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

Background: DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a drug-related hypersensitivity reaction that manifests with eosinophilia, systemic symptoms, and is sometimes life-threatening. It is clinically characterized by a generalized rash, fever, facial edema, and multiorgan failure. It may be accompanied by paraclinical findings such as leukocytosis, eosinophilia, and abnormalities in renal and liver function tests.

Case report: We present the case of a 10-year-old female patient hospitalized with a diagnosis of pansinusitis complicated by epidural empyema requiring surgical drainage. Prior to this, she was treated with levetiracetam. After surgery, she was maintained on a triple regimen of vancomycin, ceftriaxone, and metronidazole. Upon completion of this treatment, she developed a generalized dermatosis that did not respond to second-generation antihistamines or corticosteroids. After this, the patient presented with fever, facial edema, and a seizure. Laboratory studies were ordered, revealing leukocytosis and eosinophilia. DRESS syndrome was suspected, with a RegiSCAR score of 5, corresponding to a probable case. Treatment with immunoglobulin was initiated, with clinical improvement and resolution of the condition observed.

Conclusions: DRESS syndrome is a severe drug-induced reaction, with an estimated mortality rate of 10%. Early recognition and timely initiation of treatment are essential for prognosis and prevention of potential complications.

Background: Erythema nodosum is the most common clinical-pathological variant of panniculitis, presenting with erythematous nodular lesions. Infections are the most common cause. However, other causes cannot be ruled out: immunological, inflammatory, or metabolic. Therefore, the diagnosis must be multidisciplinary and direct treatment toward the underlying cause, as in most cases, it is usually the tip of the iceberg of a significant pathological process.

Case report: An 18-year-old female patient with a history of hepatoblastoma, nephrocalcinosis, and recurrent infections presented one month later with characteristic erythematous lesions on the left tibia, with subsequent edema and limited movement. Paraclinical studies were performed, and the diagnosis of septal panniculitis without vasculitis and perivascular inflammatory infiltrate was confirmed by biopsy.

Conclusion: Although erythema nodosum usually heals spontaneously, it can be the initial expression of infectious, immunological, or genetic diseases, so an early and multidisciplinary diagnostic approach is important to guide treatment and improve prognosis.

Introduction: Allergic pulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus antigens. Its diagnosis can be delayed when it overlaps with other pulmonary conditions. We present the case of a patient with a history of childhood asthma and post-tuberculosis pulmonary sequelae, treated for years as severe asthma without improvement. ABPA was confirmed, but the late diagnosis limited therapeutic options, resulting in a fatal outcome.

Case report: A 61-year-old woman with a history of childhood asthma, hypertension, sleep apnea, and chronic cor pulmonale presented with pulmonary tuberculosis in 2000, which resolved after treatment, leaving sequelae such as bronchiectasis and oxygen dependence. She presented with persistent dyspnea and frequent exacerbations, with no improvement with treatment for severe asthma. Paraclinical tests: total IgE 2321 IU/mL, eosinophilia 908.4. Skin tests and specific IgG/IgE for Aspergillus fumigatus were positive. ABPA was diagnosed according to the International Society of Human and Animal Mycology (ISHAM) criteria. The patient was started on itraconazole and steroids. However, he developed massive hemoptysis, septic shock, and died in March 2025.

Conclusion: Allergic bronchopulmonary aspergillosis is an immunologically mediated disease. It occurs in patients with a history of asthma or cystic fibrosis. In susceptible individuals, Aspergillus produces an exaggerated immune response. In this case, the history of tuberculosis and bronchiectasis delayed diagnosis, resulting in delayed management and fatal complications. This scenario underscores the need for a high index of suspicion for ABPA in patients with bronchiectasis, asthma, and cystic fibrosis with refractory respiratory symptoms. Early diagnosis and timely treatment can improve the prognosis and reduce potentially fatal complications.

Introduction: Ormond syndrome, or idiopathic retroperitoneal fibrosis, is a rare disease with an annual incidence of 0.1 to 0.4 cases per 100,000 inhabitants and a prevalence of 1.4 per 100,000 inhabitants. It primarily affects men (2-3:1), with diagnosis between 40 and 60 years of age. It is characterized by the growth of fibroinflammatory tissue in the retroperitoneum, with possible compression of vascular and urinary structures. Its diagnosis is complex and requires ruling out malignancy or other secondary causes. We present a case with a late diagnosis and referral to immunology due to hypogammaglobulinemia secondary to rituximab.

Case report: A 54-year-old male patient with chronic kidney disease on hemodialysis was diagnosed in 2006 with retroperitoneal fibrosis after findings of ureteral stenosis and periaortic masses. Biopsies were performed, ruling out malignancy and IgG4-RD. In 2023, the patient received rituximab for inflammatory reactivation, with clinical improvement, but developed severe hypogammaglobulinemia (IgG <500 mg/dL), prompting referral to the immunology department. Subcutaneous immunoglobulin was started, with clinical stabilization. A relevant prior finding was low IgG3 levels before rituximab, with no clear relationship to Ormond syndrome.

