture of the COVID-19 pandemic, the world is currently in an early phase of collecting clinical data and reports of its skin manifestations, and its pathophysiology is still highly conjectural. We reviewed cutaneous manifestations associated with COVID-19 in the pediatric age group. Recent Findings Children infected by SARS-CoV-2 usually develop milder respiratory symptoms, but cutaneous manifestations seem a little more prevalent than in adults. These skin features of infection by the coronavirus can be similar to those produced by other common viruses, but there are also reports of cases with more heterogeneous clinical pictures, which have made their classification difficult. To date, the more frequently reported skin variants featured in pediatric cases are purpuric (pseudo-chilblain, necrotic-acral ischemia, hemorrhagic macules, and/or cutaneous necrosis), morbilliform/maculopapular, erythema multiforme, urticarial, vesicular, Kawasaki-like, and miscellaneous (highly variable in both frequency and severity). Their pathophysiological mechanism is still elusive and is likely to be the result of the complex involvement of one or more mechanisms, like direct virus-induced skin damage, vasculitis-like reactions, and/or indirect injury as a consequence of a systemic inflammatory reaction. Summary In this review, we presented and discussed clinical cases as examples of different cutaneous responses reported in some children with SARS-CoV-2 infection, differential diagnosis considerations, and a preliminary conceptual approach to some of their probable associated pathologic mechanisms.
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Affiliation(s)
- Désirée Larenas-Linnemann
- Médica Sur Fundación Clínica y Hospital, Mexico City, Mexico
- Hospital Médica Sur, Torre 2, cons. Puente de piedra 150, T2-602 Toriello-Guerra; delegación Tlalpan, Mexico City, Mexico
| | - Jorge Luna-Pech
- Departamento de Disciplinas Filosóficas Metodoloógicas e Instrumentales, Universidad de Guadalajara, Guadalajara, Jalisco Mexico
| | | | - Noel Rodríguez-Pérez
- Consulta Privada, Universidad Autónoma de Tamaulipas, Matamoros, Tamaulipas Mexico
| | - Alfredo Arias-Cruz
- Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Blanca E. Del Rio-Navarro
- Servicio de Alergia e Inmunología Clínica, Hospital Infantil de Mexico Federico Gómez, Mexico City, Mexico
| | | | | | - Cesar Fireth Pozo-Beltrán
- Subdirección de Enseñanza e Investigación, Hospital General de Especialidades Juan María Salvatierra, La Paz, Baja California Sur Mexico
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Larenas-Linnemann D, Rodríguez-Pérez N, Arias-Cruz A, Blandón-Vijil MV, Del Río-Navarro BE, Estrada-Cardona A, Gereda JE, Luna-Pech JA, Navarrete-Rodríguez EM, Onuma-Takane E, Pozo-Beltrán CF, Rojo-Gutiérrez MI. Enhancing innate immunity against virus in times of COVID-19: Trying to untangle facts from fictions. World Allergy Organ J 2020; 13:100476. [PMID: 33072240 PMCID: PMC7546230 DOI: 10.1016/j.waojou.2020.100476] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction In light of the current COVID-19 pandemic, during which the world is confronted with a new, highly contagious virus that suppresses innate immunity as one of its initial virulence mechanisms, thus escaping from first-line human defense mechanisms, enhancing innate immunity seems a good preventive strategy. Methods Without the intention to write an official systematic review, but more to give an overview of possible strategies, in this review article we discuss several interventions that might stimulate innate immunity and thus our defense against (viral) respiratory tract infections. Some of these interventions can also stimulate the adaptive T- and B-cell responses, but our main focus is on the innate part of immunity. We divide the reviewed interventions into: 1) lifestyle related (exercise, >7 h sleep, forest walking, meditation/mindfulness, vitamin supplementation); 2) Non-specific immune stimulants (letting fever advance, bacterial vaccines, probiotics, dialyzable leukocyte extract, pidotimod), and 3) specific vaccines with heterologous effect (BCG vaccine, mumps-measles-rubeola vaccine, etc). Results For each of these interventions we briefly comment on their definition, possible mechanisms and evidence of clinical efficacy or lack of it, especially focusing on respiratory tract infections, viral infections, and eventually a reduced mortality in severe respiratory infections in the intensive care unit. At the end, a summary table demonstrates the best trials supporting (or not) clinical evidence. Conclusion Several interventions have some degree of evidence for enhancing the innate immune response and thus conveying possible benefit, but specific trials in COVID-19 should be conducted to support solid recommendations.
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Key Words
- ACE2, Angiotensin converting enzime-2
- APC, Antigen-presenting cell
- BCG, Bacillus Calmette-Guérin
- BV, Bacterial vaccine
- Bacillus calmette-guérin
- Bacterial vaccine
- CCL-5, Chemokine (C–C motif) ligand 5
- CI, Confidence interval
- CNS, Central nervous system
- COVID-19
- COVID-19, Coronavirus disease-2019
- CXCR3A, CXC chemokine receptor 3A
- DAMPs, Damage-associated molecular patterns
- DC, Dendritic cell
- DLE, Dialyzable leukocyte extract
- Exercise
- Gαs: G protein coupled receptor alfa-subunits, HSP
- Heat shock proteins, HLA-DR
- Immune response
- Immunoglobulin, IGFBP6
- Innate
- Insulin-like growth-factor-binding-protein 6, IL
- Intercellular adhesion molecule type 1, IFN
- Interferon, IG
- Interleukin, MBSR
- MCP-1, Monocyte chemoattractant protein-1
- MMR
- MODS, Multi-organ dysfunction syndrome
- Major histocompatibility complex class II cell surface receptor, ICAM-1
- Mindfulness
- Mindfulness-based stress reduction, mCa++: Intramitochondrial calcium
- MyD88, Myeloid differentiation primary response 88
- NF-κB, Nuclear factor kappaB
- NK, Natural killer
- NK-Cell
- NOD2, Nucleotide-binding oligomerization domain-containing protein 2
- OR, Odds ratio
- OxPhos: Oxidative phosphorylation, PAMPs
- PKC, Protein kinase C
- PPD, Purified protein derivative (tuberculin)
- PUFA, Polyunsaturated fatty acid
- Pathogen-associated molecular patterns, PBMC
- Peripheral blood mononuclear cell, PI3K/Akt: Phosphatidylinositol 3-kinase pathway
- R0: Basic reproduction number, REM
- Rapid eye movement, RIPK2
- Reactive nitrogen species, ROS
- Reactive oxygen species, SARS-CoV-2
- Receptor iteracting serine/threonine kinase 2, RNA
- Ribonucleic acid, RNS
- Severe acute respiratory syndrome coronavirus 2, SIRS
- Sleep
- Systemic inflammatory response syndrome, TCR:T-cell receptor
- TLR, Toll-like receptor
- TNF-α, Tumor necrosis factor alpha
- TRPV, Thermolabile calcium channels
- Th, T helper-cell
- Trained immunity
- URTI, Upper-respiratory tract infection
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Affiliation(s)
- Désirée Larenas-Linnemann
- Médica Sur, Clinical Foundation and Hospital, Mexico City, Mexico
- Corresponding author. Médica Sur, Fundación clínica y hospital, Puente de piedra 150, T2Toriello Guerra, Tlalpan, Ciudad de México, México, 14050, Mexico. E-mails:
| | | | - Alfredo Arias-Cruz
- State University of Nuevo León, School of Medicine and University Hospital Dr. José Eleuterio González, Monterrey, Nuevo Leon, Mexico
| | | | | | | | | | - Jorge A. Luna-Pech
- Departamento de Disciplinas Filosóficas, Metodológicas e Instrumentales (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | - Ernesto Onuma-Takane
- Fundación Clínica y Hospital Médica Sur, Ciudad de México, México, Mexico City, Mexico
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Larenas-Linnemann D, Rodríguez-Pérez N, Luna-Pech JA, Rodríguez-González M, Blandón-Vijil MV, Del-Río-Navarro BE, Costa-Domínguez MDC, Navarrete-Rodríguez EM, Macouzet-Sánchez C, Ortega-Martell JA, Pozo-Beltrán CF, Estrada-Cardona A, Arias-Cruz A, Rodríguez Galván KG, Brito-Díaz H, Canseco-Raymundo MDR, Castelán-Chávez EE, Escalante-Domínguez AJ, Gálvez-Romero JL, Gómez-Vera J, González-Díaz SN, Guerrero-Núñez MGB, Hernández-Colín DD, Macías-Weinmann A, Mendoza-Hernández DA, Meneses-Sánchez NA, Mogica-Martínez MD, Moncayo-Coello CV, Montiel-Herrera JM, O'Farril-Romanillos PM, Onuma-Takane E, Ortega-Cisneros M, Rangel-Garza L, Stone-Aguilar H, Torres-Lozano C, Venegas-Montoya E, Wakida-Kusunoki G, Partida-Gaytán A, López-García AI, Macías-Robles AP, Ambriz-Moreno MDJ, Azamar-Jácome AA, Beltrán-De Paz CY, Caballero-López C, Fernández de Córdova-Aguirre JC, Fernández-Soto JR, Lozano-Sáenz JS, Oyoqui-Flores JJ, Osorio-Escamilla RE, Ramírez-Jiménez F, Rivero-Yeverino D, Martínez Infante E, Medina-Ávalos MA. Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines. World Allergy Organ J 2020; 13:100444. [PMID: 32884611 PMCID: PMC7451623 DOI: 10.1016/j.waojou.2020.100444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, Supplementary data) concluded the following. Results Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50-200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.
