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 enco...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.
Sánchez J, Arenas C, García E
… +14 more, Ocampo J, Gaitán-Rozo JD, Hamann O, Chapman E, Ramírez R, Espinosa T, Velásquez M, Tamayo L, Torres-Pradilla M, Sánchez JL, Guerrero-Román M, Ensina LF, Larco JI, Chérrez-Ojeda I
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...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.
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 classific...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.
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...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 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...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.
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 economi...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.
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, bronchiec...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 di...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.
BACKGROUND: Urticaria is characterized by the transient appearance of hives, angioedema, or both. Acute urticaria lasts less than 6 weeks. The origin is idiopathic in more than 50% of cases, and the most frequent trigger...BACKGROUND: Urticaria is characterized by the transient appearance of hives, angioedema, or both. Acute urticaria lasts less than 6 weeks. The origin is idiopathic in more than 50% of cases, and the most frequent triggers are infectious processes, drugs and foods. OBJECTIVE: Describe the origin, pathophysiology and treatment of patients with acute urticaria. METHODS: A bibliographic search of articles was carried out in PubMed, where the Mesh terms: "Urticaria", "Angioedema" and "Antihistamines" were included and those with information related to acute urticaria were chosen, among those published from 2014 to 2023. In addition, the inclusion of some publications from previous years was considered, due to their relevance for this review. RESULTS: The initial search returned 135 articles, but only 104 were used for the final manuscript. CONCLUSIONS: Acute urticaria is one of the most frequent reasons for consultation in the Allergology and Dermatology emergency services. Although there are multiple etiological factors, most cases are idiopathic, so it should not be overdiagnosed as an allergic reaction.
Villarreal-González RV, Ortega-Cisneros M, Cadenas-García DE
… +10 more, Canel-Paredes A, Fraga-Olvera A, Delgado-Bañuelos A, Rico-Solís GA, Ochoa-García IV, Jiménez-Sandoval JO, Ramírez-Heredia J, Flores-González JV, Cortés-Grimaldo RM, Zecua-Nájera Y
BACKGROUND: Adverse drug reactions are defined as unexpected reactions, either derived from the pharmacokinetics of the treatment (Type A) or as a host immune response (Type B), resulting in harmful or undesirable manife...BACKGROUND: Adverse drug reactions are defined as unexpected reactions, either derived from the pharmacokinetics of the treatment (Type A) or as a host immune response (Type B), resulting in harmful or undesirable manifestations in the patient following the administration of pharmacological therapy. Type B reactions are less defined and are considered a result of hypersensitivity to pharmacological treatment, categorized as immediate (within 1 to 6 hours after exposure) and delayed or non-immediate (occurring 6 hours after exposure). OBJECTIVE: A review to describe the immunological mechanisms of delayed hypersensitivity reactions to drugs. METHODS: A search of major medical databases on delayed hypersensitivity reactions to drugs was conducted. The review was limited to articles published in the period between 2013 and 2023, taking into consideration articles written in English and Spanish. RESULTS: The terms defining delayed hypersensitivity reactions to drugs, their classification, clinical manifestations, diagnosis, treatment algorithms, and prognosis. CONCLUSIONS: Adverse drug reactions represent a challenge for the specialist physician, with a complex pathophysiology. A prompt diagnosis and treatment focused on the drug phenotype and its immunological expression are required to provide a multidisciplinary approach.
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 wit...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 bibliometr...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.
OBJETIVES: To describe the events supposedly attributable to immunization with the Pfizer-BioNTech® COVID-19 vaccine in children aged 5 to 17 years in the state of Puebla, Mexico. METHODS: Observational, cross-sectional...OBJETIVES: To describe the events supposedly attributable to immunization with the Pfizer-BioNTech® COVID-19 vaccine in children aged 5 to 17 years in the state of Puebla, Mexico. METHODS: Observational, cross-sectional and descriptive study carried out based on the analysis of reports of events supposedly attributable to immunization in children aged 5 to 17 years, who received the vaccine with the BNT162b2 mRNA platform for COVID-19, since January. to December 2022. Percentages, frequencies, averages, standard deviations and medians were used for statistical analysis. The Statistical Package for the Social Sciences 23 program was implemented. RESULTS: 1,993,373 doses of the BNT162b2 vaccine were administered. 52 events presumed to be attributable to vaccination or immunization were reported. An annual rate of 2.6 per 100,000 doses applied was estimated. The age distribution recorded a median of 10.50 years (SD: 3.53). There were 56% women and 44% men; The most frequent symptoms were: dizziness, nausea, vomiting and pain at the vaccine application site. 2 cases of seizures and 1 of flaccid paralysis were reported. CONCLUSIONS: The safety of vaccines against SARS-CoV-2 requires an improvement in strategies for epidemiological surveillance (passive and active), with a more robust approach to guarantee safe vaccination.
BACKGROUND: Hymenoptera stings can produce IgE-mediated reactions, toxic reactions, or atypical reactions, which are rare. Cold urticaria has been described among the cutaneous manifestations in the atypical ones, but th...BACKGROUND: Hymenoptera stings can produce IgE-mediated reactions, toxic reactions, or atypical reactions, which are rare. Cold urticaria has been described among the cutaneous manifestations in the atypical ones, but there is only one case of chronic urticaria. CASE REPORT: A 56-year-old female patient experienced palmoplantar pruritus and generalized urticaria 60 minutes after two vespid stings, requiring medical assistance and several cycles of home treatment with oral antihistamines and corticosteroids for resolution in 12 weeks. Allergological studies showed normal tryptase and primary sensitization to Polistes dominula venom. Given the patient's profession, venom immunotherapy was started with Polistes dominula 100% without recurrence of urticaria after its administration. CONCLUSIONS: We present a case of IgE-mediated systemic reaction followed by self-limited chronic urticaria, related chronologically to the same vespid sting trigger.
