Asthma exacerbations in the pediatric emergency area: Evaluation and prospects for improvement of pre-hospital care

INTRODUCTION

The frequency of visits to emergency department for asthma is a significant public health problem in pediatrics. This study aimed to identify the characteristics of children who visited the pediatric emergency department for asthma exacerbation and evaluated their therapeutic management prior to admission.

METHODS

A prospective study was conducted over a 6-month period in the pediatric emergency departments of five hospitals involving children aged 1-16 years admitted to the department with a clinical diagnosis of asthma exacerbation.

RESULTS

In all, 143 patients were enrolled in the study. Asthma episodes were moderate to severe in 69.2% of cases (n = 99). Initial treatment prior to admission to the emergency department was adequate in only 17.5% of cases (n = 25). Hospitalization for more than 24 h occurred in 18.2% (n = 26) patients. In children aged <3 years, viral infection was present in 91.4% cases (n = 64) and exacerbations were more severe in younger patients (P = 0.002) and children belonging to low-income stratum (P = 0.025). Only 17.4% (n = 25) were positive for SARS-CoV-2 (antigen test or polymerase chain reaction test), suggesting that the involvement of traditional respiratory viruses in asthma exacerbation continued even during pandemic. Regarding the pre-hospital care, 70.6% (n = 101) had received prior treatment, but this treatment was inadequate in 53.1% cases (n = 76).

CONCLUSION

This study showed that asthmatic children and their families had little knowledge about the disease and that physicians must be sufficiently aware of current recommendations for managing asthmatic children. Admission to the emergency department for asthma could be avoided partially by better diagnosis and therapeutic education.

Have the prevalence of eczema symptoms increased in the Mexican pediatric population? Prevalence and associated factors according to Global Asthma Network Phase I

Background

In children, atopic dermatitis or eczema is the most common inflammatory disease of the skin. According to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase IIIB in Mexico, 5.8% of children and 4.9% of adolescents had eczema symptoms. In 2012, Global Asthma Network (GAN) was established to update the prevalence of eczema and estimate potential factors contributing to its development.

Objective

To estimate the prevalence and associated factors for atopic eczema symptoms and diagnosis in children and adolescents according to GAN Phase I and compare the results with ISAAC Phase IIIB in Mexico.

Methods

A cross-sectional, multicenter survey was conducted in 15 Mexican centers during the period of 2015-2017 using the GAN Phase I questionnaires in children (6-7-year-olds) and adolescents (13-14-year-olds). The prevalences obtained from the GAN Phase I study, were compared with ISAAC Phase IIIB results; a Spearman's correlation analysis was conducted between temperature, relative humidity, and altitude and eczema symptoms, and a logistic regression was performed to predict current eczema symptoms by age group.

Results

A total of 35 777 children and 41 399 adolescents were included. Since ISAAC Phase IIIB, the prevalence of itchy rash in the past 12 months significantly increased in the children's group [6.6% (95% CI 5.7-7.4) vs 7.8 (95% CI 7.5-8.1), p = 0.000] and adolescents' group [5.8% (95% CI 5.0-6.7) vs 6.7% (95% CI 6.5-7.0), p = 0.000].In the adolescents' group, the prevalence of nocturnal awakenings caused by rash symptoms on more than one night per week had a negative correlation between altitude (Spearman's Rho = -0.558, p value = 0.031), and a positive correlation with the average annual temperature (Spearman's Rho = 0.604, p value = 0.017) and annual relative humidity (Spearman's Rho = 0.742, p value = 0.002). The most significant associations in children were the presence of sneezing or runny or blocked nose in the past 12 months [(OR 3.13, 95% CI 2.60-3.77), p = 0.000], the use of paracetamol in the first year of life ([OR 1.52, 95% CI 1.15-2.01), p = 0.003] and the use of antibiotics in the first year of life [(OR 1.30, 95% CI 1.08-1.55) p = 0.004]. Moreover, altitude at 100-1000 m above sea level was associated with current eczema symptoms in adolescents (p = 0.001).

Conclusions

There has been a significant increase in eczema symptoms in both age groups since ISAAC Phase IIIB study. Additionally, eczema symptoms were associated with temperature, relative humidity, asthma, hay fever symptoms, the use of paracetamol and antibiotics.

[Practical guide for the follow-up and management of patients with severe asthma treated with biologics]

The management of severe uncontrolled asthma with biologics is an area of extreme difficulty given the scarcity of information regarding their starting criteria, the variables to be evaluated to determine the efficacy and safety of their management, the cut-off points to determine the timing to change or add another biological and the process to decrease or withdraw steroids. This review incorporates the latest information and makes a proposal based on it.