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Key Words
- AGREE-II, Appraisal of Guidelines for Research & Evaluation Instrument
- AIT, Allergen immunotherapy
- Allergen extract
- Allergen immunotherapy
- Asthma and Immunology, DBPC
- CMICA, Colegio Mexicano de Inmunología Clínica y Alergia
- COMPEDIA, Colegio Mexicano de Pediatras Especialistas in Inmunología Clínica y Alergia
- EAACI, European Academy of Allergy
- FASIT, Future of the Allergists and Specific Immunotherapy
- GIN, Guidelines International Network
- GINA, Global Initiative for Asthma
- GP, grass pollen
- GRADE, grading of recommendations assessment development and evaluation
- GUIMIT, by its Spanish initials of Guía Mexicana de Inmunoterapia
- Guideline
- HDM, house dust mite
- Ig, immunoglobulin
- MRG, main reference guidelines
- PICO, Patient-Intervention-Comparator-Outcome
- SCIT, subcutaneous allergen immunotherapy
- SLIT, sublingual allergen immunotherapy
- Subcutaneous immunotherapy
- Sublingual immunotherapy
- US, United States of North America
- double-blind, placebo controlled
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Affiliation(s)
- Désirée Larenas-Linnemann
- Médica Sur, Clinical Foundation and Hospital, Mexico City, Mexico
- Corresponding author. Médica Sur, Fundación clínica y hospital, Puente de piedra 150, T2Toriello Guerra, Tlalpan, 14050, Ciudad de México, Mexico
| | | | - Jorge A. Luna-Pech
- Departamento de Disciplinas Filosóficas, Metodológicas e Instrumentales (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | | | | | | | - Carlos Macouzet-Sánchez
- State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
| | | | | | | | - Alfredo Arias-Cruz
- State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
| | | | | | | | | | | | | | - Javier Gómez-Vera
- Institute of Security and Social Services of State Workers, López Mateos Regional Hospital, Mexico City, Mexico
| | - Sandra Nora González-Díaz
- State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
| | | | | | - Alejandra Macías-Weinmann
- State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
| | | | - Néstor Alejandro Meneses-Sánchez
- Centro Médico Nacional Siglo Xxi. Unidad Médica De Alta Especialidad. Hospital De Pediatria Dr. Silvestre Frenk Freund., Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | - Edna Venegas-Montoya
- Mexican Social Security Institute, High Specialty Medical Unit 25, Department of Clinical Immunology and Allergy, Monterrey, Nuevo León, Mexico
| | | | | | | | - Ana Paola Macías-Robles
- Instituto Mexicano del Seguro Social, Centro Medico Nacional de Occidente Unidad de Alta Especialidad Hospital de Pediatria, Guadalajara, Jalisco, Mexico
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Jares EJ, Cardona Villa R, Sánchez-Borges M, de Falco A, Ensina LF, Bernstein JA, Arias-Cruz A, Cherrez-Ojeda I, Morfín Maciel B, Macías-Weinmann A, González Díaz S, Sole D, Giavina-Bianchi P, de Barayazarra S, Cuello M, Vinuesa M, Calderón JC, Zanacchi VA, Monsell S, Morelo Rocha Felix M, Serrano Reyes C, Piraino P, Jaller R, Guerzet Ayres Bastos P, Gómez M, D'Onofrio-Silva AC, Juan Pineda A, Castillo AJ, Roman Cañamar DE, Rangel-González DM, Monge P, Santoyo-Grandados I, Mancilla-Ávila O, Monteiro L, Ramíre Zuluaga LF, Duarte PA, Serrano RG, Weisz AS. Drug-induced anaphylaxis, elicitors, risk factors, and management in Latin America. The Journal of Allergy and Clinical Immunology: In Practice 2020; 8:1403-1405.e1. [DOI: 10.1016/j.jaip.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 10/06/2019] [Accepted: 10/07/2019] [Indexed: 12/14/2022]
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Larenas-Linnemann D, Del Río-Navarro BE, Luna-Pech J, Navarrete-Rodríguez EM, Pozo-Beltrán CF, Arias-Cruz A, Costa-Domínguez MC, Rodríguez-González M, Blandón-Vijil MV, Estrada-Cardona A, Gereda JE, Ortega-Martell JA, Rodríguez-Pérez N, Rojo-Gutiérrez MI, Espinosa-Rosales FJ, Martínez-Infante EA. [Logistic precautions in preparation and administration of allergen immunotherapy during the COVID-19 pandemic in Mexico]. Rev Alerg Mex 2020; 67:199-201. [PMID: 32892535 DOI: 10.29262/ram.v67i2.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
La pandemia actual de COVID-19 ha representado un reto mayúsculo para la sociedad y la comunidad médica, no solo por su alta contagiosidad sino por la variabilidad de las manifestaciones clínicas y su comportamiento impredecible bajo diferentes contextos sanitarios. Ante ello, las medidas preventivas específicas son relevantes para evitar o disminuir contagios entre pacientes y personal de las unidades de salud, considerando que el periodo presintomático durante el cual el individuo contagiado ya puede transmitir el virus varía entre cinco y seis o hasta 14 días, según datos de la Organización Mundial de la Salud. Además, un paciente infectado puede estar asintomático, incluso, algunas personas después de haber padecido COVID-19 pueden continuar expulsando virus por algunos días más después de recuperarse.
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Gonzalez-Diaz SN, Sanchez-Borges M, Rangel-Gonzalez DM, Guzman-Avilan RI, Canseco-Villarreal JI, Arias-Cruz A. Chronic urticaria and thyroid pathology. World Allergy Organ J 2020; 13:100101. [PMID: 32180891 PMCID: PMC7063156 DOI: 10.1016/j.waojou.2020.100101] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/27/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022] Open
Abstract
Urticaria is defined as the sudden appearance of erythematous, itchy wheals of variable size, with or without angioedema (AE) (swelling of the deeper layers of the skin). Its classification depends on time course of symptoms and the presence of eliciting factors. When it lasts less than 6 weeks it is classified as acute urticaria (AU), and if the symptoms persist for more than 6 weeks, it is classified as chronic urticaria (CU). Current International Guidelines also classify CU as chronic spontaneous urticaria (CSU) and inducible urticarial, according to the absence or presence of environmental triggering factors. CSU is defined as urticaria and/or angioedema in which there is no evidence of a specific eliciting factor. CSU is associated with autoimmunity in 30-45% of the cases, sharing some immunological mechanisms with other autoimmune diseases, and is associated with autoimmune thyroid disease (ATD) in about 4.3%-57.4% patients. Several studies suggest that adequate therapy with anti-thyroid drugs or levothyroxine in early stages of ATD and CSU, may help to remit the latter; but there is still a lack of double-blind, placebo-controlled studies that support this hypothesis in patients without abnormal thyroid hormone levels. The objective of this review is to describe the pathophysiology of chronic spontaneous urticaria and its association with autoimmune thyroid disease.
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Key Words
- AAbs, autoantibodies
- AD, autoimmune diseases
- AE, angioedema
- AMA, antithyroid microsomal antibody
- ASST, autologous serum skin test
- ATAbs, anti-thyroid autoantibodies
- ATD, autoimmune thyroid disease
- Autoimmunity
- BAT, basophil activation test
- CAU, chronic autoimmune urticaria
- CSU, chronic spontaneous urticaria
- CU, chronic urticaria
- Chronic urticaria
- DAMPs, damage-associated molecular patterns
- FcεRIa, high affinity IgE receptor
- GD, Graves' disease
- HT, Hashimoto's thyroiditis/autoimmune thyroiditis
- Histamine
- ICU, inducible chronic urticaria
- IFN-γ, gamma interferon
- IL, Interleukin
- IgE, Immunoglobulin E
- IgG, Immunoglobulin G
- Levothyroxine
- NSAH, non-sedating antihistamines
- PAF, platelet activating factor
- PAMPs, pathogen-associated molecular patterns
- T4L, free thyroxine
- TG, thyroglobulin
- TGAbs, anti-thyroglobulin antibodies
- TLR, Toll-like receptors
- TNF-α, tumor necrosis factor alpha
- TPOAbs, anti-thyroid peroxidase antibodies
- TSH, thyroid stimulating hormone
- TSHR, thyroid stimulating hormone receptor
- Thyroid disease
- Treg, regulatory T cells
- UAS, urticaria activity score
- Urticaria
- VEGF, vascular endothelial growth factor
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Affiliation(s)
- Sandra Nora Gonzalez-Diaz
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Allergy Service, Clinica El Avila, 6a. Transversal Urb. Altamira, Piso 8, Consultorio 803, Caracas, 1060, Venezuela
| | - Diana Maria Rangel-Gonzalez
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Rosa Ivett Guzman-Avilan
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Jose Ignacio Canseco-Villarreal
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Alfredo Arias-Cruz
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
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Cardona V, Álvarez-Perea A, Ansotegui-Zubeldia IJ, Arias-Cruz A, Ivancevich JC, González-Díaz SN, Latour-Staffeld P, Sánchez-Borges M, Serrano C, Solé D, Tanno L, Cabañes-Higuero N, Chivato T, De la Hoz B, Fernández-Rivas M, Gangoiti I, Guardia-Martínez P, Herranz-Sanz MÁ, Juliá-Benito JC, Lobera-Labairu T, Praena-Crespo M, Prieto-Romo JI, Sánchez-Salguero C, Sánchez-González JI, Uixera-Marzal S, Vega A, Villarroel P, Jares E. [Clinical Practice Guide for Anaphylaxis in Latin America (Galaxia-Latam)]. ACTA ACUST UNITED AC 2020; 66 Suppl 2:1-39. [PMID: 31443138 DOI: 10.29262/ram.v66i6.588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Anaphylaxis is a severe allergic reaction with a rapid onset and it is potentially life-threatening. Its clinical manifestations are varied; they may affect the skin, the cardiovascular system, the respiratory system, and the digestive system, among others. The treatment of choice, which is an intra-muscular injection of epinephrine (adrenaline), must be applied promptly. Therefore, being prepared to recognize it properly is of crucial importance. The objective of this clinical practice guide is to improve the knowledge of health professionals about anaphylaxis and, consequently, to optimize the treatment and long-term management of this reaction. This guide is adapted to the peculiarities of Latin America; especially in matters regarding the treatment. The need to introduce epinephrine auto-injectors in countries that don't have them yet is highlighted.
