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

Background: Non-IgE-mediated gastrointestinal food allergy includes adverse reactions to food mediated by the innate immune system and cellular immunity. It is characterized by subacute or chronic gastrointestinal symptoms after ingestion of a relevant food allergen, making diagnosis difficult.

Objective: To carry out an updated bibliographic review of non-IgE-mediated gastrointestinal food allergy, that summarizes incidence, pathophysiology, clinical manifestations, diagnostic tools and treatment.

Methodolgy: A search was conducted in the databases Medline, EMBASE, Scielo, Google Scholar and the Advanced Medicine Informatics Network (RIMA) using the keywords: non-IgE-mediated food allergy, allergic proctocolitis; cow's milk-induced anemia; food protein-induced enteropathy; food protein-induced enterocolitis syndrome; Celiac disease and Heiner syndrome. The search was limited to articles published in English and Spanish from January 2015 to May 2024.

Results: While progress has been made in the recognition of these diseases, the prevalence and pathophysiology remain uncertain. Involvement of the innate immune system and cellular immunity in gastrointestinal inflammation has been found, but further studies are needed to clarify the immunopathogenesis and associated biomarkers.

Conclusions: Non-IgE-mediated gastrointestinal food allergy account for an unknown proportion of food allergies. Since there are no biomarkers or non-invasive confirmatory tests, the diagnosis relies on clinical features and is confirmed when the symptoms improve with elimination of the offending food. Management includes avoidance of the causative food from the diet, supportive treatment in case of accidental exposure, and nutritional counseling.

Background: Monoclonal antibodies are a therapeutic option for allergy, autoimmune, oncological diseases, among others, and work by inhibiting interactions between effector molecules and their specific receptors. However, the increasing use of these drugs has led to an increase in adverse drug reactions (ADRs). ADRs are defined as unexpected responses to therapeutic treatments. They are divided into type A, derived from the pharmacokinetics of the treatment or as a host immune response type B.

Objectives: Review of the use of monoclonal antibodies in the treatment of allergic diseases, addressing key aspects such as pharmacokinetics, pharmacodynamics, posology, contraindications and adverse reactions.

Methodology: A search of major medical databases on monoclonal antibodies for the treatment of allergic diseases was conducted. It was limited to original articles in English and Spanish, published between 2014 and 2024.

Results: Monoclonal antibodies for allergic diseases are described, including their mechanism of action, trade name, indications, posology, contraindications and adverse reactions.

Conclusion: The collection of data on biological drugs is crucial for a comprehensive and up-to-date understanding of their clinical use. Understanding adverse reactions improves diagnosis and the quality of medical care.

Objetives: To evaluate the persistent symptoms in subjects with infection of COVID-19, partially or fully recovered.

Methods: An observational, descriptive, cross-sectional, prospective study was conducted in individuals who were infected with SARS-CoV-2. We included Individuals of any gender and age who voluntarily answer a survey after developing infection to identify signs and symptoms associated, we analyzed whether there was any relationship between female sex and obesity, or age related with post-COVID-19 syndrome by X² test and t Student test.

Results: 197 individuals were included with mean age 41.57 (SD 14.2 years), 61.9% were female. Post-COVID syndrome was present in 52.3%, depression, anosmia, dysgeusia, nausea, alopecia and behavior disorders were greater in women; arthralgia, dyspnea, cough, and odynophagia were greater in obesity being statistically significant (p<0.05).

Conclusions: Post-COVID syndrome was found in 52.3%, with a variety of symptoms female sex had a higher risk of presenting post-Covid syndrome with symptoms such as depression, behavior disorders, anosmia, and baldness.

Objective: To determine the prevalence and evaluate the distribution of sensitization to aeroallergens in pediatric and adult patients with allergic rhinitis.

Methods: Observational, cross-sectional and retrospective study, carried out from the analysis of clinical records of patients with skin tests, to intentionally identify signs and symptoms of allergic rhinitis, as well as aeroallergens to which they reacted positively.

