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

Background: Urticarial vasculitis (UV) is a rare entity affecting small blood vessels, characterized by persistent (>24 hours) urticarial lesions with histopathological findings of leukocytoclastic vasculitis. It is classified as normocomplementemic (NUV) and hypocomplementemic (HUV), the latter associated with systemic diseases such as systemic lupus erythematosus (SLE). Its incidence is 0.5 per 100,000 person-years.

Case report: Clinical presentation: A 66-year-old female with a history of SLE, hypothyroidism, and osteoarthritis developed in 2022. In 2022, she developed a dermatosis disseminated to all four body segments with pruritic wheals lasting up to 72 hours, persisting for more than six weeks, and followed by post-inflammatory hyperpigmentation. No triggering factors were identified. She also presented episodes of palpebral and labial angioedema. Given the clinical features, a skin biopsy and complement measurement were performed. Imaging/laboratory studies: Skin biopsy: Superficial neutrophilic vasculitis (venulitis) with erythrocyte extravasation. Lab results 2023: C3: 79.7 mg/dL. C4: 10.8 mg/dL.

Conclusion: This case highlights the importance of considering hypocomplementemic urticarial vasculitis in patients with SLE and persistent urticarial lesions, as well as conducting a targeted history. Given the risk of systemic involvement, close follow-up and a multidisciplinary approach are essential. The diagnosis of UV requires clinical-histopathological correlation, with biopsy recommended for persistent lesions (>24 h), residual bruising, or systemic manifestations. Early identification and appropriate management are essential to prevent systemic complications. Treatment focuses on addressing underlying autoimmune diseases and managing symptoms with antihistamines, corticosteroids, or immunosuppressants, depending on the severity and systemic involvement.

Case report: A 24-year-old woman with asthma (2013) and allergic rhinitis (2014) was treated for 3 years with subcutaneous immunotherapy, inhaled salmeterol/fluticasone, and external antihistamines. She presented to our department (2019). Upon admission, her asthma persisted with uncontrolled asthma, daily use of a rescue inhaler, and persistent moderate-severe rhinitis. Asthma treatment was adjusted according to guidelines, reaching step 4 of treatment, with persistent lack of control (ACT 16 points), meeting criteria for starting Benralizumab 30 mg (July 26, 2024). Two doses were completed with clinical improvement (ACT). However, during two doses, the patient presented with fever, headache, myalgia, and arthralgia, so treatment was discontinued. Symptoms worsened. A decision was made to switch from the biotechnological agent to mepolizumab (February 4, 2025), with adverse effects after the third dose.

Conclusion: A percentage of patients with asthma presented with severe symptoms, 80% with an eosinophilic phenotype, associated with difficult control and increased exacerbations. Monoclonal antibodies are indicated in these patients. Benralizumab, which targets IL-5Rα, induces eosinophil depletion through antibody-mediated cytotoxicity. Several studies (MELTEMI) have been conducted to evaluate the safety of long-term use. The most common non-serious adverse effects include upper respiratory tract viral infections (47.3%), while less common adverse effects are headache and arthralgia, which account for 20.9% and 6.4%. Biotechnological agents reduce exacerbations, reduce corticosteroid use, and improve control and quality of life. However, they are not exempt from adverse effects, and even the less common ones should be identified to assess continued treatment.

Introduction: Common variable immunodeficiency (CVID) is the most common symptomatic immunodeficiency in adults, diagnosed by exclusion in cases of hypogammaglobulinemia without an identifiable cause. Its manifestations range from recurrent infections to autoimmunity and risk of malignancy.

