Background: Hereditary angioedema (HAE) is a primary immunodeficiency disorder characterized by C1 complement inhibitor deficiency and unregulated activation of complement. Aspirin hypersensitivity is related to an increase in the amount of leukotrienes with eosinophil and mast cell activation and increased levels of glandular kallikrein with upregulated local conversion of bradykinin. Both conditions can be present in the same patient. Objectives: We present five patients with HAE; they were all being treated in similar ways according to the therapeuthic options available in our institute (danazol). However, three of them had recurrent episodes of angioedema; in these cases, it was identified aspirin hypersensitivity as a cause of poor disease control. A review of the literature is included. Case Presentation: We present the cases of four females and one male (age range 21 -58 years) with type I HAE. Subjects were all ISSSTE beneficiaries (state workers) treated at the National Medical Center "20 de Noviembre". Aspirin hypersensitivity was identified in three patients. Elimination of NSAIDs along with dietary elimination of high salicylate-containing foods improved control of angioedema crisis (severe and/ or recurrent episodes). Discussion: Aspirin hypersensitivity was identified as a factor for poor control in our patients with HAE. Such cases improved with dietary elimination of high salicylate-containing foods and avoidance of NSAIDs. Conclusions: This is the first report of patients with HAE and aspirin hypersensitivity as a cause of poor control. We recommend a deliberate search of these comorbidities, especially in cases of poor disease control. Further studies are needed to continue the investigation on this topic.
Introduction: Primary immunodeficiencies are a spectrum of diseases that encompasses alteration of the innate and adaptive immune response. Isolated lymphocytopenia may be a manifestation of primary immunodeficiency, which is rarely considered as a diagnostic option by non-immunological physicians. Objectives: To conduct a brief review of the primary immunodeficiencies that are most frequently associated with lymphocytopenia in order to provide a resource that will help non-immunological clinicians to recognize and appropriately refer to these cases. Materials and Methods: Review of the literature with scientific articles indexed in English and Spanish. We consulted Pubmed database with the keywords: primary immunodeficiencies and severe combined immunodeficiencies. The limit of time was 5 years and only review papers. Results: The search in the database results in 68 papers and we analyzed 35 articles because the objective of the review was Severe Combined Immunodeficiencies. Discussion: Persistent lymphopenia (usually <2500 xmm 3) detected in blood cell cytometry that accompanies severe, recurrent infections, autoimmune manifestations, atopy and cancer may suggest severe combined immunodeficiency. Causes of secondary immunodeficiency such as HIV should be ruled out. Conclusions: Persistent lymphopenia can be associated with severe combined immunodeficiency. The study should be extended in these cases by a specialist or refer the patient to a referral center for a complete evaluation.
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