BACKGROUND: The atopic dermatitis is a chronic skin disease that appears in patients with a personal or family history of allergic asthma and rhinitis. It is associated to the specific activation of a gene group. In most instances, the response to the conventional treatment is adequate. The are cases, though, know as refractory, where that is not the case. The study of two therapeutic alternatives, Transfer Factor (TF) and Cyclosporin A (CyA), was elaborated for this type of patients. MATERIAL AND METHODS: Patients with severe refractory AD were studied, being admitted to the Allergic Service to the ISSSTE Lic. Adolfo López Mateos, ISSSTE, between September 1997 and june 1998. They were randomly divided in two groups. The first one was subjected to CyA, on a 4 mg/kg/day dosage, with monthly surveillance of kidney and hepatic functions and blood pressure twice a week. Group two was subjected to TF, as follows: one unit every third day for the first week, two units per week for the next three weeks and one monthly unit to complete six months. Initial and final clinical and immunologic testing was performed on both groups (eosinophils, total IgE, CD4 and CD8). RESULTS: Six patients included group A, and 12 patients in group B. Both groups showed a significant statistic reduction in the total eosinophils count, without an statistic difference between them. None showed changes in the total IgE. CyA reduced the CD4 levels, while the TF increased the levels of CD8 cells, both with a p < 0.05. Both groups showed clinical improvement satistically significant, but no differences with a p > 0.05 appeared between them. Tolerance to the treatments was adequate, and there was not need to suspend the treatment in any case. Only three patients showed hypertricosis and other one presented headaches, with CyA. CONCLUSION: Both treatments showed therapeutic benefits in the treatment of patients with severe refractory AD, with similar immunologic improvement. Both drugs present different action mechanisms, so their joint application could offer clinical benefit to the patient (synergetic action), cost reduction, and long term treatments with reduced adverse effects.

Cyclosporine↗

PubMedDate not supplied

[Latex allergy in a population at risk].

BACKGROUND: The allergy to latex is an illness whose prevalence has been increased in very significant form in the last years. OBJECTIVE: To know the allergy incidence to latex in population of risk, as well as to identify the related sintomatology and the importance or paper that play the atopia antecedents and time of contact with latex for the development of the illness. METHOD: We carry out a prospective, descriptive, experimental and traverse study in population of risk, in the service of Allergy and clinical Immunology of the Hospital Regional Lic. Adolfo López Mateos, ISSSTE. One hundred patients of both sexes were included, with age of 20 to 50 years, with the antecedent of being personal medical and paramedic and to have presented contact with latex material in a minimum period of one year. They were carried out clinical history with registration of sintomatology nasal, bronchial, cutaneous and associated to contact with latex. They were carried out cutaneous test for prick to latex with positive control with the help of histamine solution and negative control with solution of Evans and immediate reading of the same one. RESULTS: 22% of the patients in study, they presented positive skin test latex, with a time of exhibition 10 year-old average, 68% presented antecedent of atopy personal, family and, likewise the associate sintomatology was in a 33.3% dermatology, 54.5 nasal, nobody presented bronchial symptoms and a 9% asymptomatic was reported. CONCLUSION: We support that the immediate skin test latex for Prick is an important parameter of support diagnosis for allergy to type 1 latex.

Adult↗

PubMedDate not supplied

[Leukotrienes in asthma].

The objective of the present article is to revise the biochemical and pharmacological knowledge of the leukotrienes, including the enzymatic and cellular processes that participate in its synthesis. The half-filled biological effects through diverse receptors as the cystenil-leukotrienes, have a primordial participation in the physiopathology of the asthma. The 5-lipooxigenase inhibitor, 5-lipooxygenase-activating protein antagonist, and cystenil-leukotrienes, are three classes of new modulators for clinical use. Their effect has been revised in diverse clinical models of asthma, as the one induced by allergens, exercise, aspirin and in multicenter asthma trials are reviewed. The conclusions in general guide to that their pharmacology and the clinical experience that one has, contain them as a new therapeutic role in the treatment of the asthma.

Animals↗

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[Asthma phenotype during the first six years of life].