Results: 1531 skin reactivity tests were reviewed, of which 983 corresponded to patients with a diagnosis of allergic rhinitis with a positive test. The prevalence of the disease was 64.2% (n = 983); the pediatric population had a prevalence of 55.8% (n = 549) and the adult population 44.1% (n = 434). The aeroallergens with the higest frequency of sensitization were: Dermatophagoides pteronyssinus (59.5%), Dermatophagoides farinae (45.3%), cat (26.1%), Cupressus arizonica (21.7%), dog (21.6%) and Fraxinus excelsior ([Ash], 19.6%).

Conclusion: There is a high prevalence of allergic rhinitis in the studied cohort. The house dust mites Dermatophagoides mix (Pteronyssinus and Farinae) were the main allergens. Cosensitization to cat and dog was high. The tree pollen species with the highest impact were: Cupressus arizonica, Fraxinus excelsior and Quercus robur (Roble, Encino, Oak). The grass pollen varieties with the greatest influence: Cynodon dactylon (Bermuda, Capriola) and Lolium Perenne (English grass).

Objective: To analyze the relationship between cellular immune response, assessed through delayed hypersensitivity intradermal tests, and nutritional status in older adult women.

Methods: A correlational observational study was conducted on elderly women, without evidence of infection, with an average age of 69.2 ± 5.9 years. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) scale, and the in vivo cell-mediated immune response was measured through delayed hypersensitivity tests to various microbial antigens.

Results: A total of 36 older adult women were enrolled in the study. Of these, 83.3% had a normal nutritional status, while 16.7% were at risk of malnutrition, with an average MNA score of 25.6 ± 2.7. The intradermal reaction test at 48 hours, showed an induration greater than 5 mm in 58.3% for Gram-positive bacteria, 38.9% for tetanus/diphtheria, 66.7% for candidin, and 0% for Escherichia coli. A positive response to candidin was more frequent in women at risk of malnutrition (OR: 1.3: CI_95%: 1.1 - 1.7; p = 0.05). After 96 hours, a candidin induration greater than 7 mm showed an area under the ROC curve of 0.75 (CI_95%: 0.57 - 0.94; p = 0.05) for predicting the risk of malnutrition.

Conclusion: Older adult women with good nutritional status maintain an adequate cellular immune response, whereas those at risk of malnutrition exhibit greater reactivity to candidin, suggesting a possible immunological alteration associated with malnutrition.

Background: The main cause of allergy to honey is linked to the head of the bee.

Case report: A 44-year-old man with no relevant history presented with pharyngeal, palmo-plantar and axillary itching, dysphagia, dizzinessa nd sweating after ingesting honey. Addiotionally, when he drinks banana yogurt and cow's milk smoothie he notices slight pharyngeal itching. Normal basal tryptase (5.03 ug/L), total IgE 212.2 kU/L, IgEs: honey 37.3 and Apis 0.69 kU/L. SDS-PAGE and immunoblot of honey and banana yogurt extracts with the presence of bands between 12 to 70 kDa (honey); 12 to 35 kDa (banana yogurt) and SDS-PAGE and immunoblot of bee venom extract with the presence of bands from 10 to 50 kDa and the patient's serum recognized two proteins: one compatible with the major allergen Api m 1 at 16 kDa and another compatible with Api m 11 at 50 kDa.

Conclusion: The patient is sensitized to several honey proteins (2 between 50-75 kDa and 1 between 20-25 kDa). He doesn't recognize any protein in the banana yogurt. Additionally, the patient recognizes a bee venom protein of about 50 kDa (compatible with Api m 11), and this may be the primary sensitization pathway.

Background: Ixekizumab is a high-affinity IgG4 monoclonal humanized antibody useful for the treatment of ankylosing spondylitis. Benign skin reactions are a common adverse event with ixekizumab but systemic hypersensitivity reactions are much more unusual.