An independent in-depth analysis proposing adjusted Global Initiative on Asthma (GINA) Step 1-2 treatment suggestions

The Global initiative on asthma (GINA) strategy included major changes for the treatment of mild asthma in the 2020 version, that are even taken to a next level in 2021, leaving a preferred track with only rescue therapy with inhaled corticosteroid and formoterol (ICS-FORM) for step 1-2 in 12+ years-old. It has been questioned how solid the evidence behind these recommendations is. We decided to independently conduct an in-depth analysis of published evidence based on a comprehensive evaluation of original articles and related appendices and publications, including quality of evidence and risk-of-bias per article. We first defined the major asthma treatment goals and proceeded to review how these were met in publications referenced in the main asthma guidelines. For patients with GINA 2021 Step 1 characteristics the analysis supports GINA's decision to avoid SABA monotherapy and to prefer ICS-FORM rescue with as alternative ICS rescue every time a SABA is used for ≥12 years, even though evidence is extrapolated from step 2 patients. For 6-11 year-olds we propose to consider ICS-FORM rescue as an alternative, as its use has been approved in this age-group, be it not as rescue-medication. For patients with GINA 2021 Step 2 characteristics our proposal slightly differs from GINA 2021. We propose to continue avoiding the separate use of SABA, using ICS rescue whenever a fast-acting bronchodilator is taken (even with ICS maintenance). Also, the superiority of ICS-FORM rescue over classical step 2 treatment is not uniform and year-long experience is lacking. Consequently for now, both treatment options seem equal: ICS-FORM rescue or ICS maintenance with SABA (+ICS) rescue. For 6-11 year-olds ICS rescue every time a SABA is used has the advantage of lower total ICS dose; as alternative we suggest ICS-FORM rescue. The best treatment option depends on patient characteristics and treatment goals. Recommendations should be reviewed as soon as new evidence becomes available.

Prevalence and risk factors associated with allergic rhinitis in Mexican school children: Global Asthma Network Phase I

Background

The International Study of Asthma and Allergies in Childhood (ISAAC) showed a wide variability in prevalence and severity of allergic rhinitis (AR) and rhinoconjunctivitis (ARC), in addition to other atopic diseases (Asher et al, 2006).¹ The Global Asthma Network (GAN) has continued to study these conditions.

Objective

To estimate the prevalence of AR and ARC in children and adolescents in Mexico and to assess their association with different risk factors.

Methods

GAN Phase I is a cross-sectional, multicentre survey carried out in 15 centres corresponding to 14 Mexican cities throughout 2016–2019 using the validated Spanish language version of the GAN Phase I questionnaires. The questionnaires were completed by 35 780 parents of 6–7 year old primary school pupils (children) and by 41 399 adolescents, 13–14 years old.

Results

The current and cumulative prevalence of AR was higher in the adolescents (26.2–37.5%, respectively) in comparison to the children (17.9–24.9%, respectively), especially in female participants. This tendency was also observed in the current prevalence of ARC, where 15.1% of female adolescents reported nasal symptoms accompanied with itchy-watery eyes in the past year. The most important risk factors for AR and ARC were the presence of wheezing in the past 12 months, wheezing in the first year of life, the previous diagnosis of asthma and eczema symptoms. Furthermore, allergic symptoms had a negative tendency concerning altitude.

Conclusion

This is the largest AR epidemiological study ever conducted in Mexico. It shows an increase in AR prevalence, as well as significant associations with modifiable risk factors, which could help to establish recommendations to reduce the burden of this condition.

[MIA 2021, Comprehensive Asthma Management. Guidelines for Mexico]

BACKGROUND

Asthma continues to be one of the most frequent chronic respiratory diseases in our country. New methods for diagnosis and treatment have been described; accordingly, the international guidelines were renewed.

OBJECTIVE

To create a national platform for the development of updated guidelines, solidly based on evidence: Comprehensive Asthma Management (Spanish acronym: MIA).

METHODS

MIA uses the ADAPTE method. The MIA development group consists of experts in pulmonology-allergology-methodology and representatives of 13 institutions and societies of specialties that manage asthma. The international reference guidelines (selected with AGREE-II): GINA 2020, GEMA 5.0, BTS/SIGN 2019 and ATS/ERS consensus document 2014-2019 on severe asthma. MIA covers suspected asthma, diagnosis, treatment, and special groups. Key clinical questions were formulated on treatment steps 1-3, biomarkers and severe asthma.