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Affiliation(s)
- Victoria Cardona
- Universitat Autónoma de Barcelona, Hospital Universitario Vall d'Hebron, Servicio de Medicina Interna, Sección de Alergología, Barcelona, España.
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Larenas-Linnemann D, Luna-Pech JA, Rodríguez-Pérez N, Rodríguez-González M, Arias-Cruz A, Blandón-Vijil MV, Costa-Domínguez MC, Del Río-Navarro BE, Estrada-Cardona A, Navarrete-Rodríguez EM, Ortega-Martell JA, Pozo-Beltrán CF, Brito-Díaz H, Canseco-Raymundo MR, Castelán-Chávez EE, Domínguez-Silva MG, Escalante-Domínguez AJ, Gálvez-Romero JL, García-Reyes MG, Gómez-Vera J, González-Díaz SN, Guerrero-Núñez MGB, Hernández-Colín D, Macías-Weinmann A, Mendoza-Hernández DA, Meneses-Sánchez NA, Mogica-Martínez MD, Moncayo-Coello CV, Montiel-Herrera M, O'Farril-Romanillos P, Onuma-Takane E, Ortega-Cisneros M, Rangel-Garza L, Stone-Aguilar H, Torres-Lozano C, Venegas-Montoya E, Wakida-Kusunoki G, Macouzet-Sánchez C, Partida-Gaytán A, López-García AI, Macías-Robles AP, Ambriz-Moreno MJ, Azamar-Jácome AA, Báez-Loyola C, Beltrán-De Paz CY, Caballero-López C, Fernández de Córdova-Aguirre JC, Fernández-Soto R, Lozano-Sáenz JS, Oyoqui-Flores JJ, Osorio-Escamilla R, Ramírez F, Rivero-Yeverino D, Orozco-Martínez MS, Rojo-Gutiérrez MI, Martínez E, Medina-Ávalos MA. [GUIMIT 2019, Mexican Guideline on Immunotherapy. Guideline on the diagnosis of IgE-mediated allergic disease and immunotherapy following the ADAPTE approach]. ACTA ACUST UNITED AC 2020; 66 Suppl 1:1-105. [PMID: 31200597 DOI: 10.29262/ram.v66i5.631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND In Mexico, allergen immunotherapy (AIT) and immunotherapy with hymenoptera venom (VIT) is traditionally practiced combining aspects of the European and American school. In addition, both types of extracts (European and American) are commercially available in Mexico. Moreover, for an adequate AIT/VIT a timely diagnosis is crucial. Therefore, there is a need for a widely accepted, up-to-date national immunotherapy guideline that covers diagnostic issues, indications, dosage, mechanisms, adverse effects and future expectations of AIT (GUIMIT 2019). METHOD With nationwide groups of allergists participating, including delegates from postgraduate training-programs in Allergy/Immunology-forming, the guideline document was developed according to the ADAPTE methodology: the immunotherapy guidelines from European Academy of Allergy and Clinical Immunology, German Society for Allergology and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology were selected as mother guidelines, as they received the highest AGREE-II score among international guidelines available; their evidence conforms the scientific basis for this document. RESULTS GUIMIT emanates strong or weak (suggestions) recommendations about practical issues directly related to in vivo or in vitro diagnosis of IgE mediated allergic diseases and the preparation and application of AIT/VIT and its adverse effects. GUIMIT finishes with a perspective on AIT modalities for the future. All the statements were discussed and voted on until > 80 % consensus was reached. CONCLUSIONS A wide and diverse group of AIT/VIT experts issued transculturized, evidence-based recommendations and reached consensus that might improve and standardize AIT practice in Mexico.
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Arias-Cruz A, González-Díaz SN, Macías-Weinmann A, Ibarra-Chávez JA, Sánchez-Guerra D, Leal-Villarreal L, Salinas-Díaz MR. [Quality of life in chronic urticaria and its relationship with economic impact and disease control in patients attended to at the University Hospital of Monterrey, Mexico]. ACTA ACUST UNITED AC 2019; 65:250-258. [PMID: 30176203 DOI: 10.29262/ram.v65i3.398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic urticaria (CU) manifests itself with hives and sometimes angioedema. Physical and social discomfort worsens patient quality of life. CU has an important impact on patients' economy. OBJECTIVE To evaluate the relationship of quality of life (QoL) with economic burden and chronic urticaria control of in patients treated at our center. METHODS Cross-sectional, descriptive, observational study. We included CU-diagnosed adult patients. The CU-Q2oL and UCT questionnaires in Spanish and the economic burden and comorbidities questionnaire developed by our center were applied. A sample size of 36 patients was calculated. RESULTS 36 patients were included, out of which 58.3% were females. Mean age was 39.9 ± 15.6 years. Regarding QoL, 66.7% of patients reported being "A little" affected, 25% "Somewhat" and 8.3% "A lot", and its relationship with monthly income yielded a p-value of 0.017. 38.9% of patients reported having a monthly income of less than $ 5000 pesos. When disease control was compared with the CU-Q2oL, a significant difference was obtained for questions concerning itching. CONCLUSION There was association between the quality of life of patients with chronic urticaria and monthly income, the lower the income, the more will the quality of life be affected. Furthermore, greater CU control was observed to reduce the negative effects on quality of life caused by itching.
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Affiliation(s)
- Alfredo Arias-Cruz
- Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Centro Regional de Alergia e Inmunología Clínica, Monterrey, Nuevo León, México.
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González-Díaz SN, Arias-Cruz A, Villarreal-Pérez JZ, Sánchez-Guerra D, Monge-Ortega OP. [Evaluation of vitamin D serum levels in asthmatic adults and their relationship with asthma control]. ACTA ACUST UNITED AC 2019; 65:362-371. [PMID: 30602206 DOI: 10.29262/ram.v65i4.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Decreased levels of vitamin D influence on the control and severity of asthma. OBJECTIVE To evaluate the relationship between vitamin D serum levels and asthma control, as well as nutritional status, quality of life and patient comorbidities. METHODS Cross-sectional, observational, descriptive study of 43 asthmatic patients older than 18 years of age. Multiple logistic and multiple linear regression multivariate analyses of variance were performed; a p-value ≤ 0.05 was considered to be statistically significant. RESULTS Insufficient vitamin D levels were determined in 83.7 % of patients; 93 % had at least one asthma exacerbation in the previous year. There was no relationship between vitamin D serum levels and asthma control as measured by ACT and FEV1. There was a significant association between body mass index and vitamin D levels (p = 0.013). With a quality of life questionnaire for asthmatic adults, 76.7 % were recorded to have a poor quality of life. CONCLUSIONS No relationship was observed between vitamin D serum levels and asthma control in the patients. Most patients had insufficient vitamin D serum levels, uncontrolled asthma, and poor quality of life. Overweight and grade I obesity were associated with vitamin D insufficient levels.
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Affiliation(s)
- Sandra Nora González-Díaz
- Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Centro Regional de Alergia e Inmunología Clínica, Monterrey, México.
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González-Díaz SN, Partida-Ortega AB, Macías-Weinmann A, Arias-Cruz A, Galindo-Rodríguez G, Hernández-Robles M, Ibarra-Chávez JA, Monge-Ortega OP, Ramos-Valencia L, Macouzet-Sánchez C. [Evaluation of functional capacity by 6-minute walk test in children with asthma]. ACTA ACUST UNITED AC 2019; 64:415-429. [PMID: 29249104 DOI: 10.29262/ram.v64i4.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Asthma patients show lower exercise tolerance. OBJECTIVE Assessment of functional capacity in children with asthma. METHODS Girls and boys from 6 to 17 years old were included in two groups: asthmatic patients and healthy subjects. PSPQ was applied and vital signs, peak expiratory flow and Modified Borg Dyspnea Scale were measured at the beginning and the end of 6MWD. RESULTS Participants included 58 subjects, including 32 asthmatic patients, and 55.2 % male subjects. Mean age: 10.6 years ± 3.1. Asthmatic group: mean distance covered in meters 456.04 ± 54.05, meters covered by gender 456.31 ± 48.73 male and 455.74 ± 61.29 female (p = 0.28). Control group: the mean was 468.28 ± 54.52 meters, meters covered by gender 465.98 ± 58.04 male, 471.44 ± 51.95 female (p = 0.35). The difference between asthmatic group and control group was 12.24 meters in favor of control group (p = 0.378). There was no association between body mass index (BMI) and distance covered (p = 0.53), but a Pearson correlation p = -0.445. In the male gender, CF was positively associated with self-perception in CAF variables: physical condition, physical attractiveness, strength (p = 0.04) and physical self-concept in general (p = 0.02). CONCLUSIONS There was no significant difference in the distance covered between the two groups. The main impact factor was the body mass index with an inverse relation to the distance. Males had better physical self-perception, which is positively associated with CF.
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Affiliation(s)
- Sandra Nora González-Díaz
- Universidad Autónoma de Nuevo León, Centro Regional de Alergia e Inmunología Clínica, Monterrey, Nuevo León, México.