Conclusion: This case highlights the importance of considering Ormond syndrome in unexplained retroperitoneal fibrosis and the need for a multidisciplinary approach. It also underscores the importance of early diagnosis and close follow-up in patients with chronic fibroinflammatory disease, as well as immunological monitoring in those receiving immunosuppression, to prevent and treat associated complications. Given its rarity, it is essential to document more cases to improve understanding and management of this condition.

Objective: To evaluate the frequency of IgE sensitization and allergenic capacity of pollen grains of Artocarpus communis, Cecropia peltata and Fraxinus uhdei in allergic rhinitis patients.

Methods: A cross-sectional study with comparative groups: a rhinitis group and a control group. The three pollen extracts were prepared, and IgE sensitization was assessed using the skin prick test and serum-specific IgE. Allergenicity and clinical relevance were subsequently evaluated using the basophil activation test (BAT) and the nasal challenge test (NCT).

Results: A total of 60 people were included in the control group and 60 in the case group. None in the control group and a total of 8 (13.3%) from the rhinitis group were sensitized to one of the 3 pollen extracts: two (3.3%) to A. communis, two (3.3%) to C. peltata and four (6.6%) to F. uhdei. All three extracts were able to induce basophil activation in patients with IgE sensitization, but not in those without sensitization. NCT was performed in the eight patients with IgE sensitization, resulting positive for 1/2 patients with Artocarpus, 1/2 with Cecropia y 2/4 with Fraxinus.

Conclusions: All three pollen sources tested induce IgE sensitization and clinical symptoms, highlighting the importance of evaluating the allergenicity of native plant sources for each region.

Background: Acquired angioedema (AEA) is rare and usually appears after the fourth decade of life. It is characterized by recurrent episodes of nonpuriginous angioedema affecting the skin, gastrointestinal tract, and upper respiratory tract, making it difficult to distinguish from hereditary angioedema.

Case report: Clinical presentation: A 44-year-old man with a history of non-Hodgkin lymphoma (NHL) in 2021, which was remitted. He presented with facial angioedema lasting 5 hours in June 2024, painless and non-puriginous. He denies recognizing any environmental factors, medications, or foods that exacerbate the condition, nor does he have a history of atopy. Laboratory/imaging studies: normal bile duct, IgE, ANA, C3, and C4. Thyroid profile was unremarkable. ESR and stool samples were normal. Autologous serum albumin (ASL) was negative. Physical urticaria tests were negative. C1 inhibitor was pending. Possible infectious processes were ruled out. Outcome: Partial improvement with antihistamines. In January 2025, the patient presented with a dry cough, which progressed to hemoptysis. A chest CT scan demonstrated a tumor in the right apex. Bronchoscopy with biopsy confirmed infiltration by NHL.

Conclusion: There are two forms of AEA: type I with a recognized association with lymphoproliferative disorders, with NHL accounting for 20% of cases. It can precede the onset of NHL by an average of 2.3 years; in this case, it was the first manifestation of relapse. She has currently started chemotherapy without further episodes of angioedema. Late-onset angioedema in adulthood can be associated with a wide variety of underlying diseases, with hematologic malignancies being a significant group. A deliberate search for clinical data on malignancies leads to their timely identification.

Objective: This study evaluates the economic burden of hereditary angioedema (HAE) and compares the impact of on-demand treatment versus longterm prophylaxis (LTP) with Lanadelumab, from the perspective of the public health system in Mexico.

Method: A systematic literature review and modified Delphi Panel were conducted to understand the resource use of public sector institutions in the diagnosis and treatment of HAE. Costs were obtained from institutional sources such as the IMSS contracting portal and the Diagnosis Related Groups (DRG-2017). The economic burden considered direct medical costs. The results express the annual cost per patient with and without long-term prophylaxis.

Results: With a correct diagnosis, the cost is $5,154.78 MXN (250.20 USD). Without long-term prophylaxis, the annual cost per patient is $3,446,790.56 MXN (167,229.63 USD), with 70% peripheral attacks, 28% abdominal attacks, and 1% laryngeal attacks. Medical expenses are divided into 38% treatment, 36% complications, and 20% hospitalizations. With LTP, the annual cost is $2,641,682.18 MXN (128,221.44 USD), with 8% for attack treatment and 92% for prophylaxis. Prophylactic treatment reduces the economic burden of HAE attacks by 94.2% compared to on-demand treatment and decreases the economic burden by 23% from an institutional perspective.

Conclusions: HAE represents a high economic burden, affecting hospitalizations and productivity. LTP with Lanadelumab reduces the burden on the Mexican healthcare system.

