Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993)最新文献

Objective: To determine the frequency of sensitization to polyethylene glycol and polysorbate in allergic patients with a complete vaccination schedule against COVID-19 who presented systemic adverse reactions.

Methods: Cross-sectional, descriptive, observational and prolective study. Allergic patients between 18 and 60 years old, with complete vaccination schedule against COVID-19, with systemic adverse reactions were included. Skin tests were performed with polyethylene glycol 2000 and PS 80. The results were analyzed by calculating averages, percentages and frequencies.

Results: Fifty-five patients were included, 74.5% were women, average age was 31.4 (SD 11.6), the most prevalent allergologic diagnosis was allergic rhinitis, adverse reactions after vaccination were late in 54 patients, with myalgias being the most common. Sensitization was found in 40%, of these 32.7% were positive to polysorbate 80. The vaccines with the highest prevalence of sensitization were AstraZeneca and Sputnik. Adverse reactions during skin testing occurred in 5 patients and the most frequent adverse event was headache.

Conclusions: A high frequency of sensitization to polyethylene glycol 2000 and polysorbate 80 was found. In sensitized patients, alternatives with vaccines that do not contain the excipients to which they were positive can be recommended to avoid the risk of subsequent adverse events.

Objective: To determine the factors associated with a poor prognosis in patients with RA at a 3rd level hospital.

Methods: Observational, analytical, longitudinal study of a cohort of patients with RA. The study continued for one year. The following were assessed as PPFs: sex, comorbidities, smoking, DAS 28 (disease activity), ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), ACCP (anti-citrullinated peptide antibody), RF (rheumatoid factor), and bone erosions. To statistical analysis: A Cox proportional hazards analysis was performed to analyze PPFs.

Results: A total of 260 patients were included, 26 failures and 234 censored, predominantly female sex, mean age 47 ± 11.7 years, the PPFs were: ACCP, late start of DMARD, and smoking. ACCP positive have 5.8 times the risk of escalating treatment, late DMARD have 4.6 times and those who smoked 7.7 times the risk.

Conclusions: Defining the PPFs remains a great challenge for researchers, however, it is imperative to identify them to predict the response to treatment and thus limit the functional and life damage of patients.

Objective: To evaluate the effect of high-dose eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation on the severity of allergic rhinitis and the quality of life of patients affected by this condition.

Methods: Randomized, double-blind, placebo-controlled study. Both groups received pharmacological treatment with intranasal fluticasone and allergy immunotherapy during the escalation phase. The control group received a placebo, while the experimental group received EPA capsules: 1340 mg and DHA: 924 mg daily for 2 months.

Results: The experimental group included 10 patients (2 men and 8 women), with a mean age of 31.5 ± 15.1 years, while the control group included 12 patients (5 men and 7 women) with a mean age of 27.4 ± 14.3 years (p = 0.56 for age). After the intervention, the median quality of life and nasal symptom scores were also similar between both groups (p = 0.668 and p = 0.920, respectively), with no significant differences.

Conclusion: Supplementation with high doses of EPA and DHA in patients with persistent allergic rhinitis was safe, but there was no evidence of a reduction in severity or improvement in quality of life compared to the placebo group. Further clinical trials are required to clarify its potential role as an adjunctive strategy.

Objective: To determine the frequency of sensitization to aeroallergens in skin prick tests and its association with the geographic distribution, time of year, age, and sex of patients with asthma and/or allergic rhinitis.

Methods: This was an observational, descriptive, and retrospective study conducted in patients older than 2 years with a diagnosis of asthma and/or allergic rhinitis. The results of skin prick tests collected between January and December 2023 at the Allergy Service of the Juárez Hospital in Mexico City were analyzed. A total of 23 allergens were evaluated. The results were categorized by age, sex, and allergen type using descriptive statistics.

Results: 734 tests were analyzed, of which 587 (79.9%) were positive. The positivity rate was highest in children (62.5%), followed by adults (22%) and older adults (1.4%). 52.5% of the cases were in women. The most frequently identified aeroallergens were tree pollen (37.6%), dust mites (20.4%), grasses (12.9%), and animal dander (12.5%). The most prevalent tree pollens were Fraxinus americanus (6.7%) and Prosopis sp. (4.7%), while the most common dust mites were Dermatophagoides pteronyssinus (11.1%) and D. farinae (9.3%). A high rate of polysensitization was observed (85.7%).