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Cardona V, Álvarez-Perea A, Ansotegui IJ, Arias-Cruz A, González-Díaz SN, Latour-Staffeld P, Ivancevich JC, Sánchez-Borges M, Serrano C, Solé D, Tanno LK. [Management of anaphylaxis in Latin America: current situation]. ACTA ACUST UNITED AC 2019; 64:171-177. [PMID: 28658725 DOI: 10.29262/ram.v64i2.250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anaphylaxis is a systemic and severe allergic reaction, which can be fatal. The first-line treatment of choice, according to international guidelines, is intramuscular adrenaline. However, different studies show that the performance of health professionals managing anaphylaxis is often inadequate. OBJECTIVE To assess the current resources available in Latin American countries for the diagnosis and treatment of anaphylaxis. METHODS Online survey promoted by the Latin American Society of Allergy and Immunology to representatives of the national allergy societies of Latin American countries. RESULTS Responses were received from 10 countries out of the 14 countries invited to participate. Only five of the countries have clinical practice guidelines in anaphylaxis. Adrenaline autoinjectors are available only in two countries, Argentina and Brazil, but are not subsidized by public health systems. In all countries, adrenaline is available in ampoules, which is the presentation usually prescribed to patients for self-administration. The use of adrenaline was estimated to be less than 50 % of cases in five countries, while antihistamines and corticosteroids are almost always used. The determination of serum tryptase is possible in some health centers, often private, in five of the countries surveyed. CONCLUSION It is necessary to improve resources related to the diagnosis and management of anaphylaxis in Latin American countries.
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Affiliation(s)
- Victoria Cardona
- Hospital Vall d'Hebron, Servicio de Medicina Interna, Sección de Alergia. Barcelona, España.
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González-Díaz SN, Arias-Cruz A, Monge-Ortega OP. Adverse immune reactions and non-immune medications for perioperative use. ACTA ACUST UNITED AC 2019; 66:99-114. [PMID: 31013411 DOI: 10.29262/ram.v66i1.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Reactions to medications can occur through a mechanism mediated by immunoglobulin or otherwise, not both. Drug allergy is a type of adverse reaction to the drug and comprises a range of hypersensitivity reactions mediated by different immunological mechanisms with diverse clinical manifestations. A rate of 3.2 fatal cases of anaphylaxis associated with drugs per 100,000 inhabitants per year is estimated, which seems to be approximately 10 times higher in hospitalized patients. The incidence of perioperative anaphylactic reactions is estimated at 1 in 10,000-20,000 anesthetic procedures. The diagnosis is based on a careful clinical history and physical examination. In some cases, skin tests, progressive challenges and methods to induce tolerance to the medication may be required. In hospitalized patients and at perioperative intervals, muscle relaxants, neuroleptics and morphinomimetics are frequently used and adverse reactions may occur to these drugs. This review shows a general description of the reactions of these medications, emphasizes allergic reactions and analyzes strategies for the diagnosis and treatment of these reactions.
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Affiliation(s)
- Sandra Nora González-Díaz
- Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Centro Regional de Alergia e Inmunología Clínica, Monterrey, Nuevo León, México.
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Gonzalez RV, Gonzalez-Diaz S, Arias-Cruz A, Macias-Weinmann A, De Lira-Quezada C. SUCCESSFUL RAPID TOCILIZUMAB DESENSITIZATION IN A PATIENT WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gonzalez-Diaz S, Arias-Cruz A, De Lira-Quezada C, Gonzalez DR, Escalante G, Cotaya RG, Mares-Gil J, González-Llano O. ACQUIRED HYPERSENSITIVITY TO EGG FOLLOWING AUTOLOGOUS STEM CELL TRANSPLANTATION. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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De Lira-Quezada C, Macias-Weinmann A, Gonzalez-Diaz S, Arias-Cruz A, Gonzalez RV, Gomez IP, Ramirez-Rodriguez R. EARLY AND DELAYED HYPERSENSITIVITY REACTIONS TO PACLITAXEL: DESENSITIZATION AS A CHALLENGE. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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González-Díaz SN, Arias-Cruz A, Ibarra-Chávez JA, Elizondo-Villarreal B, Rivero-Arias DM, Salinas-Díaz MR. [Prevalence of sensitization to fungi in patients with respiratory allergy]. ACTA ACUST UNITED AC 2018; 63:143-53. [PMID: 27174757 DOI: 10.29262/ram.v63i2.161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND As part of the etiology of respiratory allergy we have genetics, prenatal factors and sensitivity to various airborne allergens, between these fungi are found. Relationship has been found between sensitization to fungal in skin tests and allergy pathogenesis and aggravation. There is a few literature in Mexico and in the north of the country it is lacking regarding this problem. OBJECTIVE Assess the prevalence of sensitization to fungi in patients with respiratory allergy in skin tests to airborne allergens; determine the most prevalent fungus and prevalence of sensitization to each species of fungus per year, to assess the prevalence of sensitization to fungi by years. MATERIAL AND METHOD Cross-sectional, observational and descriptive study conducted from 1 January 2010 to 31 December 2014 in patients treated at the Regional Center of Allergy and Clinical Immunology (Monterrey, Mexico) where we reviewed a database with patients whom performed skin tests, sensitization to 6 species of fungi were evaluated. We performed tables of data capture and statistical analysis. RESULTS 4880 patients had respiratory allergy, a 17.1% prevalence of sensitization to fungal skin tests was determined. The fungus specie most prevalent was Alternaria alternata with 5.5%. The year range with the highest prevalence of sensitization was 0-10 years with a 6.7. CONCLUSIONS The prevalence of fungi sensitization was higher than the global prevalence found, but lower than the prevalence found in other researches in Mexico.
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Affiliation(s)
- Sandra Nora González-Díaz
- Centro Regional de Alergia e Inmunología Clínica, Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
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Guzman-Avilan R, Guzman-Avilan K, Gonzalez-Diaz S, Arias-Cruz A, Elizondo-Villarreal B. P114 Measurement of exhaled breath fraction temperature in patients evaluation with respiratory allergy. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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DeLira-Quezada C, Gonzalez-Diaz S, Arias-Cruz A, Gonzalez RV. P046 Rapid oral tolerance induction protocol to trimetoprim and sulfametoxazol in a patient with HIV. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gonzalez-Diaz S, Arias-Cruz A, Macias-Weinmann A, Garza LR, Gonzalez DR, Gomez IP. P185 Positive autologous serum and plasma skin test prevalence in individuals with chronic idiopathic urticaria. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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González-Díaz SN, Arias-Cruz A, Elizondo-Villarreal B, Monge-Ortega OP. Psychoneuroimmunoendocrinology: clinical implications. World Allergy Organ J 2017; 10:19. [PMID: 28616124 PMCID: PMC5460476 DOI: 10.1186/s40413-017-0151-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 04/18/2017] [Indexed: 12/21/2022] Open
Abstract
Psychoneuroimmunoendocrinology, which was first described in 1936, is the study of the interactions between the psyche, neural and endocrine functions and immune responses. The aim of psychoneuroimmunoendocrinology is to apply medical knowledge to the treatment of different allergic, immune, autoimmune, rheumatic, neoplastic, endocrine, cardiovascular and dental pathologies, among other disorders. Epigenetic factors and major stresses from different types of stimuli acting through distinct pathways and neurotransmitters are highly involved in altering the psychoneuroimmunoendocrine axis, resulting in the emergence of disease. The main purpose of this report is to expand the understanding of psychoneuroimmunoendocrinology and to demonstrate the importance of the above-mentioned interactions in the etiology of multiple pathologies. In this review, a search of the medical literature using PubMed (free access search engine for the Medline database of the National Library of Medicine of the United States) over the years 1936 to 2016 was conducted, and descriptive and experimental studies and reviews of the scientific literature were included.
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Affiliation(s)
- Sandra Nora González-Díaz
- Department of Allergy and Clinical Immunology Service, University Hospital "Dr. José Eleuterio González" Autonomous University of Nuevo Leon (UANL), Monterrey, Nuevo León 64460 Mexico
| | - Alfredo Arias-Cruz
- Department of Allergy and Clinical Immunology Service, University Hospital "Dr. José Eleuterio González" Autonomous University of Nuevo Leon (UANL), Monterrey, Nuevo León 64460 Mexico
| | - Bárbara Elizondo-Villarreal
- Department of Allergy and Clinical Immunology Service, University Hospital "Dr. José Eleuterio González" Autonomous University of Nuevo Leon (UANL), Monterrey, Nuevo León 64460 Mexico
| | - Olga Patricia Monge-Ortega
- Department of Allergy and Clinical Immunology Service, University Hospital "Dr. José Eleuterio González" Autonomous University of Nuevo Leon (UANL), Monterrey, Nuevo León 64460 Mexico
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Macouzet-Sánchez C, Gonzalez-Diaz S, Arias-Cruz A, Ibarra-Chávez J. P054 Differences in sensitization to pollen in adults and children with respiratory allergy in northeastern mexico. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ortega AP, Gonzalez-Diaz S, Arias-Cruz A, Macias-Weinmann A, Monge-Ortega O, Ibarra-Chávez J, Macouzet-Sánchez C, Ramos Valencia L, De Lira Quezada C, Guzman R. P138 Evaluation of functional capacity by six-minute walk test in pediatric asthma patients. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ochoa Montemayor M, Gonzalez-Diaz S, Arias-Cruz A, Macias-Weinmann A, Sánchez-Guerra D. P053 Prevalence of food allergen sensitization in patients with mugwort allergy. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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González-Díaz SN, Arias-Cruz A, Rivero-Arias DM, Partida-Ortega AB, Elizondo-Villarreal B, Ibarra-Chávez JA, Ramos-Valencia L, Monge-Ortega OP, Macouzet-Sánchez C, Salinas-Díaz MR. [Cross-reactivity in allergic fungal sinusitis. Case report]. ACTA ACUST UNITED AC 2016; 63:316-9. [PMID: 27560920 DOI: 10.29262/ram.v63i3.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The presence of allergic mucin in allergic fungal sinusitis (AFS) is a manifestation that identifies it as a hypersensitivity process. AFS has a phenomenon of cross-reactivity to IgE-bound proteins having at least two shared epitopes. CLINICAL REPORT A 13-year-old male with nasal obstructive symptoms of three years of evolution. An obstructive mass was identified in the sinuses through physical examination and CT. In endoscopic surgery, the left nostril polyp was identified with the macroscopic appearance of allergic mucin; the polyp was resected. Final histopathological examination using periodic acid-Schiff and Grocott's methenamine silver staining indicated Aspergillus. Two weeks after surgery, percutaneous tests showed sensitization to Alternaria, Helminthosporium sativum, and Deramatophagoides farianae with negativity to Aspergillus fumigatus. CONCLUSIONS The absence of significant titers of specific IgE antibodies to Aspergillus fumigatus was the evidence that the hypersensitivity response was triggered by a pathogen other than that isolated in histopathological study, which coupled with positive tests for other fungi may be explained by the cross-reactivity phenomenon in a phenomenon of likely hypersensitivity.
