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

Introduction: Severe congenital neutropenia type 1 (SCN1) is a rare inherited disorder caused by arrested granulocyte maturation, frequently associated with mutations in the ELANE gene, which encodes neutrophil elastase.

Case report: A 3-year-5-month-old female patient with a history of recurrent perianal infections and necrotizing fasciitis secondary to appendicitis complicated by septic shock. She required laparotomy, appendectomy, ileostomy, debridement, and vasoactive amine support. During her hospitalization, persistent severe neutropenia, lymphopenia, and eosinophilia were identified. Bone marrow aspirate showed arrested myeloid leukemia with an absence of neutrophils. Among the infectious isolates, the following were isolated: P. aeruginosa and Stenotrophomonas maltophilia, as well as rhinovirus/enterovirus. The neutrophil count remained persistently low (100-530/μL), responding to G-CSF (5 mcg/kg/dose). Genetic sequencing revealed a heterozygous missense mutation in ELANE (c.684C>G, p.Tyr228Ter).

Conclusion: The diagnosis of NCG1 was clinically supported by severe infections, persistent neutropenia, absence of mature granulocytes in the bone marrow, and genetic confirmation. This mutation generates a premature stop codon. Other relevant variants include GFI1, HAX1, VPS45, JAGN1, CSF3R, and WAS. NCG1 should be suspected in pediatric patients with recurrent severe infections and persistent neutropenia. Early identification and the use of G-CSF can improve clinical outcome and reduce infectious complications.

Case report: A 77-year-old male patient with a history of facial angioedema 20 years prior after ingesting 500 mg of acetylsalicylic acid (ASA). In 2024, he underwent angioplasty with coronary stenting without ASA. He was admitted to the emergency department with chest pain. Coronary angiography confirmed acute myocardial infarction requiring stenting and repositioning. The catheterization department recommended triple therapy with clopidogrel, anticoagulant, and ASA. Due to the history of adverse reactions, a consultation was requested to assess tolerance to ASA. An oral challenge/desensitization was performed. Prior to the procedure, he presented with a peak expiratory flow (PEF) of 450 L/min, normal vital signs (VS), and a 5-point clinical score. ASA was administered every 15 minutes in progressive doses of 10 mg, 32 mg, 85 mg, and 174 mg, until reaching a cumulative dose of 301 mg. PEF, SV, and EC were monitored every 15 minutes for up to 4 hours after the start of treatment, with no changes. The following day, a loading dose of 300 mg of ASA was administered prior to coronary catheterization, followed by a maintenance dose of 100 mg/d.

Conclusion: Various desensitization regimens exist. Khan proposes a regimen with 90-minute intervals using doses of 40.5 mg, 81 mg, 162 mg, and 325 mg. In our case, reducing the intervals to 15 minutes facilitated desensitization in a shorter time, which is useful in cardiac emergencies. Desensitization allowed tolerance to the loading dose prior to cardiac intervention and the maintenance dose without adverse reactions.

Background: In allergic rhinitis (AR), allergen-specific immunotherapy (SIT) is the only disease-modifying treatment. It may include adjuvants to improve tolerance and safety.

Objective: To evaluate the efficacy, safety, quality of life, medication reduction, and number of infections with sublingual (SL) administration of whole bacterial extract (WBE) as an adjuvant to SIT in AR.

Methods: An experimental, randomized, double-blind, controlled study was conducted with 40 patients aged 5 to 60 years with moderate or severe AR due to SSTN. Patients were randomly assigned to an experimental group (SLIT with a standardized extract for Dermatophagoides pteronyssinus and/or Dermatophagoides farinae and SBE) or a control group (SLIT with a standardized extract for Dermatophagoides pteronyssinus and/or Dermatophagoides farinae). TNSS, RQLQ, medication, infections, and adverse effects were assessed at 30, 60, and 90 days.

Results: Both groups showed clinical improvement; however, there was only a significant change in the TNSS in the experimental group (p=0.049). Respiratory infections decreased in both groups, and the reduction in medication use was more evident in the experimental group from the first month. Two patients in the control group reported mild local adverse effects.

Conclusion: Compared with other studies that used different adjuvants and routes of administration, similarities were observed in the reduction of symptoms and medication use. No previous studies were found comparing the reduction of infections or improvement in quality of life with SIT and bacterial lysates. Bacterial suspension as an adjuvant to SLIT with standardized extracts in AR for mites is effective and safe.

Background: Job Syndrome is a primary immunodeficiency disorder with an incidence of 1 per million people. It is characterized by elevated IgE levels, eosinophilia, recurrent infections (bacterial and fungal), eczematous dermatitis, musculoskeletal and vascular anomalies. Diagnosis is based on IgE > 1000 IU/ml and eosinophilia. Treatment is multidisciplinary, including bone marrow transplantation, stem cell therapy, and human immunoglobulin.

