BackgroundThe World Allergy Organization estimates 520 million people with food allergy on the world. The data that support the prevalence fluctuate in relation of the method employed to obtain these, for example, questionnaires, measurements of IgE-specific, oral challenges; the last one is considerate the gold standard. Similar situation occur to allergy to cow´s milk (CMA), the prevalence reported is 1 to 17.5% in preschoolers, 1 to 13.5% in 5 to 16-year-olds, and 1 to 4% in adults. About 40% of infants referred for specialist management of Gastroesophageal Reflux Disease (GERD) have CMA. This situation increases to 56% in severe cases. These allergic reactions are typically not IgE-mediated. The gold standard for GERD is the pH measurement in 24 hours (specificity 100%), exist other test more accessible, with considerable sensivity (80%) like scintigraphy.MethodsThe objective was determinate the frequency of GERD in patients with IgE-mediated CMA. We evaluated retrospectively 20 patients with IgE-mediated CMA of a group of 47 patients with food allergy between 6 months to 39 years aged. They had one or more IgE-specific to proteins that are considered major allergens: casein, beta-lactoglobulin (BLG) or alpha-lactalbumin (A-LA). All the patients had study to discard GERD, through by scintigraphy (study with more access in our Institute). Patients with CMA and negative scintigraphy, had pH measurement. We made 3 groups each one to represent the positivity of IgE-specific to major allergens and these were associated with the presence or absence of GERD.ResultsGERD was found in 80% of patient with CMA. 77.8% of patients with IgE to casein had GERD diagnosed by scintigraphy (P < 0.008) Likelihood ratio obtained for this relationship was 7; 70% of patients with IgE to A-LA have GERD (P < 0.03), the likelihood ratio was 4. No significant difference was found between the presence of IgE to BLG and GERD. Additionally, we found that 40% of patients with food allergy without CMA presented GERD.ConclusionsWe found high association between IgE-mediated CMA and evidence of GERD on Mexican people opposed to previous literature.
BackgroundPrevious studies have shown that after the treatment with immunotherapy there is a reduction in the number of visits to emergency services for asthma crisis, a significant improvement in pulmonary function tests: forced vital capacity (FVC), forced expiratory volume percentage in 1 second (FEV1%) and in the percentage of peak expiratory flow (PEF%) and the dose and number of drugs. There is also evidence of decreased response to skin tests and IgE levels with immunotherapy specific to Dermatophagoides pteronyssinus (Dpt).MethodsThe objective of this study was to evaluate the clinical effects of immunotherapy in patients with allergic disease treated at the National Institute of Respiratory Diseases in Mexico City, Mexico. There was a random selection in a prospective study of 99 patients with positive skin tests and more than 18 months of treatment with subcutaneous immunotherapy specific to epithelia, pollens from trees, grasses and weeds; at the beginning and the end of the immunotherapy there was an evaluation of the scale of rhinitis symptoms and asthma control; pulmonary function tests were performed as well (spirometry).ResultsAt the initial evaluation, 97% of patients presented moderate to severe persistent rhinitis, 80% of patients with asthma was uncontrolled; after 18 months with specific immunotherapy 80% of patients presented moderate intermittent rhinitis and asthma control was achieved in 85% of the patients. The FEV1 average increased from 78% at the beginning to 89% (P < 0.001). The average bump at the beginning of the specific immunotherapy was 12 cm for Dpt, for trees 10 cm, for weeds 8 cm and for grasses 8 cm; at the end of the SIT the average bump for Dpt was 10 cm, trees 2 cm, weeds 1cm and grass 0 cm (P value < 0.01).ConclusionsThe specific subcutaneous immunotherapy had beneficial clinical effects in patients with allergic disease, with significant improvement in pulmonary function tests and reduced positivity in skin tests, specifically for patients who were sensitive to pollens from trees, weeds and grasses.
BackgroundThere are studies in Mexico and worldwide about the patterns of positivity of skin prick test and the most frecuently allergens were: Dermatophagoides pteronyssinus (DPT), tree pollens (Ash/Oak in Mexico, Oak in U.S.A, Birch in Europe), grasses (Bermuda in Mexico, Timothy in U.S.A and Lolium in Europe) and thirdly cat ephitelium(CE). The reactivity to allergens was more common in males and the age groups in which there were positive skin test with the highest prevalence was from 5 to 15 years and 21 to 40 years.MethodsThe objective is to determine the pattern of skin prick test reactivity to aeroallergens in patients with rhinitis and asthma allergic in Mexico city, attending in the National Institute of Respiratory Disease (INER). This is a prospective, observational and longitudinal study based on data analysis of skin prick test results of individuals with clinical diagnosis of airway allergy (rhinitis/asthma). We use standardized allergens (alkalbello), detailed clinic history was collected in all cases. The statistical analysis was performed with the program SPSS14.ResultsWe obtained a total of 519 patients with positive skin prick test between January 2009 and March 2011. This group comprised 47% females and 53% male, with a mean age of 19 years between 3 to 79 years. We have 253patients with allergic rhinitis (AR) and asthma (A), 173 with RA and 93 with A. 55% of the patients reacted to one allergen extract (AE) and 45% of the patients reacted with 2 or more AE. The most frequently indoor allergenswith positive skin prick test were Dpt (65.1%), Dermatophagoides farinae (Df) in 32.3%, CE(31.7%), Cockroach (11.5%). Among the outdoor allergens ash was positive in 23.3%, Ligustrum (18.8%) oak (17.7%) birch (13.6%) Western Juniperus (9.6%), Ulm (8.6%).ConclusionsThe most frequently positivity skin prick test were Dpt, Df, CE, Ash, Privet, Oak. The reactivity to allergens was more common in males, and there are 3 peaks of age of positivity on prick test (7–12 years, 25–29 years and 36 years).
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