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Affiliation(s)
- Sandra Nora González-Díaz
- Universidad Autónoma de Nuevo León. Centro Regional de Alergia e Inmunología Clínica, Monterrey, Nuevo León, México.
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Elizondo-Villarreal B, Gonzalez-Diaz SN, Arias-Cruz A, Leal-Villarreal L, Del Carmen Zarate-Hernandez M, Rivero-Arias DM, Monge Ortega OP, Ibarra-Chavez JA. Prevalence of Sensitization to Mold Allergens in Patients with Respiratory Allergy. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jares EJ, Baena-Cagnani CE, Sánchez-Borges M, Ensina LFC, Arias-Cruz A, Gómez M, Cuello MN, Morfin-Maciel BM, De Falco A, Barayazarra S, Bernstein JA, Serrano C, Monsell S, Schuhl J, Cardona-Villa R. Drug-Induced Anaphylaxis in Latin American Countries. J Allergy Clin Immunol Pract 2015; 3:780-8. [PMID: 26143020 DOI: 10.1016/j.jaip.2015.05.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/03/2015] [Accepted: 05/04/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Information regarding the clinical features and management of drug-induced anaphylaxis (DIA) in Latin America is lacking. OBJECTIVE The objective of this study was to assess implicated medications, demographics, and treatments received for DIA in Latin American patients referred to national specialty centers for evaluation. METHOD A database previously used to compile information on drug-induced allergic reactions in 11 Latin American countries was used to identify and characterize patients presenting specifically with a clinical diagnosis of DIA. Information regarding clinical presentation, causative agent(s), diagnostic studies performed, treatment, and contributing factors associated with increased reaction severity was analyzed. RESULTS There were 1005 patients evaluated for possible drug hypersensitivity reactions during the study interval, and 264 (26.3%) met criteria for DIA. DIA was more frequent in adults and in elderly females (N = 129 [76.6%] and N = 30 [75%], respectively) compared with children and/or adolescents (N = 21 [42.9%], P < .01). Severe DIA was less frequent with underlying asthma (N = 22 vs 35 [38.6% vs 61.4%], P < .05) or atopy (N = 62 vs 71 [43% vs 59% ], P < .01). Nonsteroidal anti-inflammatory drugs (NSAIDs) (N = 178 [57.8%]), beta-lactam antibiotics (N = 44 [14.3%]), and other antibiotics (N = 16 [5.2%]) were the most frequently implicated drug classes. Anaphylaxis was rated as severe in N = 133 (50.4%) and anaphylactic shock (AS) was present in N = 90 (34.1%). Epinephrine was only used in N = 73 (27.6%) overall, but in N = 70 (77.8%) of patients with AS. CONCLUSION In Latin American patients referred for evaluation of DIA, NSAIDs and antibiotics were implicated in approximately 80% of cases. Most of these reactions were treated in the emergency department. Epinephrine was administered in only 27.6% of all cases, although more frequently for anaphylactic shock. Dissemination of anaphylaxis guidelines among emergency department physicians should be encouraged to improve management of DIA.
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Affiliation(s)
| | - Carlos E Baena-Cagnani
- Centro de Investigación en Medicina Respiratoria, Faculty of Medicine, Catholic University of Cordoba, Cordoba, Argentina
| | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico-Docente La Trinidad, Caracas, Venezuela
| | - Luis Felipe C Ensina
- Allergy, Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Alfredo Arias-Cruz
- Centro Regional de Alergia e Inmunología Clínica, Hospital Universitario, Monterrey, Mexico
| | | | - Mabel Noemi Cuello
- Allergy and Immunology Department, Consultorios San Juan, San Juan, Argentina
| | | | - Alicia De Falco
- Allergy and Clinical Immunology, Universidad Nacional de La Plata, La Plata, Argentina
| | | | - Jonathan A Bernstein
- Department of Internal Medicine and Division of Immunology/Allergy Section, University of Cincinnati, Cincinnati, Ohio
| | | | - Silvana Monsell
- Allergy Unit, CMP S.A., Libra Foundation, Buenos Aires, Argentina
| | - Juan Schuhl
- Allergy Unit, Hospital Britanico, Montevideo, Uruguay
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Larenas-Linnemann D, Michels A, Dinger H, Arias-Cruz A, Ambriz Moreno M, Bedolla Barajas M, Javier RC, Cid Del Prado MDLL, Cruz Moreno MA, Vergara LD, García Almaráz R, García-Cobas CY, Garcia Imperial DA, Muñoz RG, Hernandez Colín D, Linares Zapien FJ, Luna Pech JA, Matta Campos JJ, Martinez Jimenez N, Avalos MM, Medina Hernandez A, Maldonado AM, López DN, Pizano Nazara LJ, Sanchez ER, Ramos López JD, Rodriguez-Pérez N, Rodriguez Ortiz PG, Shah-Hosseini K, Mösges R. In the (sub)tropics allergic rhinitis and its impact on asthma classification of allergic rhinitis is more useful than perennial-seasonal classification. Am J Rhinol Allergy 2015; 28:232-8. [PMID: 24980234 DOI: 10.2500/ajra.2014.28.4035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Two different allergic rhinitis (AR) symptom phenotype classifications exist. Treatment recommendations are based on intermittent-persistent (INT-PER) cataloging, but clinical trials still use the former seasonal AR-perennial AR (SAR-PAR) classification. This study was designed to describe how INT-PER, mild-moderate/severe and SAR-PAR of patients seen by allergists are distributed over the different climate zones in a (sub)tropical country and how these phenotypes relate to allergen sensitization patterns. METHODS Six climate zones throughout Mexico were determined, based on National Geographic Institute (Instituto Nacional de Estadística y Geografía) data. Subsequent AR patients (2-68 years old) underwent a blinded, standardized skin-prick test and filled out a validated questionnaire phenotyping AR. RESULTS Five hundred twenty-nine subjects participated in this study. In the tropical zone with 87% house-dust mite sensitization, INT (80.9%; p < 0.001) and PAR (91%; p = 0.04) were more frequent than in the subtropics. In the central high-pollen areas, there was less moderate/severe AR (65.5%; p < 0.005). Frequency of comorbid asthma showed a clear north-south gradient, from 25% in the dry north to 59% in the tropics (p < 0.005). No differences exist in AR cataloging among patients with different sensitization patterns, with two minor exceptions (more PER in tree sensitized and more PAR in mold positives; p < 0.05). CONCLUSION In a (sub)tropical country the SAR-PAR classification seems of limited value and bears poor relation with the INT-PER classification. INT is more frequent in the tropical zone. Because PER has been shown to relate to AR severity, clinical trials should select patients based on INT-PER combined with the severity cataloging because these make for a better treatment guide than SAR-PAR.
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Yong-Rodríguez A, Macías-Weinmann A, Palma-Gómez S, Arias-Cruz A, Pérez-Vanzzini R, Gutiérrez-Mujica JJ, González-Díaz SN. Perfil de sensibilización a alergenos en niños con dermatitis atópica atendidos en el Servicio de Alergología del Hospital Universitario de la Universidad Autónoma de Nuevo León, México. RAM 2015. [DOI: 10.29262/ram.v62i2.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introducción. La sensibilización a alérgenos observada en la dermatitis atópica aumenta el riesgo del niño a padecer de rinitis alérgica y asma. Estudios recientes indican que entre mayor actividad de proteasas haya en los alérgenos a los que se está sensibilizado hay un mayor defecto en la barrera cutánea y una mayor gravedad de la enfermedad.Métodos. Revisamos los reportes de las pruebas cutáneas por “prick” realizadas en nuestro servicio a niños de 5 meses a 16 años de edad, con diagnóstico de dermatitis atópica, durante el periodo de enero de 2012 a enero de 2014. Evaluamos la frecuencia de sensibilización a aeroalérgenos y alimentos, así como el tamaño de la roncha en la respuesta cutánea para cada alérgeno en particular.Resultados. Se incluyeron los reportes de pruebas cutáneas de 66 niños, 30 hombres y 36 mujeres. Cuarenta y seis pacientes (69%) estaban sensibilizados a aeroalérgenos y 38 (58%) a alimentos. Los ácaros del polvo de casa (Dermatophagoides pteronyssinus/Dermatophagoides farinae) fueron los alérgenos con mayor frecuencia de respuesta positiva en las pruebas cutáneas. De los niños con sensibilización a alimentos, solo los niños sensibilizados a la leche de vaca, el huevo y al pescado tuvieron una roncha mayor de 6 mm de diámetro.Conclusión. En los niños con dermatitis atópica es común la sensibilización a aeroalérgenos con un alta actividad de proteasas y la polisensibilización es muy común. La sensibilización a alimentos es común en estos pacientes, pero solo un pequeño porcentaje de ellos muestra respuestas cutáneas lo suficientemente grandes para relacionarlas con gravedad de la enfermedad.
