[Food sensitization and factors associated with uncontrolled asthma in the Yaqui Valley, Mexico]

OBJECTIVE

To determine the frequency of food allergy sensitization and the factors associated with uncontrolled asthma in patients from the Yaqui Valley.

METHODS

A cross-sectional analytical study in a second-level hospital in Ciudad Obregon, Mexico. Asthma control was classified according to the Global Initiative for Asthma, the nutritional status with body mass index, food sensitization with skin prick tests, and the rest of variables through direct questioning or medical records. The frequencies of sensitization and the factors associated with uncontrolled asthma were determined through descriptive and inferential statistics; a value of p < 0.05 was considered statistically significant.

RESULTS

230 patients were included. The frequency of sensitization to at least one food allergen was of 79%. The most frequent sensitizing allergens were eggs, corn, beans, shrimp, and cow's milk.

CONCLUSION

Our study describes the pattern of food sensitization in patients with asthma and the factors associated with the uncontrolled disease. It is the first investigation of its kind that has been carried out in this region of Mexico.

[The clinical practice of allergen immunotherapy in Mexico according to 277 allergists who were surveyed during a three-year AIT course]

BACKGROUND

There are different guidelines for the diagnosis of allergic diseases and the application of allergen immunotherapy (AIT).

OBJECTIVE

To describe how Mexican allergists diagnose and treat respiratory and food allergies with AIT.

METHODS

227 allergists who attended an immunotherapy symposium were surveyed; the topics investigated were the daily practices in the diagnosis of respiratory and food allergies, as well as ways to apply AIT.

RESULTS

The surveyed allergists use skin prick tests for the diagnosis of both respiratory and food allergies in 100 % and 87.7 % of their cases respectively; in vitro diagnosis through serum specific IgE in 55.5 % and 63 %, and molecular diagnostics in 14.1% and 13.2 %. For aeroallergens, 81 % prescribe subcutaneous AIT, 77.9 % use liquid sublingual AIT, and 1.8 % prefer SLIT in tablets; however, 45 % indicated that they would use tablets in the future. Regarding food allergens, most respondents did not prescribe AIT; however, 55% of them are interested in oral AIT and 59% of them are interested in sublingual AIT.

CONCLUSIONS

Generally, the diagnosis and treatment of allergic diseases are carried out according to international guidelines; besides, the interviewed allergists expressed flexibility to adopt new schemes.

Pollen allergen skin test and specific IgE reactivity among Filipinos: a community-based study

BACKGROUND

Despite the clinical importance of pollen allergens among Filipinos, few studies delve into the sensitization profiles of Filipinos against pollen allergens. This study determined the sensitization profile of Filipinos to pollen using skin prick test (SPT) and pollen-specific ELISA.

METHODS

Pollen from fifteen selected plant sources was collected and extracted for use in sensitization tests. Volunteers were interviewed for their clinical history prior to blood sampling and SPT. The blood samples collected were assessed using Enzyme-Linked Immunosorbent Assay (ELISA).

RESULTS

The best panel of pollen allergens for the skin prick test was Mangifera indica (64%), Acacia auriculiformis (28%), Mimosa spp. (25%) Amaranthus spinosus (22%), Lantana camara (20%), Pilea microphylla (16%) and Dichanthium aristatum (15%). Young adults had more sensitizations to pollen than among early childhood and elderly. There were more allergic subjects that have rhinitis (61%) than asthma (42%) and atopic dermatitis (35%). Pollen-specific IgE levels show low percent reactivity as compared to the skin test with Cocos nucifera obtaining the highest IgE reactivity (21%).

CONCLUSIONS

Pollen allergens from both arboreal and herbaceous plants used in this study yielded positive reactivities for both skin tests and specific IgE tests.

[Skin reactivity in allergic conjunctivitis]

BACKGROUND

Allergic conjunctivitis is caused by an IgE-mediated mechanism or immediate hypersensitivity due to allergen direct contact on the conjunctival surface of sensitized patients, which elicits mastocyte activation and inflammatory mediators' release. Up to 47% of patients with allergic conjunctivitis can develop sensitization to perennial allergens; more than 24% of patients can experience sensitization to multiple allergens.

OBJECTIVE

To estimate positive skin reactivity to allergens in patients diagnosed with allergic conjunctivitis in the allergology outpatient clinic of Centro de Especialistas Santo Domingo, in Cartagena, Colombia, during 2017.

METHOD

Cross-sectional study of 92 patients aged between 3 and 74 years, included by convenience sampling.

RESULTS

70.65% had positive skin prick tests to at least one allergen. Most common allergens with positive skin reactivity were house dust mites (65.2%), animal epithelia (15.2%), insects (15.2%) and food (14.1%). Allergic rhinitis (51%), allergic asthma (23%) and atopic dermatitis (10%) were the most commonly associated allergic pathologies.

