Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Risk and safety requirements for diagnostic and therapeutic procedures in allergology : World Allergy Organization Statement

Peer reviewe

Semblanza del Dr. Mario Sánchez-Borges.

Resulta muy grato hablar sobre la venezolanidad y hacerlo de aquellos valores del campo médico revierte particular orgullo; el Dr. Mario Sánchez Borges, científico a carta cabal, médico de corazón, compañero de labores y amigo de muchísimos años es un singular ejemplo. A Mario lo conocimos de bachiller en el internado rotatorio de pregrado del Hospital “Carlos J Bello” de la Cruz Roja Venezolana

A Commentary: Is Context an Important Consideration in Asthma?

Asthma is a well known and high impact global health problem [1]. It shares, along with other prevalent entities, a number of not insignificant difficulties in the delivery of health care needs for it’s control [2]. From a clinical Point of view, the use of inhaled steroid medications (Clinical Efficacy measured as: No. of asthmatics patients controlled /No. of asthmatics patients treated) have proven their worth and are the mainstay of treatment in many Published Guidelines about asthma; and deservedly so. However, from a public health point of view, the clinical effectiveness of such strategies (Clinical Effectiveness measured as: No. of asthmatics patients controlled. Total No. of asthmatic patients) remains a problem around the world [1,3,4]. Many draw backs seems to exist in this over all lack of capacity to deliver comprehensive health care to asthmatic patients and their families. Some of these have been extensively considered, such as: a. need for intensive / recurrent education efforts [1] about the disease and it’s treatment; b. the inconveniences with the use of inhaled medications [5]; c. un modifiable housing environmental conditions [3]; d. tobacco smoke exposure [1,3]; e. the culture around poverty and all that it implies [3,4]; f. patient’s adherence and the cost of these treatments, among many others.</p

A Novel Phenotype of Nonsteroidal Anti-Inflammatory Drug Hypersensitivity

Background Some nonsteroidal anti-inflammatory drug (NSAID)-hypersensitive patients develop adverse reactions when challenged with weak cyclooxygenase 1 (COX-1) inhibitors.Objectives To investigate the prevalence and clinical features of this high-risk population.Materials and methods Patients from 2 outpatient allergy clinics consulting between October 2005 and October 2007 because of adverse reactions to classic NSAIDs were submitted to confirmatory double-blind oral challenges with the suspected NSAID and with acetaminophen, preferential and/or specific COX-2 inhibitors. Patients were then classified as low-risk and high-risk groups according to the results of provocation tests.Results Three hundred three patients were studied: 179 (59.0%) were tolerant to acetaminophen and the selective COX-2 inhibitors (low-risk group), whereas 124 (40.9%) developed reactions to at least one of the ''low COX-1 inhibitors'' (high-risk group). No distinctive demographic or clinical characteristics were present when both groups of patients were compared.Conclusions A large proportion of patients sensitive to classic NSAIDs cannot tolerate the weak COX-1 inhibitors. Oral challenges should be performed by trained specialists to advise these patients about the use of NSAIDs. Keywords: aspirin, angioedema, cyclooxygenases, NSAIDs, urticari

Common mistakes in the treatment of patients with anaphylaxis

Anaphyaxis is a situation threatening life and may occur at any age. Unfortunately, despite of the existence of up-dated guidelines for its treatment, many patients are wrongly diagnosed and treated and, sometimes, deaths are reported. This paper summarized the most common difficulties and mistakes that we have seen repeatedly in patients consulting to our services due to have suffered episodes of anaphylaxis in order to give orientation about implementation of plans of treatment of these reactions. The recommendations included in this document are derived from mentioned guidelines

Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs: An Update

After beta lactam antibiotics, hypersensitivity reactions to nonsteroidal antiinflammatory drugs are the second cause of hypersensitivity to drugs. Acute manifestations affect the respiratory tract (aspirin exacerbated respiratory disease), the skin (urticaria and angioedema), or are generalized (anaphylaxis). Correct diagnosis and treatment in order to prevent unnecessary morbidity and the potential risk of death from these severe reactions, and to provide proper medical advice on future drug use frequently requires the participation of allergology specialists familiar with these clinical conditions

Urticaria in Children Attending Allergy Services

Background: There is little information on urticaria occurring in children, especially in limited resource countries. Objective: To determine the demographic and clinical features of urticaria in children living in a developing country. Patients and method: A prospective study was done in children from two allergy outpatient clinics were prospectively studied. Clinical data was obtained from the medical history and physical examination. Laboratory evaluations and immediate-type skin tests with food and aeroallergen extracts were done in selected cases. Urticaria subtypes were de ned according to current EAACI/GA(2)LEN/WAO guidelines. Results: One hundred and twenty-three subjects were studied, 71 with acute urticaria and 52 with chronic urticaria. In patients with chronic urticaria, but not in those with acute urticaria, there was a significant predominance of girls. Triggers of urticaria were more common in acute than in chronic urticaria. Insects, foods, and drugs were the most common inducers of symptoms in acute urticaria, while urticaria induced by skin pressure was referred more often in chronic urticaria. In patients with acute or chronic urticaria there was a higher involvement of the head, upper and lower limbs. In patients with chronic urticaria, generalized urticaria, angioedema, and wheals on pressure sites were more frequent than in patients with acute urticaria. Spontaneous, papular, drug-induced, and dermographic urticaria were the most common subtypes in both groups of children. Conclusions: In children attending allergy services, acute urticaria was more frequent than the chronic type. Symptom triggers were different in acute than in chronic urticaria. Most common subtypes were spon- taneous, papular, drug-induced, and dermographic urticaria