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Yong-Rodríguez A, Macías-Weinmann A, Palma-Gómez S, Arias-Cruz A, Pérez-Vanzzini R, Gutiérrez-Mujica JJ, González-Díaz SN. [Profile of sensitization to allergens in children with atopic dermatitis assisting to Allergology Service of University Hospital, Nuevo Leon, Mexico]. Rev Alerg Mex 2015; 62:98-106. [PMID: 25958372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Sensitization to allergens in atopic dermatitis patients is a risk factor for developing asthma and allergic rhinitis in the future,as well as an aggravating factor in the course of the disease. Recent studies have attributed the activity of the proteases of some antigens to cause a grater defect in the epithelial barrier and a more severe disease. OBJECTIVE To know the sensitization to allergens pattern in children with atopic dermatitis attended at Allergology Service of University Hospital of UANL, Mexico, and to know if these children have higher sensitization to antigens with proteolytic activity. MATERIAL AND METHOD A retrospective study was done reviewing the skin prick test reports done in our service to children ranging from 5 months to 16 years old, diagnosed with atopic dermatitis during a period of 2 years, from January 2012 to January 2014. The frequency of sensitization to aeroallergens and food were analyzed as well as the weal size (≥6mm) on the skin in response to each particular allergen in the case of food skin prick test. RESULTS Reports of skin tests of 66 children, 30 boys and 36 girls, were included; 37 of children were sensitized to more than one allergen,18/66 had asthma and/or allergic rhinitis, 40/66 60% skin prick tests were positive to high activity protease aeroallergens (Dermatophagoides pteronyssinus/Dermatophagoides farinae). Regarding food, sensitization was seen in 38 children; fruits and vegetables were the two most common foods. Only seven children had skin prick weal bigger than 6 mm, mainly to egg, fish and cow's milk. CONCLUSIONS Children with atopic dermatitis are often sensitized to high protease activity aeroallergens, polysensitization is very common and the association with airway allergy is seen early in life. Sensitization to food is also common in these patients, but only a small percentage showed a response large enough to be associated with disease severity.
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Affiliation(s)
- Adrián Yong-Rodríguez
- Centro Regional Alergología e Inmunología Clínica (CRAIC), Hospital Universitario, Monterrey, Nuevo León, México.
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González-Díaz SN, Palma-Gómez S, Pérez-Vanzzini R, Arias-Cruz A. Mastocitosis. RAM 2015. [DOI: 10.29262/ram.v62i1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
La mastocitosis es una de las ocho subcategorías de las neoplasias mieloproliferativas de la clasificación de tumores de tejidos linfoides y hematopoyéticos de 2008 de la Organización Mundial de la Salud; es un grupo heterogéneo de enfermedades mieloproliferativas que se distinguen por la proliferación excesiva de mastocitos morfológica e inmunofenotípicamente atípicos, además de la acumulación de estas células en uno o varios órganos o tejidos, incluidos la piel, la médula ósea, el hígado, el bazo y los ganglios linfáticos.
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Pérez-Vanzzini R, González-Díaz SN, Arias-Cruz A, Palma-Gómez S, Yong-Rodríguez A, Gutiérrez-Mujica JJ, García-Calderín D, Ibarra-Chávez JA. Hipersensibilidad a la picadura de mosquito manifestada como síndrome de Skeeter. RAM 2015. [DOI: 10.29262/ram.v62i1.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Las reacciones por picaduras de mosquito son reacciones inmunológicas con afectación de la hipersensibilidad mediada por IgE, IgG y linfocitos T. Éstas son frecuentes y van desde reacciones locales pequeñas o grandes, hasta reacciones alérgicas sistémicas. El síndrome de Skeeter es una reacción inflamatoria local grande inducida por la picadura de mosquito, en ocasiones acompañada de síntomas sistémicos como fiebre y vómito. El diagnóstico se basa en la historia clínica y la exploración física, con el apoyo de la identificación de IgE específica mediante pruebas cutáneas. El tratamiento consiste en la prevención de picaduras, administración de antihistamínicos y, en algunos casos, de esteroides. La inmunoterapia específica aún requiere mayor estudio. Comunicamos dos casos de pacientes que manifestaron reacciones de hipersensibilidad a la picadura de mosquito, que fueron evaluados en nuestro centro con pruebas cutáneas positivas.
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Rodriguez AY, Gonzalez-Diaz SN, Macias-Weinmann A, Arias-Cruz A, Gomez SP, Perez-Vanzzini R, Gutierrez-Mujica JJ. Sensitization to Food and Spt Wheal Magnitud Among Children Attending to an Allergy Service in a Major Mexican City Near the United States. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pérez-Vanzzini R, González-Díaz SN, Arias-Cruz A, Palma-Gómez S, Yong-Rodríguez A, Gutiérrez-Mujica JJ, García-Calderín D, Ibarra JA. [Hypersensitivity to mosquito bite manifested as Skeeter síndrome]. Rev Alerg Mex 2015; 62:83-87. [PMID: 25758116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
The reactions to mosquito bites are immunological reactions with involvement of IgE, IgG and T cells mediated hypersensitivity. These reactions are common and range from small local reactions, large local reactions to systemic allergic reactions. Skeeter syndrome is defined as a large local induced inflammatory reaction to mosquito bite and sometimes accompanied by systemic symptoms such as fever and vomiting. Diagnosis is based on clinical history and physical examination, supported by the identification of specific IgE by skin testing. Treatment includes prevention, antihistamines and steroids in some cases. Specific immunotherapy still requires further study. This paper reports two cases of patients with hypersensitivity reactions to mosquito bites, which were evaluated in our center presenting positive skin tests.
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Affiliation(s)
- Rafael Pérez-Vanzzini
- Centro Regional de Alergia e Inmunología Clínica, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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González-Díaz SN, Palma-Gómez S, Pérez-Vanzzini R, Arias-Cruz A. [Mastocytosis]. Rev Alerg Mex 2015; 62:60-74. [PMID: 25758114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Mastocytosis is one of the eight subcategories of the myeloproliferative neoplasms of the classification of lymphoid and hematopoietic tissues' tumors of 2008 of World Health Organization; it is an heterogeneous group of myeloproliferative diseases characterized by the excessive proliferation of atypical mastocytes in morphological and immunophenotype terms, besides the cumulus of these cells in one or several organs or tissues, including skin, bone marrow, liver, spleen and lymph nodes.
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Affiliation(s)
- Sandra Nora González-Díaz
- Centro Regional de Alergología e Inmunología Clínica, Hospital Universitario Dr. José Eleuterio González, Monterrey, Nuevo León, México.
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Arias-Cruz A, González-Díaz SN, Jares EJ. Professor Carlos E. Baena-Cagnani. Medicina Universitaria 2015. [DOI: 10.1016/j.rmu.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Larenas-Linnemann D, Mayorga-Butrón JL, Sánchez-González A, Ramírez-García A, Medina-Ávalos MA, Figueroa-Morales MA, Montes-Narváez G, Romero-Tapia SJ, Stone-Aguilar H, Xochihua-Díaz L, Salas-Hernández J, Hernán-Ruiz H, Betancourt-Suárez MA, Cano-Salas MDC, Curiel-Aceves L, Dibildox-Martínez J, Fernández-Vega M, García-Bolaños C, Iduñate-Palacios F, Jiménez-Chobillon MA, López-Lizárraga DN, Matta-Campos JJ, Olvera-Salinas J, Rivera-Gómez MA, Virgen-Ortega C, Sienra-Monge JJL, Del Río-Navarro BE, Arias-Cruz A, Sacre-Hazouri JA, Aguilar-Aranda A, Vásquez del Mercado-Cordero R, Barnica-Alvarado RH, Velasco-Hidalgo L, Solís-Galicia C. ARIA México 2014. Adaptación de la Guía de Práctica Clínica ARIA 2010 para México. Metodología ADAPTE. RAM 2014. [DOI: 10.29262/ram.v61i0.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Antecedentes: la prevalencia de rinitis alérgica en todo el mundo es alta. El Estudio Internacional de Asma y Alergias en la Niñez (ISAAC de International Study of Asthma and Allergies in Childhood) Fase III reporta una prevalencia estimada total en México de 4.6%. Existen guías de práctica clínica basadas en evidencia de rinitis alérgica, pero su promoción, aceptación y validez no son óptimas ni adecuadas para México.Objetivo: generar una guía de tratamiento de la rinitis alérgica y su repercusión en el asma adaptando la guía ARIA 2010 a la realidad mexicana mediante un proceso de transculturización, por medio de la metodología ADAPTE.Material y método: a través de la metodología ADAPTE un grupo de desarrollo de la guía, integrado por múltiples especialistas que tratan pacientes con rinitis alérgica, valoró la calidad de la guía ARIA 2010, revisó y tradujo las preguntas clínicas clave y ajustó las recomendaciones, preferencias del paciente y comentarios a la realidad mexicana (seguridad, costos y aspectos culturales). Para lograrlo se corrieron páneles Delphi, con tantas rondas como fuera necesario hasta lograr un acuerdo. Por medio de una revisión sistemática de la bibliografía se creó una pregunta especial no incluida en ARIA 2010 de la utilidad de realizar lavados nasales en pacientes con rinitis alérgica.Resultados: se incluyeron 45 preguntas de la guía original ARIA 2010, divididas en seis bloques que abarcan prevención, tratamiento médico, inmunoterapia y terapias alternativas de pacientes con rinitis alérgica con o sin asma. La mayor parte de las preguntas alcanzaron acuerdo en una a dos rondas, sólo una requirió tres para ello.Conclusiones: se cuenta ahora con una guía de rinitis alérgica de uso sencillo, adaptada, actualizada y válida para México.