CONCLUSIONS

Positive skin reactivity to the studied allergens was significantly higher in patients with allergic conjunctivitis and other associated conditions.

[Frequency of skin reactivity to food allergens in allergic patients]

BACKGROUND

Food allergy is deemed to have a worldwide prevalence ranging from 2 to 10 %.

OBJECTIVE

To determine the frequency of skin reactivity to food allergens by age groups.

METHODS

Cross-sectional, descriptive, prolective, observational study. Patients aged from 2 to 64 years with symptoms consistent with allergic disease were included. Skin prick tests were carried out with food allergens. Frequencies and percentages were estimated.

RESULTS

One-hundred and ninety-one patients were included, out of which 63.4% were females. Mean age was 22.5 years; 19.3 % showed positive skin reactivity to at least one food. Distribution by age group was as follows: preschool children 13.5 %, schoolchildren 24.3 %, adolescents 2.7 % and adults 59.5 %. Diagnoses included allergic rhinitis in 84.3 %, asthma in 19.4 %, urticaria in 14.1 % and atopic dermatitis in 8.4 %. Positive skin reactivity frequency distribution in descending order was: soybeans with 5.2 %, peach with 4.7 %, grapes, orange and apple with 3.6 %, nuts with 3.1 %, pineapple, avocado, tomato and tuna with 2.6 %.

CONCLUSION

The frequency of skin reactivity to food allergens was similar to that reported in the national and Latin American literature, but sensitization to each specific allergen varied for each age group.

Is nonhomogeneous expression of tissue mast cells or allergen specific IgEs bound to tissue mast cells possible?

Skin prick tests (SPTs) are widely used to demonstrate an IgE-mediated hypersensitivity reaction to a specific allergen. However, local allergic conditions cannot be diagnosed with SPTs. Local specific IgE production was only presented before in mucosal tissues. We present a patient with house dust mite sensitization that had variable SPTs results in different body regions.

Optimizing diagnostic tests for persulphate-induced respiratory diseases

BACKGROUND

Persulphates from hair bleaching products are considered the major cause of occupational-rhinitis and asthma in hairdressers. The specific inhalation challenge (SIC) is considered 'reference standard' for diagnosing persulphate-induced asthma and rhinitis; however, the currently validated method of performing SIC with persulphate powder is time consuming with a duration of up to 4 days. The value of skin prick tests (SPTs) and histamine release tests (HRTs) with persulphates is unknown. The aim of this study was to establish a novel rapid SIC with persulphate powder to test for both rhinitis and asthma simultaneously in 1 day. In addition, we assessed the suitability of SPTs and HRTs for detecting persulphate-induced respiratory diseases.

METHODS

The study population included 19 hairdressers with a history of work-related rhinitis and/or asthma symptoms, 12 symptomatic controls (10 with concurrent allergic asthma and rhinitis and two with non-allergic asthma), and 40 healthy controls. A previous severe asthmatic reaction and/or anaphylactic reaction to persulphates was considered an exclusion criterion for hairdressers. The 19 hairdressers and 12 symptomatic controls had SIC performed with 3 × 5 min exposures to potassium persulphate powder in a provocation chamber. All participants, including the 40 healthy controls, were subjected also to SPTs and HRTs with three persulphate salts at concentrations of 2-20 % and 0.03-1 %, respectively.

RESULTS

None of the symptomatic controls had a nasal or bronchial response to SIC with potassium persulphate. Six hairdressers presented a nasal and two a bronchial response. No severe reactions occurred. No positive SPTs were recorded, neither among hairdressers, symptomatic controls, nor healthy controls. All three groups showed nonspecific non-IgE mediated histamine release to persulphates in HRT.

CONCLUSIONS

The proposed method for performing SIC showed a high specificity for detecting persulphate-induced asthma and rhinitis. The rapid SIC was able to produce positive nasal and bronchial responses in symptomatic hairdressers without any severe reactions occurring. SPTs and HRTs cannot predict asthma or rhinitis caused by persulphates.

Diagnosing Allergic Rhinitis

Allergic rhinitis (AR) is the most common immunologic disease in industrialized societies and has a significant impact on quality of life. Most asthmatics also have rhinitis. AR may present with comorbidities, including chronic otitis media with effusion, cough, and pollen-food cross-reactivity. AR may occur in isolation or be part of a mixed rhinitis.

Drug allergy in tertiary care in Turkey: results of a national survey. The ADAPT study: adult drug allergy perception in Turkey

BACKGROUND

No data are available on the incidence of drug hypersensitivity (DH) reactions in outpatient settings of tertiary allergy/immunology clinics. Our aims were to document the frequency of outpatient hospital admissions due to DH reactions to allergy/immunology clinics in adults and the management of these reactions in real life. We also investigated whether drug allergy affected social and medical behaviours of the patients.