Case report: We describe the case of a 54-female patient with HLAB27+ spondyloarthritis. Treatment with ixekizumab 80 mg subcutaneous (containing polysorbate) was prescribed. The patient experienced immediate severe dyspnea, skin erythema and flushing. Intradermal test (0.8 mg/ml) was clearly positive in the immediate reading. The patient was planned to undergo ixekizumab desensitization according to an 8-step protocol with good tolerance.

Conclusion: We report a patient with HLAB27+ spondyloarthritis treated with ixekizumab who developed a systemic IgE-mediated reaction. A successful and easy to perform subcutaneous desensitization protocol is described.

Background: 22q11 deletion syndrome consists of a variable grouping of phenotypic features and immunological defects secondary to the loss of genetic material located in the 22q11.2 band. The 22q11 deletion spectrum encompasses different syndromes related to the same etiology and with overlapping anomalies, including DiGeorge syndrome, velocardiofacial syndrome, among others.

Case report: A 6-month-old male patient of indigenous Rarámuri ethnicity was referred to the Children's Specialty Hospital of Chihuahua due to severe malnutrition and respiratory distress. Upon admission, a grade V/VI holosystolic murmur and global neurodevelopmental delay were detected. He required endotracheal intubation and was admitted to the Pediatric Intensive Care Unit, where he had a long hospital stay. Some type of inborn error of immunity was suspected due to infectious processes, congenital heart disease, and evidence of facial dysmorphisms (malar hypoplasia, narrow palpebral fissures, tubular-like nose, and small mouth with high-arched palate), in addition to DiGeorge syndrome.

Conclusions: 22q11 deletion syndrome causes heterogeneous clinical manifestations, including multiple cardiac abnormalities and chronic diseases. In the Rarámuri population, there are currently no reports of this type of inborn error of immunity, so our patient exemplifies the need to intentionally search for these disorders, especially in those with severe infections, heart disease, and distinctive morphological characteristics. Disease detection programs are necessary, particularly in vulnerable populations.

Background: Congenital neutropenia is a primary immunodeficiency characterized by quantitative anomalies in neutrophil counts. It is classified as mild, moderate, or severe. Hematopoietic stem cell transplantation stands as a potential therapeutic intervention; nevertheless, graft-versus-host disease emerges as a main complication.

Case report: We report the case of a 2-year-old female patient, with a history of congenital neutropenia. She had scalp abscesses and preseptal cellulitis, which were satisfactorily treated. After a multidisciplinary approach, a protocol was initiated to receive an allogenic hematopoietic progenitor cell transplant; graft versus host disease was subsequently diagnosed, ultimately resulting in death of the patient.

Conclusion: Graft-versus-host disease remains a significant complication in patients who undergo allogeneic hematopoietic stem cell transplants. Its recognition, management, and treatment are clinically relevant aspects given the substantial degree of associated morbidity and mortality.

Objective: To develop a treatment algorithm for patients with penicillin allergy.

Methods: Retrospective study, carried out in adult patients with penicillin allergy, who were in group 3 or 4 of the established classification, and attended the outpatient clinic of the Department of Pulmonology and Allergy of the Central Hospital of the Social Security Institute, between January 2021 and December 2022. Each patient underwent an amoxicillin provocation test, after obtaining informed consent.

Results: 60 patients were registered, who were able to remove the penicillin allergy label and whose medical history was corrected, with financial benefits for the patient and the health service of Paraguay.

Conclusions: Penicillin allergy labels can lead to irrational prescription of antibiotics, prolonged hospital stays, and increased need for consultation. Risk stratification, based on historical characteristics alone, is capable of safely identifying ideal patients for direct challenge testing. This study demonstrates the feasibility of the first penicillin delabeling program applicable in an outpatient setting, which can be performed even outside of hospital allergy services.