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

Background: Genuine sensitization to beef and pork is rare, with the best-characterized allergens being beef and pork (Bos d 6 and Sus s1). There are different presentations of mammalian meat allergy: cat-pork syndrome, alpha-gal syndrome, milk-related allergy, and primary sensitization.

Case report: A 49-year-old man presented with urticaria after ingesting beef and pork and mild intermittent nasal symptoms. The initial approach was aeroallergen testing: positive for cat. Cat-pork syndrome was suspected. A prick-to-prick test was performed on raw and cooked pork: positive; raw beef: positive; cooked beef: indeterminate; oral examination was performed: positive; 40 minutes later, wheal-like lesions were present on the neck, anterior thorax, and face. Fel d 1 (0.92 kcal/L) and Fel d 2 (0.05 kcal/L) were ordered, confirming genuine cat sensitization and ruling out cat-pig syndrome. Specific IgE to pork (0.18 kcal/L), confirming sensitization to pork. Given the presence of symptoms associated with beef and the likelihood of α-Gal syndrome, skin and intradermal polygeline testing was performed: negative. Bos d4 (0.02 kcal/L) and Bos d5 (0.01 kcal/L) were negative, confirming primary sensitization to beef.

Conclusion: After ruling out other mechanisms, primary sensitization to mammalian meat is presumed. A molecular approach can improve diagnostic accuracy and guide therapeutic decision-making in this case: Total avoidance.

Allergic rhinitis (AR) affects the quality of life of 400 million patients worldwide, and while the pharmacological treatment options are extensive, more effective and safer treatments continue to be developed. The immunomodulator Transferon Oral^® (TO) improves the clinical presentation of patients with AR; however, the immunological mechanisms by which it exerts its therapeutic effect are under investigation. This study aimed to develop an ovalbumin (OVA)-induced AR murine model. AR was established in female BALB/c mice (5-8 weeks old) by intraperitoneal inoculation of 200 μL of OVA (1 mg/mL)/Al(OH)₃ (1.3%) on days 0, 1, 2, 7, 8, 14 and 21, and subsequently stimulated daily intranasally (RIN) with 20 μL of OVA (1 mg/mL) until day 42. The establishment of RA was evidenced by the increase in serum IgE against OVA by ELISA (OD > 0.5) and clinical signs. Subsequently, the effect of TO (0.75 μg) orally and dexamethasone (Dexa; 125 μg) intraperitoneally was evaluated in RA mice (n=6) for 21 days with daily RIN. TO significantly decreased specific IgE levels (p < 0.0001) at 7 and 14 days of treatment, while Dexa did so until day 14 (p < 0.0001) compared to the RA control group. Additionally, an analysis showed that TO reduced basal lamina thickness and decreased eosinophil and mast cell infiltration in NALT compared with RA controls. This work demonstrates that TO modulates the core RA molecule, IgE, and cell migration in NALT, and is the first step toward understanding its mechanism of action in this disease.

Introduction: Angioedema is a form of localized swelling involving the deeper layers of the skin and mucous membranes, caused by fluid extravasation and lasting for several days. While aging of the skin is a natural process, various compounds such as hyaluronic acid, active amino acids, and peptides are used for their anti-aging properties. However, in some individuals, these substances can overstimulate the immune system, triggering hypersensitivity reactions.

Case report: A 38-year-old woman with a medical history of controlled hypertension and allergy to quinolones. She underwent hyaluronic acid injections in the lips and glabellar region four months before presenting symptoms. Over the last three months, she experienced intermittent, firm, painful, erythematous lip swelling with paresthesia, which did not respond to antihistamines or steroids. Immunological tests showed positive antinuclear antibodies (ANA) with a granular pattern, but rheumatology ruled out autoimmune disease. An ultrasound revealed encapsulation of the injected material.

Conclusion: Hyaluronic acid, widely used in aesthetic medicine, can cause immune mediated adverse effects, including angioedema. Though rare with an incidence of 0.42% such reactions can be serious. Treatment options include dissolving the material using hyaluronidase, applying radiofrequency, administering intralesional corticosteroids, or performing surgery. Type IV hypersensitivity angioedema is rare and may be caused by bacterial proteins or impurities in hyaluronic acid. It does not respond to antihistamines and requires treatment with hyaluronidase, intralesional steroids, radiofrequency, or surgery. This raises questions about the mechanisms underlying the immunogenicity of hyaluronic acid that warrant further investigation.