BACKGROUND: Acute liver failure in pediatric age is a serious multisystem disease, characterized by a failure of the synthesis and detoxification function of the liver. Among the etiologies, viral infection should be inv...BACKGROUND: Acute liver failure in pediatric age is a serious multisystem disease, characterized by a failure of the synthesis and detoxification function of the liver. Among the etiologies, viral infection should be investigated. Treatment is supportive and some cases require liver transplantation. CASE REPORT: A 2-year-old girl was admitted for acute liver failure. The PCR viral panel was positive for Adenovirus 41 and IgG antibodies to SARS-CoV-2 were also found. Supportive treatment was started without improvement, so intravenous immunoglobulin was administered, with resolution of the liver failure. CONCLUSIONS: Immunoglobulin has immunomodulatory mechanisms in children with severe acute hepatitis of infectious etiology, so in some cases, its administration can be considered as adjuvant therapy.
BACKGROUND: Allergic sensitization to topical antimicrobial treatments is a well-known problem. Furacin® is one of the most widely used in our environment. It contains 0.2% nitrofurazone and polyethylene glycol (PEG) as...BACKGROUND: Allergic sensitization to topical antimicrobial treatments is a well-known problem. Furacin® is one of the most widely used in our environment. It contains 0.2% nitrofurazone and polyethylene glycol (PEG) as a vehicle. CASE REPORT: 57-year-old male with no history of interest. He presented skin rash, blisters, and serous exudate 2-3 days after starting treatment with Furacin® (applied to an infected skin wound). Epicutaneous tests were performed with a true test battery, nitrofurantoin 1% in petrolatum, PEG15000 and 4000 1% in petrolatum, pure PEG 400, PEG monomethyl ether 350 1% in water. Positive result at 96 hours for nitrofurantoin. CONCLUSION: Nitrofurazone is widely used as a topical antibiotic because of its bactericidal spectrum. It (including its excipients) should be considered in case of adverse reactions after application.
Severe asthma is an entity with a complex diagnosis, requiring an adequate differential diagnosis and identification of endotypes for a correct approach and therapeutic process. In the present review, we show a synthesis...Severe asthma is an entity with a complex diagnosis, requiring an adequate differential diagnosis and identification of endotypes for a correct approach and therapeutic process. In the present review, we show a synthesis of the current literature on the diagnosis, pathophysiology, and management of severe asthma, having critically analyzed the evidence in search engines such as Medline, Scopus, and Embase.
OBJECTIVE: Determine the level of knowledge of mothers of children under 5 years of age about vaccination schedule. METHODS: Cross-sectional, observational, descriptive, and analytical study, carried out in the Family Me...OBJECTIVE: Determine the level of knowledge of mothers of children under 5 years of age about vaccination schedule. METHODS: Cross-sectional, observational, descriptive, and analytical study, carried out in the Family Medicine Unit 1 of Orizaba, Veracruz, in which two questionnaires were applied to mothers of children under 5 years of age, one prepared by PAHO that qualifies attitudes. of parents about vaccines, and another that evaluates knowledge of immunizations. Absolute frequencies and percentages were estimated; and the association with Pearson's was determined. RESULTS: A total of 138 women were registered, with age limits of 18 to 48 years. The level of knowledge was high (70.3%) and was related to the age, education (p = 0.00) and occupation (p = 0.03) of the mothers. The highest frequencies were for housewives (47.1%), professionals (3.5%), married (60.2%) and of the Catholic religion (81.2%). CONCLUSIONS: This study confirms the null hypothesis, which indicates that 70.3% have high knowledge about vaccination, and it is associated with the age, education, and occupation of the mothers.
González-Díaz SN, Macías-Weinmann A, De Lira-Quezada CE
… +5 more, Gonzalez-Gonzalez V, Hernández-Sánchez H, Guzmán-Avilán RI, Noyola-Pérez A, Macouzet-Sánchez C
OBJECTIVE: Report the prevalence and severity of the most common allergic diseases in children living in Monterrey, México. METHODS: Cross-sectional multi-center survey on the most common allergic diseases, completed by...OBJECTIVE: Report the prevalence and severity of the most common allergic diseases in children living in Monterrey, México. METHODS: Cross-sectional multi-center survey on the most common allergic diseases, completed by parents of 6-7-year-old children and by 13-14- year-old adolescents in the Monterrey metropolitan area, between January 2018 and December 2019. RESULTS: A total of 3,044 questionnaires were eligible for the analysis. Among children between 6-7 years old, 30.2% (n = 143/473) presented wheezing at any time in their life; with a higher prevalence in the male population. In the adolescent group, 26.4% reported having experienced wheezing at some point in their life, with a slight predominance in the female group (54.9%). CONCLUSIONS: Knowing the prevalence of allergic diseases in our population gives us tools to generate strategies that allow us to provide the best quality healthcare to our patients.