Background: Ant sting allergy can trigger from local cutaneous manifestations to fatal anaphylaxis, last one with an incidence of 23.5% in adults. Immunotherapy is effective in 9798% of cases to reducing the frequency and severity of these reactions, to reduce the risk of anaphylaxis to 5% compared to 60% in patients without immunotherapy.

Objective: Describe the clinical characteristics, course, and response to specific immunotherapy in patients with ant sting allergy.

Methods: A retrospective, observational, and descriptive study was conducted in nine patients with allergic reactions to ant stings from 2017 to 2025. Age, sex, history of atopy, type of reaction, skin testing, and clinical course were analyzed.

Results: The mean age was 37.8 years (range 1159), with a female predominance (66.7%). Of the patients, two (22.2%) had local reactions and seven (77.8%) had systemic reactions, including two cases of anaphylaxis. Thirty-three percent (33.3%) had a history of allergic rhinitis, and 22.2% had an allergy to other insects. Five patients received immunotherapy; during follow-up, none presented systemic reactions after re-exposure, and one patient had a mild cutaneous reaction without requiring hospitalization.

Conclusion: A high frequency of systemic reactions was observed in patients allergic to ant venom, exceeding that reported in the literature. Immunotherapy reduced the severity of reactions after re-exposure. Ant venom immunotherapy is effective in reducing the severity of allergic reactions and the risk of anaphylaxis during future exposures, being the only treatment shown to modify the natural history of the disease.

Introdution: The milpa diet (MD) is a balanced and accessible nutritional model based on the biodiversity of Mexico. Currently, research on allergens involved in food allergy (FA) has focused on foods with high global consumption, without analyzing foods included in MD.

Objective: To describe the allergens contained in MD.

Methods: A specific search was performed using the PUBMED-NCBIwebsite for MD and their respective allergens implicated in FA. Of the articles identified, those that had at least one allergen reported in the WHO/IUISsoftware were evaluated, as well as their UniProt code, necessary to access protein sequencing by BLAST software. We then conducted identification analysis using the AllerCatPro 2.0 software, setting a threshold of above 60% correlation of identity among proteins included in MD.

Results: Only 11 (16.9%) MD foods have reported associations with FA (pineapple, chili pepper, tomato, amaranth, sapodilla, peanut, avocado, squash, corn, green beans, and papaya). Likewise, 19 protein families were associated; profilins and nsLTP1 were the most frequent, presented in four and six foods, respectively. Five proteins (PR-10, TLP, cyclophilin, class IV chitinase, and nsLTP2) were identified in two foods, while twelve proteins (oleosins, conglutins, defensins, polygalacturonase, cupin, chymopapain, bromelain, L-ascorbate oxidase, 11S and 2S globulins, beta-fructofuranosidase, and ole-1-like protein) were identified in at least one food. The highest identity was found between profilins from chili pepper (cap*a*2.0201) and tomato (Sola*l*1.0101) at 94.7%.

Conlusion: Among 1080 molecules implicated in allergic responses, the bioinformatic analysis identified only ~5% in MD. However, in vitro confirmation of these findings is necessary. Foods in the MD contain a higher proportion of nsLTP1 and profilins.

Introduction: Asthma has a significant global impact, affecting approximately 260 million people worldwide. Although mortality has decreased in recent years, it still causes around 420,000 deaths annually. This study aims to describe hospital mortality due to asthma in Mexico during the period 20202024.

Methods: A descriptive, observational, cross-sectional, and retrospective analysis was conducted using public records from the General Directorate of Health Information. Deaths with a diagnosis of asthma (ICD-10 codes J45, J46) were analyzed. Hospital mortality, averages, frequencies, and proportions were calculated. The variables included: year, age, sex, and federal entity.

Results: In Mexico, between 2020 and 2024, a total of 188 hospital deaths due to asthma were recorded, with an overall hospital mortality rate of 0.09% and an annual average of 0.1%. Mexico City reported the highest number of deaths (n=21), while Hidalgo registered the highest mortality rate (0.42%). The year with the most deaths was 2023 (n=46), and 2021 had the highest mortality rate (0.14%). Of all deaths, 56.45% were in women and 43.55% in men, with mortality rates of 0.1% and 0.08%, respectively. Adults aged 60 years and older accounted for the highest number of deaths (n=64) and the highest mortality rate (0.31%). The 10 to 14-year-old age group had the highest number of discharges but only 7 deaths, with a low mortality rate (0.01%).

Conclusions: Although asthma mortality has shown a decreasing trend in recent years, it remains a public health problem in Mexico. Between 2011 and 2021, an estimated 36,009 Years of Life Lost due to Premature Death occurred annually due to asthma, highlighting its ongoing epidemiological burden. Since most asthma-related complications and deaths are largely preventable, more effective strategies must be implemented to support its prevention.