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Palma-Gómez S, González-Díaz SN, Arias-Cruz A, Macías-Weinmann A, Amaro-Vivian LE, Pérez-Vanzzini R, Gutiérrez-Mujica JJ, Yong-Rodríguez A. [Adverse reaction to not iodinated contrast]. Rev Alerg Mex 2014; 61:368-371. [PMID: 25473874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Adverse reactions to drugs are relatively frequent in clinical practice, and some of them can be life threatening. Reactions to contrast material (CM) represent an important percentage of these adverse reactions. It has been found that 70% of reactions to contrast material happen within the first five minutes of their administration. Despite the fact that hypersensitivity reactions are traditionally classified as non-allergic, in recent years investigators have reported positive skin prick tests in patients with immediate and late reactions to contrast material. This paper reports the case of a female patient with non-Hodgkin lymphoma that has presented on two distinct occasions adverse reactions to contrast material. We discuss on the type of reaction, severity, suggested prophylaxis, prognosis and recommendations, keeping in mind the underlying disease and the need to have further image studies performed.
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Affiliation(s)
- Samuel Palma-Gómez
- Centro Regional Alergología e Inmunología Clínica (CRAIC), Hospital Universitario, Monterrey, Nuevo León, México.
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Palma-Gómez S, González-Díaz SN, Arias-Cruz A, Macías-Weinmann A, Amaro-Vivian LE, Pérez-Vanzzini R, Gutiérrez-Mujica JJ, Yong-Rodríguez A. Reacción adversa a contraste no iodado. RAM 2014. [DOI: 10.29262/ram.v61i4.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Las reacciones adversas a medicamentos son relativamente frecuentes en la práctica clínica y algunas ponen en riesgo la vida. Las reacciones al medio de contraste representan un porcentaje importante de esas reacciones adversas. Se ha encontrado que 70% de las reacciones adversas a los medios de contraste iodados ocurren en los primeros cinco minutos tras su administración. A pesar de que las reacciones de hipersensibilidad inducidas por contraste tradicionalmente se clasifican como no alérgicas, en los últimos años los investigadores han reportado pruebas por punción positivas en pacientes con reacciones inmediatas como tardías. Se reporta el caso de una paciente con linfoma no Hodgkin que ha tenido en dos ocasiones reacciones adversas al contraste. Se comenta el tipo de reacción, la gravedad, el tratamiento profiláctico sugerido, pronóstico y recomendaciones, tomando en cuenta el padecimiento subyacente y la necesidad de hacer nuevos estudios de imagen.
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Jares EJ, Sánchez-Borges M, Cardona-Villa R, Ensina LF, Arias-Cruz A, Gómez M, Barayazarra S, Bernstein JA, Serrano CD, Cuello MN, Morfin-Maciel BM, De Falco A, Cherrez-Ojeda I. Multinational experience with hypersensitivity drug reactions in Latin America. Ann Allergy Asthma Immunol 2014; 113:282-9. [PMID: 25065979 DOI: 10.1016/j.anai.2014.06.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/21/2014] [Accepted: 06/22/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND Epidemiologic drug allergy data from Latin America are scarce, and there are no studies on specific procedures focusing on this topic in Latin America. OBJECTIVE To assess the clinical characteristics and management of hypersensitivity drug reactions in different Latin American countries. METHODS An European Network of Drug Allergy questionnaire survey was implemented in 22 allergy units in 11 Latin American countries to report on consecutive patients who presented with a suspected hypersensitivity drug reaction. Each unit used its own protocols to investigate patients. RESULTS Included were 868 hypersensitivity drug reactions in 862 patients (71% of adults and elderly patients were women and 51% of children were girls, P = .0001). Children presented with less severe reactions than adults and elderly patients (P < .0001). Urticaria and angioedema accounted for the most frequent clinical presentations (71%), whereas anaphylaxis was present in 27.3% of cases. There were no deaths reported. Nonsteroidal anti-inflammatory drugs (52.3%), β-lactam antibiotics (13.8%), and other antibiotics (10.1%) were the drugs used most frequently. Skin prick tests (16.7%) and provocation tests (34.2%) were the study procedures most commonly used. A large proportion of patients were treated in the emergency department (62%) with antihistamines (68%) and/or corticosteroids (53%). Only 22.8% of patients presenting with anaphylaxis received epinephrine. CONCLUSION Nonsteroidal anti-inflammatory drugs and antibiotics were the drugs used in at least 75% of patients. More than half the reactions were treated in the emergency department, whereas epinephrine was administered in fewer than 25% of patients with anaphylaxis. Dissemination of guidelines for anaphylaxis among primary and emergency department physicians should be encouraged.
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Affiliation(s)
| | | | | | - Luis Felipe Ensina
- Universidade de Santo Amaro and Universidade Federal de São Paulo, Sao Paulo, Brazil
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Palma-Gómez S, González-Díaz SN, Arias-Cruz A, Macías-Weinmann A, Amaro-Vivian LE, Pérez-Vanzzini R, Gutiérrez-Mujica JJ, Yong-Rodríguez A. [Effects of reforestation on tree pollen sensitization in inhabitants of Nuevo Leon, Mexico]. Rev Alerg Mex 2014; 61:162-167. [PMID: 25177852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Climate change has implications for health, ecology and society. Urban green areas are a key element in the planning of cities, promoting citizen interaction with the environment, as well as health. Lack of planning and design of these areas as well as the selection of ornamental trees can be a trigger of pollen allergy in the surrounding population. Reforestation is among the programs implemented by the government that have an impact on allergy. Environmental reforestation programs do not take into account the allergenic potential of some species. In the last 4 years, the government of Nuevo Leon, Mexico, has planted nearly 18,000 Quercus species trees, in addition to an unknown number of Fraxinus species trees that are listed as tree species with high pollen production. OBJECTIVE To identify changes in tree pollen sensitization, based on environmental reforestation programs. MATERIAL AND METHOD A retrospective and descriptive study was done in which positive skin prick tests to pollen from trees in the interval of 2010-2014 were analyzed, correlating between tree species used for reforestation and increased sensitivity to the former. RESULTS A statistically significant increase in pollen sensitization to species with which Nuevo Leon was reforested was found, along with a decrease in sensitization to the species that were not reforested. CONCLUSIONS Reforestation contributes to some extent to the change in the pattern of positive skin tests and may result in more frequent exacerbations of respiratory diseases. It is an activity that should always be regulated and assisted by experts in the according field.
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Affiliation(s)
- Samuel Palma-Gómez
- Centro Regional de Alergología e Inmunología Clínica (CRAIC), Hospital Universitario, Monterrey, Nuevo León, México.
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Palma-Gómez S, González-Díaz SN, Arias-Cruz A, Macías-Weinmann A, Amaro-Vivian LE, Pérez-Vanzzini R, Gutiérrez-Mujica JJ, Yong-Rodríguez A. Efectos de la reforestación en la sensibilización al polen de árboles en habitantes de Nuevo León, México. RAM 2014. [DOI: 10.29262/ram.v61i3.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Antecedentes: el cambio climático tiene consecuencias en la salud, el medio ambiente y la sociedad. Las áreas verdes urbanas son importantes en la planeación de las ciudades para promover la interacción de los ciudadanos con el ambiente y la salud. La falta de planeación y diseño de estas áreas y la mala selección de árboles han contribuido a aumentar la incidencia de alergia al polen entre la población. Con frecuencia los programas de reforestación ambiental no toman en cuenta el potencial alergénico de algunas especies. El gobierno de Nuevo León en los últimos cuatro años ha plantado cerca de 18 mil árboles de la especie Quercus, además de un número indeterminado de árboles de la especie Fraxinus, cuyo polen es alergénico.Objetivos: identificar el cambio en la sensibilización al polen de árboles de acuerdo con los programas de reforestación ambiental.Material y método: estudio restrospectivo y descriptivo en el que se analizaron las pruebas cutáneas positivas para polen de árboles de los últimos cuatro años, correlacionando entre la especie de árbol utilizada para la reforestación y el aumento de la sensibilidad a ésta.Resultados: se encontró un incremento estadísticamente significativo en la sensibilización al polen de las especies con las que se reforestó Nuevo León, además de disminución en la sensibilización a las especies con las que no se reforesta.Conclusión: la reforestación contribuye, en cierta medida, al cambio en el patrón de la positividad de las pruebas cutáneas y puede traer como consecuencia exacerbaciones más frecuentes de enfermedades respiratorias. Es una actividad que debe ser regulada y asesorada siempre por expertos.
