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

Atopic dermatitis (AD) is a disease that significantly impacts the quality of life of patients. Although there are multiple evidence-based guidelines, they are usually aimed at providing recommendations to AD specialists rather than primary care physicians (PCPs). The aim of this study was to construct a consensus document for PCPs, with the aim of presenting evidence-based recommendations that allow general practitioners, family physicians, pediatricians, internists and emergency physicians to provide appropriate care to AD patients, facilitating their diagnosis, management, and avoiding delays that can deteriorate patients' f quality of life. As a central source of information, we used the recommendations of different international AD guidelines. Delegates from distinct medical societies identify barriers to care and possible solutions for the application of recommendations in primary care. Subsequently, a second evaluation for physicians from different Latin American countries was carried out. The main doubts and barriers that PCPs face in applying the recommendations proposed by the guidelines were identified across different areas, diagnostic criteria, non-pharmacological therapies, pharmacological therapies, management in special conditions and guidelines for referral to a specialist. Consensus solutions were proposed for each identified issue. In conclusion, this consensus contains recommendations regarding the management and treatment of AD in children and adults, which clarify doubts and provide tools to primary care physicians to offer effective treatment for patients and their families.

Background: Hereditary Angioedema is an autosomal dominant disorder caused by a lack or decrease in the function of the C1 inhibitor. It is a rare disease with low prevalence. Treatment focuses on symptom relief and short- and long-term prevention of acute attacks.

Case report: 53-year-old male patient, with recurrent edema in the face, feet, scrotum, associated with abdominal pain since he was 20 years old. Patient has a history of hereditary angioedema in first-degree relatives of consanguinity. Laboratory tests showed low levels of plasma protein (antigenic), functional C1-INH and C4. The patient received several medical treatments. Given the recurrence of symptoms, prophylactic management with Lanadelumab was indicated. However, the patient presented erythema and induration at the application site with subsequent secondary generalized pruritus. For this reason, prophylaxis was suspended.

Conclusion: This case of hereditary angioedema type 1 presents the difficulty in the treatment and the relapse of the patient after trying various therapies, as well as the finding of the adverse effect presented to the prophylactic medication with Lanadelumab, which has been poorly documented in the literature medical worldwide.

Objectives: To evaluate the prevalence of methylisothiazolinone sensitivity and associated factors in individuals with suspected allergic contact dermatitis.

Methods: Cross-sectional study based on patch tests, including methylisothiazolinone 0.2%, in 286 participants with suspected allergic contact dermatitis, in Brasília/DF, Brazil, between March/2020 and March/2022.

Results: 13.6% of participants were diagnosed with allergic contact dermatitis and sensitive to MI. The mean age was 43.7 years, and the majority were women (71,8%). The average duration of the disease was 60 months. The most common location was hands (76.9%) and upper limbs (33.3%). In 97.4%, allergy to methylisothiazolinone was considered of current relevance. In the multivariate model, being domestic/household increased the chance of presenting sensitivity to MI by 4.2 (95% CI= 1.36 - 13.5). Presenting lesions in several places of the body was also significantly associated (OR=2.84; CI 95%=1.17 - 6.86) to be sensitive to the test substance.

Conclusion: The findings confirm the epidemic of allergy to methylisothiazolinone. They reinforce the need for the inclusion of this isolated substance in the Brazilian baseline series. We emphasize the need for regulations on the use of methylisothiazolinone in industrial products and household detergents, as is done for cosmetics. Studies in other centers are needed to confirm these results.

Objective: to perform a cost-effectiveness analysis of asthma treatment with budesonide/formoterol against other treatment options used at Mexico's National Institute for Respiratory Diseases.

Methods: A complete economic evaluation of cost-effectiveness from a public health perspective, comparing the use of budesonide/formoterol as maintenance therapy with fluticasone/vilanterol in 103 female asthma patients managed at INER between 2015 and 2021.

Results: Average cost per patient was $743.23 USD, $733.36 USD for budesonide/formoterol and $767.24 USD for fluticasone/vilanterol. Pharmacological treatment represented over 70% of management costs for both groups, followed by follow-up visits and exacerbation management costs. LABA-ICS represented the highest proportion of pharmacologic management costs with a statistically significant difference amongst groups with an incremental cost of $80.17 USD for the fluticasone/vilanterol group. The budesonide/formoterol group showed an ICER of $613.31 USD for reducing the proportion of patients experiencing exacerbations during follow-up. Considering the willingness to pay threshold based on one GDP per capita ($10,902.98 USD in 2022), budesonide/formoterol represented a very cost-effective option.

Conclusions: The ICER favored budesonide/formoterol over fluticasone/vilanterol in terms of cost-effectiveness. A 5.5% reduction in patient exacerbations indicated decreased disease burden. While not statistically significant, fewer exacerbations per patient might still cut costs by lowering emergency visits and hospitalizations.

Objective: To establish the prevalence of bronchiectasis, correlate the IgG IV or SC immunoglobulin dose and serum IgG levels with the total Bhalla score and the severity of bronchiectasis and associate serum IgG levels with the development of pulmonary infectious processes in patients with diagnosis of innate errors of immunity.

Methods: A descriptive, observational, cross-sectional study with patients over 18 years of age diagnosed with IBD. Clinical records and computed axial tomography were reviewed.