Case report: A previously healthy 11-year-old female patient was originally from and resides at Rancho El Nogal in Arandas, Jalisco, a community of approximately 250 inhabitants. There was no significant family history; there was no known consanguinity or presence of genetic diseases in the family. Outcome: After trauma to the left leg, she developed osteomyelitis. Upon admission, pancytopenia, enlarged lymph nodes, hepatosplenomegaly, and abscesses with positive cultures for Staphylococcus aureus were detected. An approach to detecting inborn errors of immunity was initiated, revealing decreased immunoglobulin G and A levels. Due to the severe systemic infection, intravenous immunoglobulin was administered at 1 gram/kilogram, and the immunosuppression study was expanded. Abnormalities in the lymphocyte subpopulation were detected, with decreased CD19+ counts: 71 mm³, CD3+ counts: 915 mm³, CD4+ CD45RA+ T cells (naive): 92 mm³, total memory B cells (3%), non-isotype-switched (2.5%), isotype-switched (0.5%), plasmablasts (0.3%), and decreased CD21 counts (9%). The patient was classified as Freiburg 1B common variable immunodeficiency. Monthly intravenous immunoglobulin was started at a dose of 400 milligrams/kilogram. The patient responded favorably to immunoglobulin treatment, with no subsequent serious infections. She remains stable and is being monitored by immunologists.

Conclusion: CVID, although more common in adults, can present in children. S. aureus sepsis as an initial manifestation, as in this patients case, should raise concerns about possible underlying immunodeficiencies. This case highlights the importance of suspecting primary immunodeficiencies in patients with severe infections, underscoring the need for early diagnosis and treatment to optimize prognosis.

Background: Allergic rhinitis is the most common allergic disease in the world. Asthma and conjunctivitis are highly associated comorbidities, with dust mites being one of the main sources of involved allergens. The primary objective was to identify the most frequent aeroallergens in patients with allergic rhinitis, as well as to evaluate demographic factors and determine the most prevalent comorbidities.

Method: This was a cross-sectional, descriptive, observational, and retrospective study through the review of clinical records of patients diagnosed with allergic rhinitis treated in the Immunotherapy Clinic of the Allergy and Clinical Immunology Service.

Results: A total of 200 patients were studied, 74% of whom were women, with a median age of 38 years. The majority of the population evaluated were from the southern areas of Mexico City, mainly from the Iztapalapa delegation (22.50%), Álvaro Obregón (14%), and Coyoacán (12.50%). The most frequent comorbidities were asthma (61%) and conjunctivitis (60%). 88% of the patients showed polysensitization. Fraxinus excelsior was the most frequent aeroallergen (47.50%), followed by dust mites, Dermatophagoides Pteronyssinus (42%) and Dermatophagoides Farinae (40%).

Conclusions: Although dust mites are typically considered the most frequent allergens, in this study, Fraxinus was the most prevalent. The comorbidities correspond exactly as described in the literature. The study successfully achieved its primary objective of identifying the most common comorbidities and demographic factors, providing better insight into the characteristics of our current population.

Introdution: Allergic sensitization (AS) assessed through in vitro methods (iv-M) has shown adequate sensitivity and diagnostic correlation. Recently, AS profiles have been compared with pollen distribution, which strengthens the clinical relevance of their results in the population where they are applied.

Objetive: Describe the pattern of AS using iv-M, as well as the dispersion volume of the main pollens in Mexico City (CDMX) identified through iv-M.

Methods: Aeroallergen profiles (iv-M-EUROIMMUN/Lübeck) from 197 patients with allergic rhinitis recruited in 2022 were analyzed. Results were grouped by family and species. Similarly, the distribution of the most relevant pollens was studied retrospectively using iv-M data from 2017 to 2022 (www.rema.atmosfera.unam.mx). Frequency/SA (χ²) and median/pollen volume (Wilcoxon) analyses were performed using SPSS v.21, considering a p-value< 0.05 as statistically significant. Results: Weeds and trees were the predominant groups (~65% vs. grasses at 42.5%, p<0.01). Specifically, the Chenopodiaceae-Amaranthaceae (Ch-A) family (57.8% vs. Asteraceae at 20.8%, p<0.001) and the Oleaceae family (44.6% vs. Fabaceae/Fagaceae at ~31.9%, p<0.001) shaped the results. Among the main pollens, Salsola kali (50.7%), Atriplex hortensis (41.6%), and Fraxinus sp. (38%) stood out. This profile was not influenced by age or sex. Regarding pollen distribution, the Ch-A family showed high levels until 2021, when they began to decline (p<0.001). In contrast, Fraxinus sp. pollen showed high volumes only during specific months (p<0.001).