RESULTS

Based on evidence, safety, cost and local reality, the core group developed responses. Through a Delphi process the broad MIA development group suggested adjustments until consensus was reached.

CONCLUSION

A document was generated with multiple figures and algorithms, solidly based on evidence about asthma management, adjusted for Mexico with a broad base among different societies that participated in its development. It does not include guidelines for acute asthma.

Global Asthma Network Phase I study in Mexico: prevalence of asthma symptoms, risk factors and altitude associations-a cross-sectional study

Background

Global Asthma Network (GAN) was established in 2012 as a development to the International Study of Asthma and Allergies in Childhood to improve asthma care globally.

Objective

To survey asthma, allergic rhinitis and atopic dermatitis in primary and secondary school children and to investigate and evaluate its prevalence, severity, management and risk factors in Mexico.

Methods

GAN Phase I is a cross-sectional, multicentre survey carried out in 15 centres corresponding to 14 Mexican cities throughout 2016–2019 using the validated Spanish language version of the GAN Phase I questionnaires. The questionnaires were completed by parents of 6–7-year-old primary school pupils (school children) and by 13–14-year-old adolescents.

Results

A total of 35 780 school children and 41 399 adolescents participated. Wheezing ever prevalence was 26.2% (95% CI 25.8% to 26.7%) in school children and 23.9% (95% CI 23.4% to 24.3%) in adolescents. The corresponding frequencies for current wheeze were 10.2% (95% CI 9.9% to 10.5%) and 11.6% (95% CI 11.2% to 11.9%). In school children, the risk factors for current wheeze were rhinitis (OR 4.484; 95% CI 3.915% to 5.134%) and rash symptoms (OR 1.735; 95% CI 1.461% to 2.059%). For adolescents, rhinitis symptoms (OR 3.492; 95% CI 3.188% to 3.825%) and allergic rhinitis diagnosis (OR 2.144; 95% CI 1.787% to 2.572%) were the most significant. For both groups, there was a negative relation with centres’ sea level altitude higher than 1500 m above mean sea level (p<0.005).

Conclusions

The most important risk factors for asthma symptoms in both age groups were the presence of rhinitis and rash symptoms or diagnosis. On the other hand, sea level altitude higher than 1500 metres was a protective factor.

Enhancing innate immunity against virus in times of COVID-19: Trying to untangle facts from fictions

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.

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

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.

Propiedades psicométricas de la Escala de Bienestar Psicológico para Adolescentes (BIEPS-J) en una muestra mexicana

El bienestar psicológico se refiere a la satisfacción general que los individuos tienen respecto de su vida. Este concepto se ha relacionado con la salud mental y con la detección de factores favorables al desarrollo humano. El interés en su estudio en adolescentes se ha incrementado en los últimos años debido a los cambios físicos, mentales y sociales propios a esta etapa del desarrollo, por lo que son necesarios instrumentos válidos y confiables que permitan su evaluación. El objetivo de este estudio fue evaluar propiedades psicométricas de la Escala de Bienestar Psicológico para Adolescentes (BIEPS-J) en una muestra mexicana de adolescentes tardíos y obtener evidencia de su validez convergente y de criterio. Se aplicó la escala BIEPS-J y la Escala de Autoestima de Rosenberg (EAR) a 271 estudiantes de ambos sexos de entre 16 y 18 años. Un análisis paralelo indicó dos factores presentes en la escala BIEPS-J, estructurados mediante un análisis factorial exploratorio (componentes principales, rotación oblicua) y que explicaron el 54% de la varianza. Los factores fueron: 1) Relación con uno mismo y con terceros, satisfacción con sus relaciones sociales y la aceptación de sí mismo; 2) Planes y recursos personales de control, sensación del dominio de su entorno y auto-competencia, además de la presencia de metas en su vida. La consistencia interna global (α > .80) y por factor (α > .70) fue aceptable. La escala BIEPS-J mostró validez convergente con la EAR (r = .44) y el nivel de bienestar psicológico se asoció al nivel de autoestima (p < .001). El puntaje total y por factor de la escala BIEPS-J no difirió entre sexos (p > .05). Los datos indican que la escala BIEPS-A es un instrumento válido y confiable para evaluar el bienestar psicológico en población adolescente mexicana de entre 16 y 18 años.

[GUIMIT 2019, Mexican Guideline on Immunotherapy. Guideline on the diagnosis of IgE-mediated allergic disease and immunotherapy following the ADAPTE approach]

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.

