Pruebas diagnósticas in vivo en alergia inmediata a penicilina: estudio piloto

Antecedentes: La alergia a antibióticos notificada con más frecuencia es la penicilina. La falsa etiqueta de "alergia" a la penicilina afecta negativamente la calidad de vida del paciente y la atención médica. Objetivo:  Determinar la frecuencia de alergia a penicilina y amoxicilina mediante pruebas de exposición in vivo, en pacientes con antecedente de reacción inmediata a esta clase de medicamentos. Métodos.  Estudio observacional, transversal, descriptivo y prolectivo en pacientes entre 12 y 60 años con antecedente de reacción inmediata a penicilina y/o amoxicilina. Se realizaron pruebas cutáneas por prick e intradérmicas con bencilpeniciloil polilisina y penicilina G, y prueba de reto oral con amoxicilina.  La frecuencia de positividad y negatividad en estas pruebas fue calculado con un IC del 95%. Los resultados se analizaron en Epi info 7.2.5.0 Resultados.  Se incluyeron 13 pacientes (10 mujeres), con una media de edad  de 39 años (DE 12.14) y diagnóstico predominante de rinitis alérgica (61,5%). En 84,6% de casos la última reacción adversa a medicamentos ocurrió 10 años atrás y en todos se manifestó con urticaria. Sólo en cinco pacientes (38,4%) se corroboró alergia a penicilina y la reacción adversa más frecuente tras las pruebas in vivo fue prurito (23 %). Conclusiones. La historia clínica por sí sola no es suficiente, todos los pacientes con sospecha de alergia a penicilina deben ser evaluados mediante pruebas  de exposición in vivo con los determinantes mayores y menores para corroborar o descartar alergia a esta clase farmacológica

Diagnóstico de alergia inmediata para penicilina: estudio piloto

Objetivos: Confirmar la presencia de alergia a penicilina y amoxicilina mediante pruebas de exposición in vivo, en pacientes que refieren antecedente de reacción inmediata con estos medicamentos. Métodos: Estudio observacional, transversal, descriptivo y prolectivo. Se incluyeron pacientes entre 12 y 60 años con antecedente de reacción inmediata tras administración de penicilina y/o amoxicilina. Se realizaron pruebas cutáneas por prick e intradérmicas con bencilpeniciloil polilisina y penicilina G, así como desafío oral con amoxicilina. Resultados: Se incluyeron 10 pacientes femeninos y 3 masculinos. La edad promedio fue 39 años. En 84,6% de los casos la última reacción adversa a medicamentos ocurrió 10 años atrás y en todos los casos se manifestó con urticaria. Sólo en el 38,4% se corroboró alergia a penicilina. La reacción adversa más frecuente, tras las pruebas de exposición in vivo fue prurito en el 23%. Conclusiones: Los pacientes con sospecha de alergia a penicilina se deben evaluar mediante pruebas de exposición in vivo con los determinantes mayores y menores, para corroborar o descartar reacciones alérgicas y mejorar las condiciones de tratamiento

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed

Skin reactivity frequency to aeroallergens in patients with clinical symptoms of allergic disease

Background: Allergic diseases diagnosis must be based on adequate allergological anamnesis and an immunological sensitization test; the most sensitive and specific is the skin prick test. Objective: To determine the frequency of skin reactivity to aeroallergens, by age groups, in patients of the Department of Allergy and Clinical Immunology of the Hospital Universitario de Puebla, in Mexico. Methods: A cross-sectional study was conducted that included patients aged 2 to 64 years with symptoms suggestive of allergic disease, in which skin prick tests with aeroallergens were performed; the diagnostic criteria were those of international guidelines. Frequencies, percentages and dispersion measures were calculated. Results: Of 173 patients, 63 % were females. Mean age was 22.3 years. The frequency of skin reactivity for Quercus sp. was 12.72 %, for Periplaneta americana, 9.83 %, for Dermatophagoides farinae, 9.25 %, for Cynodon dactylon, 8.09 %, for Blatella germanica, 8.09 %, for Holcus halepensis, 6.94 %, for Dermatophagoides pteronyssinus, 6.36 %, for Schinus molle, 5.78 %, for Fraxinus uhdei, 5.20 %, for Lolium perenne, 5.20 %, for Ambrosia eliator, 5.20 % and for Artemisa tridentata, 4.62 %. Conclusion: Although Dermatophagoides are the most frequently reported aeroallergens, the most common aeroallergen in this study was pollen, probably owing to geographical and environmental factors, although this was not observed in the analysis by age groups

Frequency of skin reactivity to food allergens in allergic patients

Background: Food allergy is deemed to have a worldwide prevalence ranging from 2 to 10 %. Objective: To determine the frequency of skin reactivity to food allergens by age groups. Methods: Cross-sectional, descriptive, prolective, observational study. Patients aged from 2 to 64 years with symptoms consistent with allergic disease were included. Skin prick tests were carried out with food allergens. Frequencies and percentages were estimated. Results: One-hundred and ninety-one patients were included, out of which 63.4% were females. Mean age was 22.5 years; 19.3 % showed positive skin reactivity to at least one food. Distribution by age group was as follows: preschool children 13.5 %, schoolchildren 24.3 %, adolescents 2.7 % and adults 59.5 %. Diagnoses included allergic rhinitis in 84.3 %, asthma in 19.4 %, urticaria in 14.1 % and atopic dermatitis in 8.4 %. Positive skin reactivity frequency distribution in descending order was: soybeans with 5.2 %, peach with 4.7 %, grapes, orange and apple with 3.6 %, nuts with 3.1 %, pineapple, avocado, tomato and tuna with 2.6 %. Conclusion: The frequency of skin reactivity to food allergens was similar to that reported in the national and Latin American literature, but sensitization to each specific allergen varied for each age group

Correlation between the Magnitude of Skin Prick Test Reactivity and Pollen-Specific Serum IgE Levels in Patients with Respiratory Allergy

Background: For the etiological diagnosis of allergic respiratory diseases skin tests or specific serum IgE determination are used. Objective: To determine the correlation between the extent of reactivity to cutaneous prick tests and the levels of pollen speci c serum IgE in patients with respiratory allergy. Patients and methods: A prolective, descriptive and transversal study was done with patients of both genders, aged 2 to 60 years, who attended for the rst time at the service of Allergy and Clinical Immunology of University Hospital of Puebla, Mexico, with presumptive diagnosis of respiratory allergy. All patients underwent clinical history, skin prick tests with standardized allergenic extracts and quanti cation of pollen speci c serum IgE by chemiluminescence method. We estimated the correlation index r using the statistical method Pearson product-moment correlation coef cient; a value r equal to or higher than 0.70 was con- sidered a signi cant relationship or a high correlation. Results: Nine-one patients were included, of whom 58.2% were female. The diagnoses were: allergic rhinitis (79.1%), asthma and allergic rhinitis (16.5%) and only asthma (4.4%). Only signi cant correlation was found in patients with allergic rhinitis for Rumex crispus (r = 0.702) and in patients with asthma and rhinitis for Ambrosia tri da (r = 1). Conclusion: Only for Rumex crispus and Ambrosia tri da, the skin prick tests or the determination of speci c serum IgE levels are comparable diagnostic methods of allergic respiratory diseases

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort

International audienc