Conclusion: The identification of Ch-A is likely related to the presence of Ole-like-1 in Fraxinus, the species with the highest distribution volume. iv-M found that there was more SA in the Ch-A family and Fraxinus sp., both of which had more pollen spread in the years before the diagnostic evaluation.

Objective: To determine the prevalence of house mites in food pantries and assess it as a possible environmental risk factor triggering allergic diseases in the provinces of Panama and Panama Oeste.

Methods: This was a descriptive, cross-sectional exploratory study with a quantitative approach to the composition of house mites present in home pantries over a 12-month period. Data were processed using Minitab^® 17, Epi Info^® 7.2.5.0, and Microsoft Excel^®. Odds ratios (ORp) were calculated between food and dust contaminated with mites among allergic participants.

Results: A total of 326 dust samples and 330 food samples were obtained, with 100% participation (n = 330) for the surveys. The non-economically active population was the occupational group with the highest participation rate, at 64.2%. The OR for dust was CI95%: 1.11 (0.4972.501), p (0.7912), and for powdered foods, CI95%: 1.15 (0.704-1.8920), p (0.5676).

Conclusions: As with bedrooms, pantries provide the right environmental conditions for the development and proliferation of house dust mites, constituting a significant source of allergens within homes.

Background: CTLA4 deficiency is a disorder caused by mutations in the CTLA4 gene. T (TL) and B (BL) lymphocyte activity is affected, generating complex autoimmune dysregulation and immunodeficiency syndromes with variable clinical spectrum and diagnostic difficulty.

Case report: Clinical Presentation: A 16-year-old male with no significant family history presented with autoimmune hemolytic anemia, thrombocytopenia, episodes of diarrhea, atopic dermatitis, respiratory tract infections, rhinosinusitis, and recurrent otitis media, with multiple antibiotic therapies. Laboratory tests indicated immunoglobulin replacement and prophylactic antibiotic therapy with improvement. He continued to experience intermittent diarrhea and skin lesions. Biopsies ruled out infectious etiologies, and the patient was diagnosed with lichen planus, nummular eczema, and enteropathy associated with immunodeficiency. Treatment with immunosuppressants was initiated. Genetic testing diagnosed heterozygous CTLA4 deficiency. Laboratory results: IgA 1 mg, IgG 356 mg, IgM 2 mg, Leukocytes 9700/mm3, Neutrophils 8179/mm3, Monocytes 442/mm3, Lymphocytes 1055/mm3, LT 86.12% 909/mm3, LB 0.85% 9/mm3, NK cells 14.75% 156/mm3, LTCD4+ 60.82% 553/mm3, LTCD8+ 35.44% 322/mm3, isotype-switched memory LB 0%, non-isotype-switched memory LB 1.83%, CD21low LB 30.94%, LTnaive 8.84%, LTLmemory 82.66%.

Conclusion: The diagnosis of this pathology is difficult due to its wide clinical presentation. Impaired LT and LB function leads to severe autoimmune processes and progressive hypogammaglobulinemia, recurrent infections, and malignancies. Immunoglobulin, prophylactic antibiotics, immunosuppressants, and bone marrow transplantation are the mainstays of treatment. Recognizing this genetic defect allows for targeted treatment (abatacept) that will improve the quality of life and prognosis of patients.

Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystem inflammatory disease. It presents a type 2 inflammatory profile and IL-5 overexpression which stimulates eosinophil production and contributes to the development of severe and late-onset asthma.

Case report: We present the case of a female in her sixth decade of life, diagnosed with EGPA 37 years ago and currently with severe asthma. Despite being on triple inhaled therapy, she exhibited persistent severe airflow obstruction (ACT: 13; ACQ- 5: 2; blood eosinophils: 545 cells/μL). Mepolizumab 100 mg monthly (institutionally approved dosage) was initiated for over a year, with poor clinical response and multiple exacerbations. A switch to benralizumab 30 mg every two months was made, achieving sustained clinical control within four months: normalized spirometry, ACT: 22, ACQ-5: 0.2, undetectable serum eosinophils, and no exacerbations. This allowed discontinuation of the second controller inhaler and reduction to a low dose of inhaled corticosteroid, without adverse events attributable to treatment.