Case report: Evolution: We present a 13-year-old male with a history of asthma and atopic dermatitis treated with subcutaneous immunotherapy since 2016. He developed furunculous lesions that progressed to the frontal area, nose, forearms, abdomen, legs, ankles, and feet. Despite treatment with hydroxyzine, mupirocin, tacrolimus, clobetasol, and deflazacort, he showed no improvement. In 2021, he was admitted to the pediatric department, where the diagnosis was confirmed based on Grimbacher criteria. Treatment with human immunoglobulin was initiated, with adequate response. Currently, the patient is in good general condition with persistence of some skin lesions.

Conclusions: The therapeutic strategy focuses on the prevention and management of infections and symptoms. It is important to identify complications in the early stages of the disease to treat them effectively. This syndrome, although rare, should be considered a serious condition; early identification of this condition is crucial to improve outcomes in patients with similar presentations.

Introduction: Hereditary angioedema (HAE) is a rare disease characterized by episodes of cutaneous and submucosal inflammation. Its global prevalence ranges from 1:50,000 to 1:100,000 individuals and is often underdiagnosed. It is classified into three main types based on C1 inhibitor (C1-INH) levels and functionality. Type 1 is the most common (85% of cases). It is characterized by low plasma concentrations of functional C1-INH as a result of mutations in the SERPING1 gene.

Case report: We present the case of a 20-year-old male resident of Guadalajara with HAE type 1 diagnosed at age 12 and a history of drug use. He was admitted with edema in the left posterior thoracic region, which progressed to the neck, causing respiratory distress. During ambulance transport, the patient suffered cardiorespiratory arrest, requiring cardiopulmonary resuscitation. He was administered a bradykinin type 2 receptor antagonist and systemic steroid without success, and was admitted to the emergency department under advanced airway management. Laboratory tests and a CT scan revealed no significant findings. Given the persistence of facial edema, a human C1 esterase inhibitor was administered, and the patient was admitted to the intensive care unit for monitoring.

Conclusion: Based on laboratory and CT results, substance abuse was suspected as a triggering factor. The literature reports that individuals with cocaine dependence present a persistent proinflammatory state characterized by reduced baseline levels of the anti-inflammatory interleukin IL-10 and a significant increase in the proinflammatory cytokine TNF-α after exposure to stressful stimuli or use. Although the evidence in the medical literature is limited, the use of psychoactive substances could act as a triggering factor for seizures in patients with hereditary angioedema type 1. This case underscores the importance of identifying potential less-studied aggravating factors and suggests the need for a targeted history of psychoactive substance use in patients with HAE. This could be explained by their effects on vasodilation, the release of inflammatory mediators, and increased vascular permeability, mechanisms that promote bradykinin accumulation. Given the potential risk, it is essential to consider drug use in the comprehensive evaluation of precipitating factors in these patients.

Background: Overlap (SCARs) severe cutaneous adverse drug reactions, are defined as cases that fulfill diagnostic criterio for at least two of these drug-associated reactions, according to scoring systems. We present a case of an overlapping SCAR.

Case report: A 53-year-old female was diagnosed with diabetes and was being treated with metformin and linagliptin, and with high blood pressure with nifedipine. Secondary to an isolated seizure, she was treated with phenytoin, 5 weeks later, she presented with erythema in the chest region accompanied by pruritus that spread to the abdomen. Treatment was initiated with antihistamines, with poor improvement, progressing to generalized erythema and fever. Upon admission, she presented with generalized polymorphic skin lesions of a maculopapular rash and bullous lesions on the forearms, as well as pustular lesions on the face. Laboratory findings: Leukocytosis with neutrophilia (67%), eosinophilia =3,880/mm3, and acute kidney injury. Biopsy: Chronic interface dermatitis, superficial perivasculitis, and eosinophilia. According to RegiSCAR scoring system with 4 points and the EuroSCAR score with 6 points, both considered probable The patient began steroid therapy with methylprednisolone at 1.5 mg/kg for 3 days, followed by reduced doses of prednisone.

Conclusions: The patient presented a severe cutaneous adverse reaction 5 weeks after starting phenytoin, which showed overlap according to the scales. Secondary to the ambiguities among SCARs, confirmed cases of overlap are rare. In the acute stage of the disease, early identification of SCARs can be difficult due to overlapping features.

Objective: To explore the factors associated with the use of the antibiotic implicated in an adverse reaction following a negative challenge test in pediatric patients in a clinical allergology service of a health institution in Medellin.

Methods: Observational cross-sectional study with analytical intent, in pediatric patients with a history of adverse reaction to an antibiotic, who underwent a provocation test and obtained a negative result. Sociodemographic and clinical data were obtained from medical records and parents or caregivers of patients who met the inclusion criteria were surveyed.