The burden of asthma in an inner-city area: A historical review 10 years after Isaac

Background

According to the International Study of Asthma and Allergies in Childhood (ISAAC) methodology, in 2003, the prevalence of asthma symptoms in children 6-7 years old and adolescents 13-14 years old was 11.6% and 13.7%, respectively. Since then, the number of asthma cases has increased worldwide. The study was conducted in several districts in northern Mexico City to evaluate the prevalence of asthma in these age groups and examine possible risk factors. The data were compared to the 2003 results from the same area.

Methods

This was a comparative cross-sectional study following the official Global Asthma Network (GAN) methodology. The parents or guardians of participants completed a questionnaire that explored demographics, asthma symptoms, diagnoses, and possible risk factors. Central tendency measurements were determined for statistical analysis and chi-squared distribution for possible risk factors.

Results

A total of 2515 children aged 6-7 years and 3375 adolescents aged 13-14 years participated in the study. Compared to the ISAAC results, we found a greater prevalence of wheezing in both children (at some time in life, 19.2% vs. 27.1%; over the last year, 6.8% vs. 10.6%) and adolescents (at some time in life, 16.9% vs. 19.7%), and for children with an asthma diagnosis (4.5% vs. 5.1%). For both groups, the most common risk factor associated with wheezing was the presence of rhinitis symptoms.

Conclusions

Asthma symptoms are highly prevalent in Mexico City, occurring in almost 20% of adolescents. Compared to a decade ago, there was a 7.9% increase in the prevalence of asthma symptoms in children. Almost half of the children and adolescents presenting with symptoms had experienced more than four episodes per year. However, less than 50% of children and adolescents with asthma symptoms had been diagnosed with this disorder, suggesting under-diagnosis.

[Knowledge of asthma: educational intervention with the 2014 GINA guide in primary care physicians]

BACKGROUND

Asthma is a public health problem in the world, so updating the guidelines for the diagnosis and treatment of asthma is based primarily on the practice of primary care physicians. Educational interventions are useful for increasing knowledge.

OBJECTIVE

To compare the level of knowledge of asthma before and after an educational intervention.

METHODS

A quasi-experimental prospective study was conducted in general and family practitioners and pediatricians who attended a training workshop on general aspects of asthma and current guidelines for diagnosis and treatment (GINA 2014). A questionnaire consisting of 11 multiple choice questions relating to fundamental aspects of the disease and diagnosis, classification, treatment and management of attacks, was used in two assessments, baseline and post-intervention.

RESULTS

A total of 178 patients participated in the study, with knowledge pre-intervention at 25.5 points and post-intervention at 97.5 points on a scale of 100, with p < 0.05.

CONCLUSION

Educational interventions are inexpensive and effective tools to increase the knowledge of health professionals, and they have an impact on improving patient care.

Fungal Allergy: Pattern of sensitization over the past 11 years

INTRODUCTION AND OBJECTIVES

Although the prevalence of sensitization to fungi is not precisely known, it can reach 50% in inner cities and has been identified as a risk factor in the development of asthma. Whereas the prevalence of allergic diseases is increasing, it is unclear whether the same occurs with sensitization to fungi.

PATIENTS AND METHODS

A retrospective study was performed at the "Hospital Infantil de México Federico Gómez". From skin tests taken between 2004 and 2015, information was gathered about Alternaria alternata, Aspergillus fumigatus, Candida albicans, Cladosporium herbarum, Mucor mucedo and Penicillium notatum. The participating patients were 2-18 years old, presented some type of allergic condition, and underwent immediate hypersensitivity tests to the fungi herein examined. Descriptive analysis and chi-squared distribution were used.

RESULTS

Of the 8794 patients included in the study, 14% showed a negative result to the entire panel of environmental allergens. The remaining 7565 individuals displayed sensitization to at least one fungus, which most frequently was Aspergillus, with a rate of 16.8%. When the patients were divided into age groups, the same trend was observed. The highest percentage of sensitization (58%) toward at least one type of fungus was found in 2014, and the lowest percentage (49.8%) in 2008.

CONCLUSION

The rate of sensitization to at least one type of fungus was presently over 50%, higher than that detected in other medical centers in Mexico. This rate was constant over the 11-year study, and Aspergillus exhibited the greatest frequency of sensitization among the patients.