UNLABELLED: Asthma is one of the main wheezing causes during the first years of life. In our country it is a common respiratory chronic illness but insufficient studies still exist on the asthma phenotypes during the first years of life. OBJECTIVE: To know the phenotype of asthma in a group of children younger than 6 years old. MATERIAL AND METHODS: 185 children of both sexes were studied with antecedent of having presented wheezing (tree episodes or more) and it registered data about the antecedents of family and personal allergy, dietary habits during the first year of life, infections, data on the beginning and the evolution of the condition, and they were practiced determinations of peripheral eosinophilia, total serum IgE and gastric gammagram to discard illness for gastroesophageal reflux. All were carried out skin tests for foods and aeroallergens. RESULTS: In the group of 185 patients of both sexes, they had data that supported the allergic process, in 137. It was correlated the atopy antecedents significantly, positive skin tests, eosinophilia (more than 300), with elevated IgE for the age (p < 0.05). The gastric gamagrama was carried out in 144 patients, of which were positive results for gastroesophageal reflux in 64 (44%) and in 79 (54%) it was reported doubtful or negative. It was related the gastroesophageal reflux presence and the positive skin tests significantly (p < 0.05). CONCLUSIONS: The more common phenotype of asthma in our patients corresponds to a wheezing pattern that persist after the 3 years old, in relation to an allergic component. Furthermore in most of those children a positive gastroesophageal reflux was an important finding.

Asthma↗

PubMedDate not supplied

[Hypersensitivity to medications].

drug hypersensitivity is an adverse reaction provoked by an immunologic response due to the consumption of a drug, or else, by reaction to one of their metaboliteS. Currently, it is considered that 10% of general population has susceptibility to a drug hypersensitivity to a drug or biological product. These reactions obey a pattern of factors of the individual and the medicine, that define the degree of sensitivity to the drug, and according to their characteristics it is possible to develop any type of immunologic reaction (Gel & Coombs), Nevertheless, it should be established that still there are mechanisms of drug hypersensitivity of drugs that have not been totally known, so they are not integrated to this classification and they are catalogued as an undefined type of reaction. On the other hand, there are drugs that provoke drugs reactions by non-immunologic mechanisms corresponding to the drug's different aggressive effects. According to the indicated concepts, we will show some basic concepts of the diverse mechanisms of drug hypersensitivity immunologic and non-immunological, thus as some therapeutic and diagnostic concepts needed for the management of drug hypersensitivity.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMedDate not supplied

[Asthma and gastroesophageal reflux. Diagnostic correlation between gammography and digestive endoscopy].

AIMS: Incidence of gastroesophageal reflux (RGE) in asthmatic it is considered be of the rang of 33% until 89%. RGE can be classic or atypical and 30% will be payees of silent reflux. It considers at the moment so much as standard of gold to 24 hours pH esophagus like endoscopic digestive and biopsy, being determined a smaller sensibility to gastric gammagraphic but maybe a bigger utility in relation to their readiness and access easiness. OBJECTIVE: Comparative study is presented that reports sensibility/specificity of gastric gammagraphic, relating it with digestive endoscopic study and biopsy report. METHOD: All asthmatic patient of difficult control and of up to 6 years, selected of the External Consultation of the Service. Gastric gammagraphic was determined and later on the panendoscopic study with taking of biopsy. It integrated sensibility specificity for gammagraphic gastric. RESULTS: Study that understood 8 months, with a total of 44 patients, with a range of 1.4 year-old age to 6 years. Gastric gammagram was reported positive in 25 patients, (56.8%) and negative in 19,(43.18%). Endoscopic studies demonstrated incompetent hiatus in 33 (75%), esophagitis of variable degree in 20 patients, (45.4%), Gastritis in 8 (18.1%) and normal study in 8, (18.1%). Histopathologies: Esophagitis of variable degree in 33 patients (75%), chronic gastritis in 2 patients, (4.5%), Esophagus of Barrett in 2 patients, (4.5%), and normal histopathologic study in 7,(15.9%). Of the 44 patients, 81.5% showed significant reflux. It is integrated a sensibility and specificity of the gastric gammagraphic of 71.4% and 54.2%, respectively. CONCLUSIONS: Gastric gammagraphic contributes sensibility it mediates but acceptable for diagnose of RGE. In asthmatic of difficult control, it should be considered initially endoscopic study. The probability of RGE should always take into account in all asthmatic patient.