Conclusions: Sensitization to aeroallergens was more frequent in children and women. The most common allergens identified were tree pollens, particularly *Fusarium americanus*, and house dust mites, especially *Dirofilaria pteronyssinus*. These findings underscore the need for targeted preventive and therapeutic strategies that consider environmental factors such as climate change and the geographic distribution of allergens.

Objective: To describe the clinical characteristics of allergic diseases (AD) as comorbidities-distinct from primary atopic diseases (PAD)-in pediatric patients diagnosed with IEI.

Methods: An observational and retrospective study was made. We included pediatric population diagnosed with IEI and allergic comorbidity between 2013-2023. The diagnosis was done considering the criteria from the ESID and IUIS-2022. We performed a descriptive analysis of the variables (frequencies/percentages). For qualitative variables, we used OR to obtain the probability of occurrence of allergic sensitization among patients with AD and IEI. Every analysis was performed with the software R Studio version 3.2.2.

Results: There were 366 patients with diagnosis of IEI, 238 had concomitant AD. 59.6% were males. Mean age was 5 years. 84% had antibody-specific deficiencies, 8% combined immunodeficiencies associated to well-defined syndromes, 2.9% congenital defects in phagocytes, 2.5% combined-immunodeficiencies, 1.7% autoinflammatory diseases, and 0.8% defects in intrinsic and innate immunity. The distribution of the ADs was asthma 48.7%, rhinitis 18.9%, atopic-dermatitis 15.1%, food-allergy 8.4%, acute urticaria 5%, and chronic urticaria 3.8%.

Conclusion: Allergic diseases are increasingly recognized as key indicators for early IEI diagnosis. These conditions may coexist without representing PAD, emphasizing the need for comprehensive care. Recognizing this heterogeneity supports a multidisciplinary approach to improve early detection and management of IEI.

IgA vasculitis is the most common vasculitis in childhood, and its main feature is leukocytoclastic vasculitis, in which the capillaries are affected by the deposit of IgA immune complexes. Skin rash is the principal clinical manifestation, along with arthralgia or arthritis, digestive and renal tract involvement, and is often self-limiting. Although it occurs at any age, it prefers children between 3 and 12 years. It is common to identify a trigger, the most frequently associated with infection, with reports of up to 31% along respiratory tract infections, followed by gastrointestinal infections at 5%. Dermatological manifestations are the characteristic element of the disease; 100% of patients have purpura at some point; however, renal involvement determines the prognosis of these patients. The diagnosis is clinical, supported by laboratory and cabinet assistants and classification criteria; however, since the prognosis is mainly conditioned by renal involvement, having simple and safe alternatives, adequate follow-up, evaluation of the efficacy of the treatment, and the prognosis of the disease are some of the main objectives of biomarkers. Initial treatment consists of general measures, but in the case of gastrointestinal, renal, or other target organ involvement, such as testicles, therapy with corticosteroids and immunosuppressants is necessary. Since the end of the last century, it has been recognized that not all patients with IgA vasculitis had a benign outcome; however, recent data supports a deleterious outcome both in patients with nephritis and in pregnancy.

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse reaction. The incidence is 1-1,000,000 with a mortality rate of 3.8-10%, and it is a disease associated with reactivation of the herpes simplex virus.

Case report: A 34-year-old woman with atopy and venous insufficiency presented with pruritic hives on her face and arms, which progressed to a morbilliform rash, facial edema, fever, lymphadenopathy, and scaling. A complete blood count showed no abnormalities: AST: 837 U/L, ALT: 11352 U/L. Due to the suspicion of DRESS syndrome, treatment with corticosteroids was initiated and a biopsy was obtained. Upon questioning, the patient reported having taken diosmin-hesperidin and undergone systemic sunscreen (Heliocare360°®) 21 days prior to the onset of the rash. Histopathological examination revealed atrophic epidermis, vacuolar degeneration, and inflammatory infiltrate. Systemic corticosteroids were administered for three weeks, with a satisfactory response. Two months later, the patient experienced reactivation of the dermatosis and hypertransaminasemia; the autoantibody panel and serology were positive for IgM for herpes simplex virus.

Conclusion: This case underscores the need to consider severe hypersensitivity reactions, even with commonly used and apparently low-risk drugs. The importance of a comprehensive approach, including identification of the suspected medication, exclusion of differential diagnoses, prolonged clinical follow-up, and surveillance for possible viral reactivation, is emphasized.

Introduction: Egg allergy is a common cause of food hypersensitivity, especially in the pediatric population, with an estimated prevalence of 9%. The main proteins involved are ovomucoid (Gal d 1), the most allergenic, and ovalbumin (Gal d 2), the most abundant. Although most cases remit in childhood, certain factors are associated with persistence into adulthood, such as elevated levels of specific IgE, the presence of other food allergies, and atopic diseases.