Conclusion: A significant challenge in institutional clinical practice is that both biologics are approved only at doses indicated for severe eosinophilic asthma, resulting in suboptimal dosing according to international guidelines for EGPA. In institutional practice, benralizumab at 30 mg every two months may be a viable therapeutic option for patients with severe asthma secondary to EGPA, aiming to reduce corticosteroid dependence and improve respiratory function.

Introduction: The coadministration of allergen extracts with bacterial preparations has gained clinical relevance in subcutaneous immunotherapy for respiratory allergic diseases. However, there are no systematic studies evaluating the physicochemical stability or preservation of immunological activity of these mixtures. This study aimed to characterize the stability of a combined formulation using the Advanced Kinetic Model (AKM), a mathematical approach to shelf-life prediction based on nonlinear kinetics.

Methods: A lyophilized mite extract (D. pteronyssinus/D. farinae) and an inactivated bacterial suspension (IPI-Asac) were used. Incubations were performed at 4, 15, 30, 37, and 45°C for up to 90 days, with chromatographic (SEC-HPLC), electrophoretic (SDS-densitometric PAGE), and functional (ELISA-IgE) analyses. The samples were studied separately and in a 4:1 ratio (extract:bacteria). The AKM model was applied to the IgE-binding loss data to extrapolate long-term stability.

Results: No significant differences were observed between the extract alone and the mixture in terms of aggregation, protein degradation, or loss of IgE-binding capacity. At 15°C, >90% activity was retained for up to 90 days. Conclusion: The AKM model predicted a retention of 75% functional activity at 4°C for up to 1.5 years. The bacterial suspension did not alter the degradation kinetics or biophysical profiles.

Conclusions: The data obtained suggest that the inclusion of an inactivated bacterial suspension does not compromise the conformational or functional stability of the allergens. The maintenance of IgE-specific activity under simulated storage conditions supports the technical feasibility of a coformulation. The application of the AKM model provided robust predictions of biological longevity without requiring prolonged stability studies under real-world conditions. The blending of allergenic extracts with inactivated bacterial suspensions preserves their immunological and biophysical properties under accelerated thermal conditions. These findings support the possibility of formulating combination products without negatively impacting immunotherapeutic efficacy, justifying additional clinical studies and multi-batch validation.

Background: Cephalosporin-induced anaphylaxis is uncommon (6.1/10,000 exposures), and the diagnosis in pediatrics entails challenges due to nonspecific clinical histories and lack of standardized diagnostic tests. G-Penicillin has demonstrated diagnostic utility in the absence of penicilloilpolylisin, with a negative predictive value up to 95.2% when combined with controlled oral challenge. The basophil activation test (BAT) has a variable sensitivity (3875%), depending on the assessed biomarker.

Case report: A 13-year-old male presented anaphylaxis two minutes after receiving intramuscular ceftriaxone. He presented with pharyngeal pruritus, facial angioedema, dyspnea, vomiting, and altered alertness. The condition resolved with intramuscular adrenaline and intravenous crystalloid administration. Test results: BAT for ceftriaxone and cefuroxime were negative. Skin tests were negative for penicillin and cefuroxime and positive for ceftriaxone. Outcome: Oral challenge with amoxicillin was tolerated. The use of ceftriaxone and cephalosporins with an identical R1 side chain were contraindicated.

Conclusions: When dealing with a patient with drug allergy, clinicians should implement diagnostic tools that include skin testing with specific antibiotics and oral challenge. It is important to reconsider unconfirmed allergy labels, as it is estimated that between 58% and 75% of pediatric patients diagnosed with cephalosporin allergy present low-risk symptoms and could be delabeled with appropriate protocols. Cephalosporin anaphylaxis requires a combined evaluation. Penicillin G skin testing and oral challenge are key tools to guide safe antibiotic treatment.