Methods: Patients with HAE type I/II, aged ≥12 years, were included from the EMPOWER and ENABLE studies, who received lanadelumab at the approved dose and had data on the initial attack rate. Subgroups were created based on baseline HAE activity (moderate: ≥1 to <2, high: ≥2 to <, very high: ≥3 attacks/month). The effectiveness of lanadelumab was measured by the reduction in monthly attacks compared to baseline. Safety was assessed by treatment-emergent adverse events (TEAEs).

Results: A total of 123 patients were analyzed, divided into subgroups by baseline activity: moderate (29), high (15), and very high (79). The mean follow-up duration ranged from 577.5 ± 251.7 days (moderate) to 741.1 ± 281.0 days (high). Average HAE attack rates decreased in all three subgroups after lanadelumab initiation: moderate (1.3 ± 0.3 to 0.3 ± 0.4), high (2.0 ± 0.2 to 0.5 ± 0.5), and very high (5.8 ± 3.0 to 0.4 ± 0.7). TEAEs were not severe, mild/moderate, and unrelated to lanadelumab treatment.

Conclusion: HAE attack rates decreased after lanadelumab initiation, regardless of baseline activity. Safety was similar across groups; most TEAEs were mild and unrelated to treatment. These data support lanadelumab as a first-line option for long-term prophylaxis.

Background: Asthma is a chronic inflammatory disease with variable airflow obstruction. Severe asthma (310% of cases) requires high-dose corticosteroids, increasing the risk of exacerbations. The IL13 rs1800925 and rs1881457 variants, involved in the regulation of inflammation, have been associated with asthma severity in various populations, but their impact in Mexico has not been studied.

Objective: To evaluate the association of the IL13 rs1800925 and rs1881457 variants in patients with severe asthma.

Methods: One hundred patients with severe asthma and 150 healthy controls were analyzed. DNA was extracted and quantified for genotyping using allelic discrimination. Lung function, IgE levels, hospitalizations, symptoms, medications, and allergen exposure were assessed. Haplotypes and linkage disequilibrium (LD) were calculated.

Results: There were no significant differences in allele/genotype frequencies between groups. A strong LD was observed between rs1800925 and rs1881457 (D=0.83, r²=0.77, p<0.05). 77% had an eosinophilic Th2 endotype, 70% had aeroallergen allergy, and 54% had insufficient disease control. Women used more reliever medication and had more nighttime symptoms (p<0.05).

Conclusion: The variants exhibit a strong LD but do not show a significant association with AG in this population. The high prevalence of the eosinophilic Th2 endotype and sensitization to aeroallergens reinforce the role of allergic inflammation in the disease. Furthermore, sex differences suggest a greater incidence in women, which could influence the clinical management of AG. Larger studies are needed to confirm these findings.

Background: Urticaria is defined as the presence of hives, angioedema, or both. 1028% of patients have autoimmune diseases. Twenty percent have antithyroid antibodies, and only 510% present with symptoms. Two main endotypes are currently recognized: type I (anti-allergic) with IgE anti-TPO autoantibodies, and type IIb (autoimmune) with IgG antibodies and IgE anti-FcER1. However, 51% of patients have a I/IIb overlap.

Case report: Clinical presentation: A 46-year-old female with a history of untreated hyperthyroidism presented with generalized pruritic hives with facial angioedema, with more than 50 hives per day, lasting <24 hours, which disappeared without leaving a residual macule, with pruritus of 10/10, interfering with sleep and quality of life, and no triggering factor. Laboratory tests: Eo 5.3% (260), IgE T 471, TSH 0.005, FT4 1.65, C3 138, C4 30, Anti-TPO 219, anti-TG 332. Positive autologous serum test. Evolution: Treatment with levocetirizine 10 mg every 12 hours was started; after 2 months, symptoms decreased.

Conclusion: There are no specific statistics on the combined prevalence of hyperthyroidism and chronic urticaria worldwide. In this case, the patient presents elevated IgE, autoimmune disease, and positive autologous serum, leading to a diagnosis of type I/IIb overlap. Currently, there is no classification system for urticaria types that can be applied to any clinical setting, which impacts the patients therapeutic and prognostic decisions.

Objective: To analyze the effects of air pollution on the health of a vulnerable population in the Mexico City after the nine environmental contingencies presented in the year 2024.