Objective: To determine the frequency of egg sensitization in patients with symptoms reported after egg consumption and to describe the clinical characteristics of the sensitized population.

Methodology: A prospective study was conducted between August 2024 and February 2025. 57 patients (pediatric and adult) with symptoms suggestive of egg allergy were included. Skin tests to ovalbumin, ovomucoid, and egg yolk were performed. In pediatric patients, serum-specific IgE was determined.

Results: Sensitization was positive in 37.5% of children and 14% of adults. Reactivity to ovomucoid was observed in 66% of sensitized children and 85% of sensitized adults, to ovalbumin in 100% of children and 57% of adults, and to egg yolk in 33.3% and 42%, respectively. The most common comorbidities were allergic rhinitis (60%), allergy to other foods (40%), and atopic dermatitis (10%). 57% of adults had a history of anaphylaxis.

Conclusions: Sensitization to egg was more frequent in the pediatric population. Ovomucoid was the most frequently implicated allergen. The presence of atopic diseases was common, especially in adults. Although skin prick tests do not confirm the diagnosis of allergy, their high negative predictive value makes them useful as an exclusion tool.

Background: Inborn errors of immunity are a heterogeneous group of diseases caused by a diminished or absent response of one or more components of the immune system. IgG subclass deficiency is more common in childhood, especially in boys than in girls. IgG2 deficiency is the most common, followed by IgG3 deficiency.

Case report: A male pediatric patient experienced respiratory distress of viral and bacterial origin and asthma in his early years, with frequent emergency room admissions and/or hospitalizations. At age 5, he was diagnosed with cyclic neutropenia, so the Pediatric Hematology Department decided to offer conservative treatment. At age 6, he was evaluated by an Otorhinolaryngologist, who diagnosed allergic rhinitis and performed a septumplasty and turbinectomy. At age 7, he was evaluated by an Allergist, with normal laboratory results: immunoglobulin profile, lymphocyte subpopulations, and blood count. Subcutaneous allergen-specific testing was positive. Treatment with subcutaneous immunotherapy was initiated. At age 9, the patient relapsed, with symptoms of upper respiratory tract infection and asthma. Laboratory studies revealed IgG3 deficiency (7.81 mg/dL), so treatment with intravenous immunoglobulin was initiated.

Conclusion: The administration of human immunoglobulin and monoclonal antibodies is associated with a reduction in respiratory symptoms in patients with inborn errors of immunity and a better quality of life.

Background: Ocular allergy encompasses pathologies mediated by type I hypersensitivity, affecting the ocular surface. For diagnosis, it is essential to take a clinical history, perform an examination, and verify sensitization to aeroallergens using in vivo and/or in vitro tests. There are cases of patients with negative serum IgE levels, low serum IgE levels, and persistent symptoms and clinical manifestations. In these cases, ocular challenge tests are useful to confirm local allergy.

Cases report: Case 1: A 10-year-old male diagnosed with allergic conjunctivitis. Skin prick tests were negative. Serum IgE 35 IU/ml, tear sIgE, DPT 0.37 kUA/L, DF 0.14 kUA/L. Case 2: A 28-year-old male diagnosed with allergic conjunctivitis. Skin tests were negative: serum IgE 1 IU/ml, tear sIgE DPT 0.12 kAU/L, DF 0.1 kAU/L. An ocular challenge was performed with a DPT/DF mixture containing a standardized ALK-abelló extract mixture-DPT/DF-10,000 AU/ml. The TOSS (Total Ocular Symptom Score) scale was used to confirm the ocular challenge. The challenge was positive in both patients for DPT/DF [100 AU/ml] in a 1:100 dilution, with a TOSS score of 8 points each. A provocation test was performed on a healthy control patient. No local ocular reaction occurred. TOSS score = 0 points. Outcome: Patients were receiving topical ocular drug treatment.

Conclusion: Local reactions were positive in both patients, confirming local ocular allergy. A standardized allergen extract (ALK-abelló) with a DPT/DF mixture of 10,000 AU/ml was used, and the test was positive at 100 AU/ml at a 1:100 dilution. No local ocular reaction was observed in a healthy control patient at the highest concentration (10,000 AU/ml) and at a 1:1 dilution. Ocular challenge with a standardized DPT-DF extract is a safe and reproducible test that confirms local allergic conjunctivitis in both pediatric and adult patients. No adverse effects were observed with the presented protocol.