METHODS

This multi-centre study was performed for one year with the participation of 11 out of 16 tertiary allergy/clinical immunology clinics in Turkey. The study group consisted of the patients with DH reactions. Results of a questionnaire including drug reactions and management were recorded.

RESULTS

Among 54,863 patients, 1000 patients with DH were enrolled with a median of 2.1% of all admissions. In real life conditions, the majority of approaches were performed for finding safe alternatives (65.5%; 1102 out of 1683) with 11.7% positivity. Diagnostic procedures were positive in 27% (154/581) of the patients. The majority of the patients had higher VAS scores for anxiety. A total of 250 subjects (25%) reported that they delayed some medical procedures because of DH.

CONCLUSION

Our results documented the frequency of admissions due to DH reactions to allergy/clinical immunology clinics for the first time. Although physicians mostly preferred to perform drug tests in order to find safe alternatives, considering the fact that DH was confirmed in 27% of the patients, use of diagnostic tests should be encouraged, if no contraindication exists in order to avoid mislabelling patients as DH.

[Correlation between the magnitude of skin prick test reactivity and pollen-specific serum IgE levels in patients with respiratory allergy]

BACKGROUND

For the etiological diagnosis of allergic respiratory diseases skin tests or specific serum IgE determination are used.

OBJECTIVE

To determine the correlation between the extent of reactivity to cutaneous prick tests and the levels of pollen specific serum IgE in patients with respiratory allergy.

PATIENTS AND METHODS

A prolective, descriptive and transversal study was done with patients of both genders, aged 2 to 60 years, who attended for the first time at the service of Allergy and Clinical Immunology of University Hospital of Puebla, Mexico, with presumptive diagnosis of respiratory allergy. All patients underwent clinical history, skin prick tests with standardized allergenic extracts and quantification of pollen specific serum IgE by chemiluminescence method. We estimated the correlation index r using the statistical method Pearson product-moment correlation coefficient; a value r equal to or higher than 0.70 was considered a significant relationship or a high correlation.

RESULTS

Nine-one patients were included, of whom 58.2% were female. The diagnoses were: allergic rhinitis (79.1%), asthma and allergic rhinitis (16.5%) and only asthma (4.4%). Only significant correlation was found in patients with allergic rhinitis for Rumex crispus (r = 0.702) and in patients with asthma and rhinitis for Ambrosia trifida (r = 1).

CONCLUSION

Only for Rumex crispus and Ambrosia trifida, the skin prick tests or the determination of specific serum IgE levels are comparable diagnostic methods of allergic respiratory diseases.

Probiotics in the treatment and prevention of allergies in children

Several studies on the pathogenesis of allergy both in man and experimental animals continue to show the importance of commensal bacteria in the gastrointestinal tract in stimulating and directing the immune system. The interest in modulating commensal bacteria flora with pre- and probiotics to prevent and treat food allergy has multiplied in recent years. We recently studied 230 infants with atopic dermatitis and suspected cow’s milk allergy. The infants were randomly allocated to groups which received Lactobacillus GG (LGG), a mixture of four probiotic strains (MIX) or placebo for 4 weeks. We inferred that probiotics induce systemically detectable low-grade inflammation, which may explain the clinical effects and the secretion pattern of cytokines induced by PBMC. To study the ability of probiotics to prevent allergy in children, we recruited 1223 pregnant women carrying fetuses at increased risk of allergy for a double-blind placebo-controlled trial. Mothers used a mixture of four probiotic bacteria or a placebo from the 36th week of gestation. Their infants received the same probiotics plus prebiotic galacto-oligosaccharides for 6 months. At the 2-year follow-up, a total of 925 infants participated. The cumulative incidence of allergic disease did not differ significantly between the synbiotic and the placebo group. However, synbiotics significantly reduced eczema. The preventive effect of synbiotics was more pronounced against IgE-associated diseases. At the 5 year follow-up, 891(88%) of the 1018 intention-to-treat infants attended. In the probiotic and placebo groups, frequencies of allergic symptoms and IgE-associated allergic disease and sensitization were similar, and the frequencies of eczema did not differ between the groups. Atopic eczema, allergic rhinitis and asthma appeared equal frequency in the groups. However, less IgE-associated allergic disease occurred in the cesarean-delivered infants given probiotics. In cesarean-delivered childen, we noticed a delayed rise in bifidobacteria recovery in placebo-treated children which was corrected by pro- and prebiotic supplementation. Indications from studies of feces and blood at the age 6 months suggest that probiotics may enhance both inflammation and immune defence of the gut. The probiotic treatment further stimulated maturation of the immune system since the infants given probiotics showed increased resistance to respiratory infections and improved vaccine antibody responses.