Methods: A cross-sectional, descriptive study was conducted among outdoor workers (street vendors). Risk factors and respiratory symptoms were documented, and respiratory function tests were performed.

Results: A total of 300 patients were enrolled. The most frequent clinical symptoms were increased expectoration (52%), recurrent respiratory infections (44.3%), headache (39.6%), cough (35%), laryngeal irritation (34%), nasal itching (30%), dyspnea (26%), vertigo (22%), conjunctivitis (20.6%), and chest pain (19.6%). Spirometry results showed: 61.3% with a restrictive pattern, 14.3% with an obstructive pattern, 13.3% with a mixed pattern, and 11% with no abnormalities. Forty-four percent of this group experienced exacerbations of diseases such as asthma and chronic obstructive pulmonary disease.

Conclusions: Air pollution constitutes a serious public health problem, especially for low-income people, who live and work in areas with high levels of pollution, as evidenced in our study. Further epidemiological studies are essential to evaluate the impact of ozone and other pollutants on vulnerable groups, to implement more effective preventive measures.

Introduction: In allergic patients with recurrent respiratory infections, the association of antibody deficiencies, both selective and specific to polysaccharide responses, has been described.

Case report: Male, no significant family history. At age 5, presented with cervical and axillary lymphadenopathy; biopsy ruled out malignancy, followed by remission. At age 7, developed nasal symptoms and wheezing. Admitted to Allergy at age 9 and diagnosed with asthma and rhinitis, sensitized to dust mites and grass. Good response to immunotherapy in the first 2 years; during the third year, developed recurrent respiratory and gastrointestinal infections every 15 days. At age 13, further workup was decided. Physical Examination: Weight 69 kg, height 1.7 m, obstructive turbinates, central bifid uvula, grade I tonsils, no lymphadenopathy, cardiopulmonary system unremarkable. Studies: Hemoglobin 15.6 g/dL, Hematocrit 46%, WBC 4005/μL, Lymphocytes 1200/μL (20%), Eosinophils 210/μL (3.6%), Platelets 219,000/μL. Low IgA 23 mg/dL (45-236), low IgM 27 mg/dL (52-242), IgE 11.9 IU/mL (≤3100), normal IgG 1060 mg/dL (560-1760), reconfirmed. Flow cytometry normal with normal B lymphocytes. Pneumococcal polysaccharide vaccine challenge showed adequate response to only 4 serotypes (<50% response). Management: Temporary treatment with prophylactic antibiotics and immunostimulants, with improvement in infectious episodes. Currently off prophylaxis. Discussion: Adolescent with quantitative IgA and IgM deficiency, currently normal IgG levels but impaired response to polysaccharide vaccine. Maintained under immunological surveillance due to potential progression to common variable immunodeficiency.

Conclusion: Recurrent or invasive infections in treated asthma patients warrant investigation for antibody deficiency.

Objective: To establish the prevalence of sensitization to dog and cat epithelium in a pediatric population aged 3 to 6 years.

Methods: A descriptive, cross-sectional prevalence study was conducted as part of the study "Prevalence and risk factors for asthma, rhinitis, eczema, and atopy among preschool children in an Andean city." The study population consisted of children from the city of Cuenca, Ecuador, who were administered the culturally validated ISAAC survey and underwent inhalant skin testing.

Results: A total of 600 children were enrolled, with a prevalence of atopy of 33.45% (n = 179), sensitization to dog epithelium of 1.76% (n = 10), and sensitization to cat epithelium of 2.12% (n = 12), representing 5.59% and 6.70% of the atopic population, respectively.

Conclusion: The prevalence of sensitization to cat and dog epithelium in children under 6 years of age is lower than expected in the clinical setting. Future studies should assess the sample size in relation to the prevalence of sensitization to cat and dog epithelium.

Background: Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a rare, potentially life-threatening condition triggered by wheat ingestion followed by physical activity.

Case report: This report describes two cases of young individuals in Lima, Peru, diagnosed with WDEIA. The diagnosis was confirmed through skin prick testing and the Allergy Explorer2 (ALEX-2) microarray, identifying omega-5gliadin (Tria19) as the main allergen. Both patients experienced episodes of anaphylaxis, one of which required adrenaline administration.

Conclusion: The importance of molecular diagnostics to confirm WDEIA is highlighted, and preventive strategies such as avoiding wheat before exercise and emergency plans are discussed. These cases underscore the need for greater clinical awareness and improved access to life-saving interventions in resource-limited regions.