Dermatophagoides pteronyssinus: Changes in sensitisation in the past 11 years and comparison with other centres in Mexico

BACKGROUND

House dust mites are a ubiquitous air allergen in the human habitat. It has been shown that exposure to them is a fundamental factor in sensitisation and development of atopic disease. The objective of the study was to analyse changes in sensitisation to Dermatophagoides pteronyssinus (Der p.) in children treated in a tertiary level care hospital in Mexico City for a period of 11 years and compare with other studies carried out in Mexico.

METHODS

A retrospective study was performed at the Hospital Infantil de México Federico Gómez (HIMFG). Information was gathered from skin tests for Der p. performed in the Allergy Laboratory from January 2004 to April 2015. Patients 2-18 years old who presented for examination of some type of allergic condition and who had immediate hypersensitivity tests to Der p. were included in the study. Results were compared with prior reports from other institutions. Descriptive analysis and χ² statistics were used.

RESULTS

A total of 8794 patients were included in the study; 49.3% of the tests (95% CI 48-50) were positive for Der p. The percentage of monosensitised to mites was 2.7% for Der p. (95% CI 2-3). A significant difference was found between the results of older patients and those <6 years old. The frequency of sensitisation had a tendency to decrease during the 11 years analysed in all age groups.

CONCLUSIONS AND CLINICAL RELEVANCE

The frequency of sensitisation to Der p. increased with age until reaching adolescence. In the last 11 years a decrease in sensitisation to this air allergen was observed.

[Food allergy diagnosis in patients with elimination diet history. Preliminary report]

BACKGROUND

Food allergy diagnosis is performed by a double blind placebo controlled challenge; however, in a lot of patients, it is only based on clinical history, skin prick tests, or parents' perception. There is a high frequency of elimination diets without an adequate approach.

OBJECTIVES

To analyze the results of diagnostic tests in a group of children with elimination diet-based on suspected food allergy and verify such studies with double blind placebo-controlled test challenge.

MATERIAL AND METHOD

An observational, analytical and prospective study was done in a group of patients with elimination diet for suspected food allergy. We performed prick test, Prick-to-Prick test and patch test and the positive ones were verified by double-blind placebo-controlled challenge.

RESULTS

Fourty-three patients were included within a total of 1,935 tests. Both approach for immediate and late sensitivity had not statistically significant relationship between a positive test and the elimination of food. Until now, we had 4 (8%) positive challenges out of 50.

CONCLUSIONS

The frequency of allergy proved by double-blind placebo-controlled test in 50 challenges was of 8% (4/50), thus, in the preliminary report we found a high frequency of elimination diets without adequate support. It is very important that food allergy diagnosis is accurate and based on an appropriate approach; since the implementation of an elimination diet in pediatric population can have a negative influence on their growth and development.

Reporte preliminar del abordaje diagnóstico de alergia alimentaria en pacientes con antecedente de dieta de eliminación

Antecedentes: el diagnóstico de alergia alimentaria se realiza idealmente con reto doble ciego controlado con placebo; sin embargo, en muchas ocasiones sólo se basa en la historia clínica, en las pruebas cutáneas o, incluso, en la percepción de los padres. Con gran frecuencia se prescriben dietas de eliminación sin el abordaje adecuado.Objetivos: analizar los resultados de las pruebas diagnósticas de alergia alimentaria en un grupo de niños con dieta de eliminación y verificar esos estudios con la prueba de reto doble ciego.Material y método: estudio observacional, analítico, prospectivo, efectuado en un grupo de pacientes con dieta de eliminación por sospecha de alergia alimentaria. Se realizaron pruebas por punción, Prick-to-Prick y de parche a todos los pacientes y posteriormente se verificó la positividad de esas pruebas mediante reto doble ciego controlado con placebo.Resultados: se incluyeron 43 pacientes con un total de 1,935 pruebas. En el abordaje para sensibilidad inmediata y tardía no se encontró ninguna relación estadísticamente significativa entre la positividad de la prueba y la eliminación del alimento. Al momento se han realizado 50 retos, de los que 4 fueron positivos (8%).Conclusiones: la frecuencia de alergia comprobada por reto doble ciego controlado con placebo en 50 retos fue de 8% (4/50), por lo que en este reporte preliminar encontramos una alta frecuencia de eliminación de alimentos sin el sustento adecuado. Es muy importante que el diagnóstico de alergia alimentaria sea acertado y se base en el abordaje adecuado, porque la implementación de una dieta de eliminación en una población muy vulnerable, como los pacientes pediátricos, es de suma importancia y puede influir de manera negativa en su crecimiento y desarrollo.