BackgroundAsthma is a chronic multifactorial disease characterized by inflammation with multiple triggers. Inflamation of the airways is the main pathologic pathway in asthma, and not only determines the diagnosis and severity of symptoms, but is also useful to establish treatment and predict potential complications. By measuring FeNO levels, an indirect level of pulmonary inflammation can be obtained since it is produced by alveolar macrophages in response cytokines. One of the main known causes of this inflammatory response is an allergic reaction. This allergic reaction sets off a cascade of biochemical events that leads to the expression of inflamatory mediators, preformed or de novo, and IgE being the principal of such mediators. The objective was to evaluate the relationship between levels of FeNO and IgE to inflammation and allergy severity.Methods50 patients (72% female and 28% male) aged 12 to 50 years old, diagnosed with asthma were taken from the Allergy and Immunology department. A complete medical history was performed, and the diagnosis was confirmed through a clinical history and spirometric criteria, according to GINA 2010. All medications that could alter the inflammatory process were taken away for 15 days. Lastly, total serum IgE levels were measured with electrochemiluminescence technique and the FeNO with standard procedures. The data was further analyzed using a Pearson's correlation test.Results21% of the participants showed normal IgE values (<100 UI/Ml) and 33% of the participants had normal FeNO measurements (<20 ppm). A 0.29 coefficient was measured using a Pearson's correlation test, which suggests a low positive correlation between the 2 observed variables.ConclusionsThe results showed a low correlation between the IgE and FeNO levels. This result does not allow for a correlation between both parameters; which leads to a conclusion that high levels of IgE from an allergic reaction is not necessarily going to lead to a high FeNO, thus a pulmonary inflammation. Additionally, it emphasizes the importance of the allergists and pneumonologists to work together when treating an asthma patient, given the multidisciplinary nature of this pathology.
BackgroundNeonatal Lupus is a rare disease, described in 1954, which only occurs in children of mothers with antibodies to specific antigens of Systemic Lupus Erythematosus (SLE). Such antigens pass, transplacentally during gestation and is characterized by cutaneous manifestations such as rash, erythematous macules, papules or plaques which tend to coalesce; less frequent are blood disorders including aplastic anemia, neutropenia, thrombocytopenia, hemolytic anemia, pancytopenia; liver disorders with elevated liver enzymes and cholestasis; central nervous system disease such as mielopaias, convulsions; pulmonary as pneumonitis, and gastrointestinal tract such as bloody diarrhea. Alopecia is a common symptom in SLE but has not been reported in the literature in neonatal presentation.MethodsCase report: A 1 month and 4 day old infant female, who presented 3 days after birth with a persistent bloody diarrhea, without mucus also presents dehydration and metabolic acidosis that warrant intravenous correction. An infectious etiology is discarded and is referred to an allergist for study of a possible lactose intolerance which is discarded initially. However, the physical finding of hair loss is evident with areas of alopecia which together with the persistence of the diarrhea and rash is suspect of a possible immunological etiology. Therefore, it was decided to test Anti-Ro autoimmunity in the infant and his mother; given a positive results.ResultsWith the Anti-Ro test the presence of Neonatal Lupus is confirmed. A treatment with EV-dose methylprednisolone was initiated, which had little clinical response, meriting a treatment with azathioprine with a good clinical response, which improved and reduced Anti-Ro values.ConclusionsThe importance of clinical observation is evident when there are unusual features which allows for a rare diagnosis. This striking case, given the unusual presentation with alopecia which together with the clinical observations was indicative of this disease, and not of other syndromes characteristic of this age, like sepsis.
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