Results: Between January 2016 and December 2021, 571 antibiotic provocations were performed. Only 19.2% of patients received the implicated antibiotic or antibiotics of the same class after a negative challenge test, without experiencing adverse reactions related to the new use. However, 53% of those who did not receive the antibiotic, despite needing it, mainly because their parents or caregivers continued to report the allergy label. Additionally, 26.9% of parents or caregivers did not recall the negative test result, and 44.2% would refuse future administration of the antibiotic to their children, identifying failure to recall the negative challenge test result as a factor associated with this behavior.

Conclusions: Local strategies (providing individualized forms for parents and healthcare providers) should be designed to explain the meaning of a negative test result, as well as follow-up visits to verify adherence to recommendations, thus increasing the effectiveness of antibiotic allergy delabeling.

Introduction: The evaluation of patients with asthma uses clinical tools such as the Asthma Control Test (ACT), pulmonary function tests, and biomarkers. Among these, an elevated fractional exhaled nitric oxide (FeNO) level can predict a higher risk of exacerbations and response to corticosteroids and/or biological therapies, although it does not always reflect poor clinical control. Our objective was to determine the relationship between asthma severity and FeNO levels in patients attending our service.

Methods: A cross-sectional study was conducted in patients over 12 years of age with controlled asthma assessed by ACT. FeNO was measured using the NIOX-VERO^® device. Descriptive analysis and Spearmans correlation coefficient were applied.

Results: Thirty-six patients (66.7% women) with a mean age of 36.3 years (SD ± 14.4) were included. According to GINA, 63.9% had mild asthma and 36.1% had moderate asthma. 22.2% had low FeNO levels (<25 ppb) and 52.8% had high levels (>50 ppb). The mean FeNO level in mild asthma was 62.7 ppb (SD ± 62.7) and in moderate asthma, 54.8 ppb (SD ± 36.2). No significant correlation was found between asthma severity and FeNO levels (rs = 0.150, p = 0.306).

Conclusions: Although more than half of the patients had elevated FeNO levels, no significant association was observed with asthma severity. This finding is consistent with previous studies and suggests that FeNO, although useful as a biomarker of type 2 inflammation, should not be used in isolation to assess clinical severity.

Background: Chronic spontaneous urticaria is characterized by the daily appearance of hives and/or angioedema (Fig. 1) without a specific trigger, lasting more than 6 weeks. Treatment is based on second-generation H1 antihistamines, and in patients with an insufficient response, therapy with omalizumab has been effective; however, it is a costly and long-term treatment. The WAO (World Allergy Organization) has proposed a tapering regimen upon achieving complete remission.

Case report: A 66-year-old female was referred for evaluation due to generalized hives of 6 years duration under treatment with fexofenadine 180 mg, with a partial response. Triple doses of H1 antihistamines were started, with no improvement, maintaining the UCT (Urticaria Control Test) at 5 points, and omalizumab 300 mg was added every 4 weeks, with an adequate clinical response. After complete remission, omalizumab tapering began in November 2023 according to the WAO protocol (Fig. 2). The final dose was administered in March 2025.

Conclusion: We present the case of a patient with chronic spontaneous urticaria. After achieving complete remission with omalizumab, the tapering protocol proposed by the WAO was implemented. During this period, our patient remained asymptomatic, with UCT scores greater than 13, allowing for progressive reduction of antihistamine use. The omalizumab tapering protocol for the treatment of chronic spontaneous urticaria is safe and effective, reduces the risk of disease reactivation, and prevents prolonged treatment.

Background: Hypersensitivity reactions to monoclonal antibodies represent a clinical challenge, especially when there are no equivalent therapeutic alternatives. Brentuximab vedotin (BV), an anti-CD30 monoclonal antibody indicated for relapsed Hodgkin lymphoma, has been associated with immediate hypersensitivity in 1.2% of cases.

Case report: An 11-year-old patient with relapsed Hodgkin lymphoma presented with grade 3 anaphylaxis (Brown scale) with hypotension, dyspnea, cough, wheezing, bipalpebral edema, conjunctival injection, nausea, and altered consciousness during the fifth cycle of chemotherapy with AVD (doxorubicin, vinblastine, and dacarbazine) + BV. Intramuscular epinephrine and fluid therapy were administered, with resolution of the condition. Laboratory Studies: BV skin tests performed 2 weeks after the event were negative. Outcome: Given the immediacy and severity of the event, and the need to continue treatment, a successful pharmacological challenge with AVD agents was performed. Subsequently, two cycles of BV desensitization were performed (cycles 6 and 7), using different protocols, without adverse reactions.

Conclusion: Although skin tests were negative, the clinical presentation was consistent with immediate non-allergic hypersensitivity. Desensitization allowed treatment to continue with adequate tolerance and without recurrence. Repeat skin tests are currently being considered 4 to 6 weeks after the index event; if negative, a BV challenge test is considered. Skin tests support safety prior to a controlled challenge. Desensitization is an effective strategy for continuing essential treatments in pediatric oncology.