Asthma↗

PubMedDate not supplied

[Skin tests with high and minor determinants in patients with doubtful allergy to penicillin].

BACKGROUND: Currently, the skin tests are the most accepted methods for the diagnosis of allergy to penicillin. OBJECTIVE: To evaluate the efficacy and diagnosis security of the skin tests with high and minor determinants of penicillin, crystalline and penicillin, in patients with hypersensitivity reaction to penicillin. METHODS: Patients with doubtful antecedents of reaction to penicillin (problem group) and healthy patients (control group) were included. Both groups were submitted at the following tests: 1) Skin tests with high and minor determinants of penicillin, and crystalline penicillin, by prick and intradermoreaction methods. 2) In case of negativity, tests of direct challenge with penicillin were practiced. The formation of wheal with or without erythema 3 mm related to the negative control or systemic reaction, was considered positive test. RESULTS: 47 patients were included (24 for problem group, and 23 for control group), 50% of the group problem showed positive reactions with the method of prick, none patient of the control group (p < 0.001); with the intradermoreaction method, 79% in the problem group and only 13.4% in the control group showed positive reaction (p < 0.001). Cutaneous tests showed local adverse effects. Clinical history showed a sensitivity or 88%, method of prick, 50%, and intradermoreaction method, 95%.

Adolescent↗

PubMedDate not supplied

[Cell surface markers in patients with allergic rhinitis versus Der p and Der f challenge].

The allergic condition is determined genetically and they affect of the general population's 20-30% in developed countries, in the last decade have been increased the prevalence. Inside the imbalance that is manifested in the atopic patients it is on one hand the antigen-presenting cells (monocytes and B cells) and on the other hand, the lymphocytes T CD4+. The association of molecules like CD80, CD 86 (co-stimulatory molecules) in monocytes and B cells and CD30, CD62L, ALL, CD11a, CD28, CD124 and CD152 in CD4+, they have shown to be of particular interest in allergic sufferings. However we don't find a difference statistically significant among patient and controls and among nasal challenges with saline solution with specific allergen. For what we suggest that the changes in the activation, proliferation and cooperation are given in the les ion place, without an apparent repercussion in cells of peripheral blood.

Adult↗

PubMedDate not supplied

[Respiratory function tests in aspirin-induced asthma].

INTRODUCTION: Aspirin induced Asthma (AIA) is a syndrome, with typical clinical features. Aspirin and Nsaids induced Asthma is its distinctive characteristic. OBJECTIVE: Was to determine challenge and bronchodilator test usefulness, as well as its complications, in patients with Aspirin induced Asthma. MATERIAL AND METHODS: Prospective, open, transversal and comparative study of 20 patients divided in two groups of ten people each one group with an Aspirin induced Asthma antecedent, undertook a challenge and bronchodilator test, and the second group was composed of patients with extrinsic asthma which were exposed to a challenge test. All patients had a physical exam and laboratory test, besides paranasal and chest X-ray, allergic skin test and spirometry. Criteria used to make diagnosis of AIA were defined as a 15% decrease of FEV-1 in the both groups. Laboratory and other paraclinic studies were made in order to assess diagnosis and/or complications. RESULTS: In the first group it was observed a 15% statistically significant decrease of FEV-1 and FEF 25-75 values (p < 0.05), on second group an statistically significant increase in FEV-1 values of more than 15% was observed in 7 patients (p < 0.05). In the control group no statistically significative changes were observed in the patients. The more frequent complications after challenge test were wheeze, dyspnea, cough and severe bronchospasm. Zero defunctions were reported. CONCLUSION: The minimum dose to realize the diagnosis of AIA are 100 mg of aspirin. The FEV-1 decrease depend of dose of aspirin in patients with AIA. Patients with extrinsic asthma without an aspirin intolerance history, have non adverse effects with aspirin ingestion. Severe bronchospasm was the most severe complication in patients who underwent Aspirin challenge test who had an idiosyncrasy history.

Adolescent↗