Most Latin-American countries use subcutaneous immunotherapy (SCIT) extracts from the United States and Europe and sublingual immunotherapy (SLIT) from Europe, with the exception of Argentina, Brazil, Cuba and Mexico. The number of researches on immunotherapy (IT) in Latin America has increased extensively in the last years. Only few Latin American countries have their own guidelines on IT, and, in general, the economic resources for medical research on IT are still low in the area. A global approach for the future of IT in Latin America includes to improve standardization, quality control and the production of allergen products, to develop IT guidelines and clinical investigation by the highest number of countries, to improve the regulatory status for allergens products in the area, and to expand IT accessibility for low-income patients. In Cuba, the first registered allergen vaccines were developed and registered in 2006: a standardized (in biologic units) and freeze dried product for SCIT, with a sublingual version developed in 2009. As much as 23.000 IT treatments were applied in 2011, all provided to patients free of charge. In 2012, Cuban researchers developed an IT vaccine with adjuvant for subcutaneous route, which uses Neisseria meningitidis proteoliposome as an adjuvant, added to the purified Dermatophagoides siboney major allergens: Der s1 and Der s2. Since December 2012, this vaccine is in Phase I clinical trial, evaluating its safety, tolerability and immunogenicity in asthmatic patients sensitized to this allergen. Cuban perspectives on IT includes to work on new indications for IT, to investigate the preventive effect and cost-effectiveness for the current vaccines, to develop new products with mixed formulas of house dust mites for SLIT, to complete the phase I and II clinical study for dust mite plus adjuvant vaccine, to develop allergen vaccines for fungi allergy and to complete the Cuban guideline for allergen IT management.
BackgroundThe purpose of the study was to determine the skin sensitization to environmental fungi and its relation with the presence of asthma and allergic rhinitis in children aged 6 to 7 years.MethodsA cross-sectional and analytical study was conducted in 100 school children aged 6 to 7 years in a primary school of San Antonio de los Baños, La Habana, Cuba, in February-March, 2007. The ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire was applied to determine the presence of asthma and allergic rhinitis. The sensitization to environmental fungi Penicillium, Cladosporium and Alternaria was explored by skin prick tests. The statistical association between sensitization to each environmental fungi and the presence of asthma and allergic rhinitis was determine by chi-square tests.ResultsThe 27% of the selected sample suffered from asthma, 40% from allergic rhinitis and 56% showed asthma, rhinitis or both, which was grouped in a term called allergic respiratory disease. From these 56 children, 18 had positive prick tests to one or more environmental fungi (32%); 9 showed cutaneous reactivity to Cladosporium (16%), 9 to Penicillium (16%) and 5 to Alternaria (9%). There was a significant statistically association between the cutaneous reactivity to Penicillium and the presence of allergic rhinitis (X2 = 5.46 P = 0.05). There were no associations between any other fungal sensitization and the presence of asthma or allergic rhinitis.ConclusionsAllergic sensitizations to environmental fungi were relevant in children with asthma, rhinitis or both; there was a significant statistically association between sensitization to Penicillium and the presence of allergic rhinitis.
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