Results: 38 patients with IBD were included, where the prevalence of bronchiectasis was 36.8%. (Regarding the correlation of pulmonary infectious processes with serum IgG levels, a difference was found in patients from 2020 to 2022 (p= 0.002, 0.054, 0.030 respectively). The correlation of severity of bronchiectasis, total score of Bhalla scale, IgG IV or SC immunoglobulin dose and serum IgG levels by Spearman's Rho test I were found to be significantly correlated.

Conclusion: It is important to perform chest tomography studies every 3-4 years in patients with IBD to detect timely bronchiectasis, initiate treatment in time, improving patients' quality of life and survival rates, and reducing hospital costs.

Vaccines are one of the most important discoveries of humanity, being an effective intervention to protect the population against infectious diseases. When the Covid-19 vaccination campaign, the feat of Doctor Francisco Javier de Balmis y Berenguer in the Royal Philanthropic Vaccine Expedition is remembered due to the importance that vaccination has had over the years and mentioning that The National Vaccination Campaign against COVID-19 in Mexico began at the Dr. Eduardo Liceaga General Hospital of Mexico.

Objective: To evaluate the association between the expanded lymphoid profile and inborn errors of immunity using flow cytometry.

Methods: Observational and cross-sectional, case-control study, carried out in patients with a diagnosis or clinical suspicion of inborn errors of immunity, treated at the Santísima Trinidad Children's Hospital in Córdoba, Argentina, from August 2021 to November 2022. Clinical data were collected, and peripheral blood samples were obtained for flow cytometry analysis, using the PIDOT tube, to identify lymphocyte subpopulations. For statistical analysis, Fisher's exact test, odds ratio and binary logistic regression model were used.

Results: 40 cases and 20 controls were analyzed. The most frequently altered lymphocyte subpopulations were: CD4+ n (63%), Mem c/s (60%) and Mem s/s (55%). A statistically significant association was found between several lymphocyte subpopulations and health-disease status. Binary logistic regression reported Mem s/s and CD4+n as altered lymphocyte subpopulations with a greater probability to have inborn errors of immunity.

Conclusions: This study contributes to improving the understanding of inborn errors of immunity and demonstrates a strong association with altered lymphocyte subpopulation profiles. Mem s/s and CD4+n emerge as relevant biomarkers for diagnosis. Heterogeneity in different diseases and in flow cytometry underlines the importance of evaluating each patient individually, to improve diagnosis and treatment.

Objective: To describe the scientific production, through bibliometric analysis, about asthma in Latin America.

Methods: Observational, descriptive, retrospective and cross-sectional study, with a quantitative bibliometric approach, to evaluate the scientific production of asthma in Latin America, using the Scopus and SciELO platforms to recover files published between 2003 and 2022.

Results: A totoal of 3041 documents were obtained in Scopus and 592 in SciELO. In both repositories, the original articles (2379 and 478) and the reviews (379 and 43) were the most published documents. The larg-est producer was Brasil: n = 1538 in Scopus, and n = 406 in SciELO, and the journal with the highest number of publications was Jornal Brasileiro de Pneumologia with 169 articles in Scopus and 164 articles in SciELO.

Conclusions: The bibliometric analysis shows the panorama of the last 20 years in research on asthma in Latin America, where scientific production has progressively increased, mainly in Brazil, Mexico and Chile.

Background: Allergic bronchopulmonary aspergillosis is a rare entity, caused by a hypersensitivity reaction of the immune system to Aspergillus fumigatus, characterized by the presence of pulmonary infiltrates, bronchiectasis and increased eosinophils in peripheral blood.

Case report: 42-year-old male with diabetes mellitus, with poor adherence to treatment, went to the emergency room due to rapidly progressive dyspnea and severe hypoxemia, pneumonia and bilateral pleural effusion were evident, laboratory studies reported, HbA1c 9.4%, eosinophils 3650 cells/mL, serum IgE for Aspergillus fumigatus 0.84 IU/mL. Treatment was started with supplemental oxygen, prednisone and itraconazole, to which the patient showed clinical and radiological improvement.

Conclusions: Invasive mycoses have a mortality of 21 to 80%, frequently in immunocompromised patients, they are usually not described in patients with diabetes mellitus; The prevalence of fungal colonization among diabetic patients has been described as 37% compared to 4.7% in non-diabetic patients.

Background: Inborn errors of immunity originate from monogenic mutations that should be considered in the suggestive diagnosis of patients with recurrent or severe infections, allergies, autoimmunity, autoinflammatory diseases, bone marrow failure and malignancy.

Case report: Pediatric patient, male, 4 years old, treated in the medical service for fever of 39°C, difficult to control. The simple chest x-ray reported left pulmonary consolidation. The infectious condition evolved into necrotizing pneumonia of the left upper lobe, so it was decided to perform a lobectomy. The diagnosis of some inborn error of immunity was suspected. The determination of serum immunoglobulins reported IgA below the reference values. At 4 years he continued to have decreased serum IgA (5.5 mg/dL).

Conclusions: The diagnosis of selective IgA deficiency is established after 4 years of life; However, due to the patient's severe infection, addressing some inborn error of immunity had to be implemented.