Mexico has its own SPT sensitisation pattern, which is different from America and Europe. A structured chart-review of SPT results is able to show this and might be a tool for allergists in other countries.
RATIONALE: HDR are frequent motives for consultation in Allergology services. Possible etiologic factors and clinical presentation differences between Latin American children and adults have not been described yet. METHODS: An observational cross sectional study using a modified ENDA questionnaire was implemented in 19 allergology units in 11 Latin-American countries, reporting patients presenting HDR in the last year before consultation. Causal relationship was categorized according to WHO-UMC Causality Categories: certain, probable, possible, unlikely and conditional. RESULTS: 727 patients, 144 (19.8%) of them under 18 years old, presented 732 reactions. Female gender was 71.7% in adults, and 50% in children. Atopic history was present in 44.9 and 63.8% and a history of previous drug reaction in 31.9 and 36.9% of adults and children, respectively. Fourteen percent of adult, and 10.7% of children had presented previous reactions with the same drug. The clinical picture of the reaction in adults and children was angioedema in 47.9 and 48.6%, urticaria in 44.5 and 41.8%, maculopapular and macular exanthema in 20.3 and 22.6 %, erythema multiforme and SJS in 3.6 and 2.7% respectively. Certain and probable causal relationships were attributed in adults and children to NSAIDs in 55.7 and 60.3 %, beta lactams in 11.2 and 19.8%, non beta lactam antibiotics in 8.4 and 2.5 %, anticonvulsants in 3.2 and 1.7%, chemotherapy 0.8 and 2.5% of patients, respectively. CONCLUSIONS: Female sex was predominant in adults but not in children. NSAIDs and antibiotics were the drugs implicated in more than 75% of patients. Beta lactam antibiotics were more frequently involved in children.
RATIONALE: Chronic spontaneous urticaria (CSU) lesions are characterized by infiltrates of eosinophils and basophils. Studies have suggested a role for the PGD 2 /CRTh2 and eotaxin/CCR3 pathways in eosinophil recruitment to CSU lesions. Eosinophils produce PGD 2 in response to eotaxin, however the effects of PGD 2 on CCR3 expression have not been examined. Therefore, we explored CCR3 and CRTh2 as shared recruitment/activation pathways for eosinophils and basophils. METHODS: We recruited adult CSU subjects (n522) and non-allergic controls (n58). Whole blood was analyzed for baseline CCR3 and CRTh2 expression on basophils and eosinophils by flow cytometry. CCR3 expression was examined in samples stimulated with PGD 2 in the presence or absence of a CRTh2 antagonist (AZD1981). RESULTS: Basophils from CSU subjects exhibited lower CRTh2 and CCR3 at baseline compared to healthy controls (p50.0277 and p50.0001). Eosinophil CRTh2 expression was also significantly lower in CSU subjects compared to controls (p50.0049). CRTh2 and CCR3 were positively correlated on basophils (p50.0157) and eosinophils (p50.0036). Increasing concentrations of PGD 2 reduced eosinophil CCR3 expression to a lesser extent in CSU subjects compared to controls (AUC 521.7 vs 624.6, p<0.0001). AZD1981 inhibited reductions in eosinophil CCR3 induced by PGD 2 (10-6.5 M) in CSU subjects (p50.0001) and healthy subjects (p50.0469). CONCLUSIONS: Reductions in basophil and eosinophil CRTh2 and CCR3 surface expression were positively correlated in CSU subjects. PGD 2 exposure reduced eosinophil CCR3 expression in CSU and healthy subjects which was partially inhibited by CRTh2 antagonism. Further studies examining the coordination of these pathways may provide insights into the observed clinical benefits of CRTh2-targeting in eosinophilic subgroups. 154 Drug-induced urticaria (DIU) and angioedema in Latin American Countries
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