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Larenas-Linnemann D, Michels A, Dinger H, Shah-Hosseini K, Mösges R, Arias-Cruz A, Ambriz-Moreno M, Barajas MB, Javier RC, de la Luz Cid Del Prado M, Moreno MAC, Almaráz RG, García-Cobas CY, Garcia Imperial DA, Muñoz RG, Hernández-Colín D, Linares-Zapien FJ, Luna-Pech JA, Matta-Campos JJ, Jiménez NM, Medina-Ávalos MA, Hernández AM, Maldonado AM, López DN, Pizano Nazara LJ, Sanchez ER, Ramos-López JD, Rodríguez-Pérez N, Rodríguez-Ortiz PG. Allergen sensitization linked to climate and age, not to intermittent-persistent rhinitis in a cross-sectional cohort study in the (sub)tropics. Clin Transl Allergy 2014; 4:20. [PMID: 24976949 PMCID: PMC4073512 DOI: 10.1186/2045-7022-4-20] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 05/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Allergen exposure leads to allergen sensitization in susceptible individuals and this might influence allergic rhinitis (AR) phenotype expression. We investigated whether sensitization patterns vary in a country with subtropical and tropical regions and if sensitization patterns relate to AR phenotypes or age. METHODS In a national, cross-sectional study AR patients (2-70 y) seen by allergists underwent blinded skin prick testing with a panel of 18 allergens and completed a validated questionnaire on AR phenotypes. RESULTS 628 patients were recruited. The major sensitizing allergen was house dust mite (HDM) (56%), followed by Bermuda grass (26%), ash (24%), oak (23%) and mesquite (21%) pollen, cat (22%) and cockroach (21%). Patients living in the tropical region were almost exclusively sensitized to HDM (87%). In the central agricultural zones sensitization is primarily to grass and tree pollen. Nationwide, most study subjects had perennial (82.2%), intermittent (56.5%) and moderate-severe (84.7%) AR. Sensitization was not related to the intermittent-persistent AR classification or to AR severity; seasonal AR was associated with tree (p < 0.05) and grass pollen sensitization (p < 0.01). HDM sensitization was more frequent in children (0-11 y) and adolescents (12-17 y) (subtropical region: p < 0.0005; tropical region p < 0.05), but pollen sensitization becomes more important in the adult patients visiting allergists (Adults vs children + adolescents for tree pollen: p < 0.0001, weeds: p < 0.0005). CONCLUSIONS In a country with (sub)tropical climate zones SPT sensitization patterns varied according to climatological zones; they were different from those found in Europe, HDM sensitization far outweighing pollen allergies and Bermuda grass and Ash pollen being the main grass and tree allergens, respectively. Pollen sensitization was related to SAR, but no relation between sensitization and intermittent-persistent AR or AR severity could be detected. Sensitization patterns vary with age (child HDM, adult pollen). Clinical implications of our findings are dual: only a few allergens -some region specific- cover the majority of sensitizations in (sub)tropical climate zones. This is of major importance for allergen manufacturers and immunotherapy planning. Secondly, patient selection in clinical trials should be based on the intermittent-persistent and severity classifications, rather than on the seasonal-perennial AR subtypes, especially when conducted in (sub)tropical countries.
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Affiliation(s)
- Désirée Larenas-Linnemann
- Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Alexandra Michels
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Hanna Dinger
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Kijawasch Shah-Hosseini
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Ralph Mösges
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Alfredo Arias-Cruz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Centro Regional de Alergia e Inmunología Clínica, Hospital Universitario "Dr. José Eleuterio González" de la Universidad Autónoma de Nuevo León, Monterrey, Nuevo León
| | - Marichuy Ambriz-Moreno
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Martín Bedolla Barajas
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Servicio de Alergia e Inmunología Clínica, División de Medicina Interna, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Ruth Cerino Javier
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; CEINTAP (centro de investigación y tratamiento del asma pediátrico), Hospital Regional de Alta Especialidad del Niño. Dr. Rodolfo Nieto Padrón, Villahermosa, Tabasco, Mexico
| | - María de la Luz Cid Del Prado
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Manuel Alejandro Cruz Moreno
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Clinica Santa Cruz, Villahermosa, Tabasco
| | - Roberto García Almaráz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy Department, Hospital Infantil de Tamaulipas, Cd.Victoria, Tamaulipas, Mexico
| | - Cecilia Y García-Cobas
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Inmunología y Alergia, UMAE Hospital de Especialidades, CMNO, IMSS, Guadalajara, Jalisco, Mexico
| | - Daniel A Garcia Imperial
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy Department, Hospital Médica Tec 100, Querétaro, Querétaro, Mexico
| | - Rosa Garcia Muñoz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Dante Hernández-Colín
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Servicio de Alergia e Inmunología Clínica, División de Medicina Interna, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Francisco J Linares-Zapien
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Centro de Diagnostico y Tratamiento de Enfermedades Alérgicas y Asma de Toluca, Toluca, Estado de México
| | - Jorge A Luna-Pech
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Inmunología y Alergia, UMAE Hospital de Especialidades, CMNO, IMSS, Guadalajara, Jalisco, Mexico
| | - Juan J Matta-Campos
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy and Clinical Immunology Department, Hospital of specializations CMN 'Siglo XXI', Mexico, DF, Mexico
| | - Norma Martinez Jiménez
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Miguel A Medina-Ávalos
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Alejandra Medina Hernández
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Coordination of evidence based medicine (EBM), Facultad de medicina. Universidad Autonoma de Queretaro, Querétaro, Querétaro, Mexico
| | - Alberto Monteverde Maldonado
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Doris N López
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Luis J Pizano Nazara
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Clinical immunology & allergy department, Clínica Hospital San Jose, Cd.Obregón, Sonora, Mexico
| | - Emmanuel Ramirez Sanchez
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy and immunology department, General Hospital of Cancun "Dr. Jesus Kumate Rodriguez', Cancun, Quintana Roo, Mexico
| | - José D Ramos-López
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Servicio de Alergia e Inmunología Clínic, Seguro Social, Hospital General de Zona No2, Potosí, Potosí, Mexico
| | - Noel Rodríguez-Pérez
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Pediatrics and Immunology, Autonomous university of Tamaulipas, H.Matamoros, Tamaulipas, Mexico
| | - Pablo G Rodríguez-Ortiz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Hospital Star Médica Mérida, Mérida, Yucatan, Mexico
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Rangel-Garza L, Gonzalez-Diaz SN, Macias-Weinmann A, Arias-Cruz A, Zarate-Hernandez MDC, Yanez-Perez IV, Hernandez-Sanchez H. Prevalence Of Sleep Disorders In Children With Asthma and Its Association With The Level Of Control Of The Disease, Smoking and Obesity. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sanchez HH, Gonzalez-Diaz SN, Macias-Weinmann A, Arias-Cruz A, Yanez-Perez IV, Rangel-Garza L. Relationship Of Allergen Sensitization and LUNG Function In Adults Patients With Asthma In Allergy Clinic In Monterrey, Mexico. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Larenas-Linnemann D, Mayorga-Butrón JL, Sánchez-González A, Ramírez-García A, Medina-Ávalos M, Figueroa-Morales MA, Montaño-Velázquez BB, Montes-Narváez G, Romero-Tapia S, Stone-Aguilar H, Xochihua-Díaz L, Salas-Hernández J, Hernán-Ruiz H, Betancourt-Suárez MA, Cano-Salas MC, Curiel-Aceves L, Dibildox-Martínez J, Fernández-Vega M, García-Bolaños C, Iduñate-Palacios F, Jiménez-Chobillon MA, López-Lizárraga DN, Matta-Campos JJ, Olvera-Salinas J, Rivera-Gómez MA, Virgen-Ortega C, Sienra-Monge JJ, Del Río-Navarro B, Arias-Cruz A, Sacre-Hazouri A, Aguilar-Aranda A, Vásquez Del Mercado-Cordero R, Barnica RH, Velasco-Hidalgo L, Solís-Galicia C. [ARIA Mexico 2014. Adaptation of the Clinical Practice Guide ARIA 2010 for Mexico. Methodology ADAPTE]. Rev Alerg Mex 2014; 61 Suppl 1:S3-S116. [PMID: 24941973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The global prevalence of allergic rhinitis is high. International Study of Asthma and Allergies in Childhood (ISAAC) Phase III reports a total estimated prevalence of 4.6% in Mexico. There is evidence based on allergic rhinitis Clinical Practice Guidelines (CPG), but its promotion, acceptance and application is not optimal or adequate in Mexico. OBJECTIVE To generate a guideline for the treatment of allergic rhinitis and its impact on asthma by adaptating the 2010 ARIA Guideline to Mexican reality, through a transculturation process applying the ADAPTE methodology. PATIENTS AND METHOD Using the ADAPTE Methodology, the original 2010 ARIA CPG recommendations were evaluated by the guideline development group (GDG) into which multiple medical specialities managing patients with allergic rhinitis were incoorporated. The GDG valorated the quality of 2010 ARIA, checked and translated key clinical questions. Moreover, the GDG adjusted recommendations, patient preferences and included comments in the context of the Mexican reality (safety, costs and cultural issues). To accomplish this, we ran Delphi panels with as many rounds as necessary to reach agreement. One extra question, not included in the original 2010 ARIA, on the use of Nasal Lavages for AR was created sustained by a systematic literature review. RESULTS A total of 45 questions from the original 2010 ARIA were included and divided into six groups covering prevention, medical treatment, immunotherapy and alternative medicine to treat patients with allergic rhinitis with or without asthma. Most of the questions reached agreement in one or two rounds; one question required three rounds. CONCLUSIONS An easy-to-use, adaptated, up-to-date and applicable allergic rhinitis guideline for Mexico is now available.
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Gonzalez-Diaz SN, Arias-Cruz A, Rangel-Garza L. Poster 2022: Sublingual immunotherapy in the treatment of allergic rhinitis: series of cases. World Allergy Organ J 2014. [PMCID: PMC4082046 DOI: 10.1186/1939-4551-7-s1-p28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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