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

Early science with the Large Millimeter Telescope: a 1.1 mm AzTEC survey of red-<i>Herschel</i> dusty star-forming galaxies

We present Large Millimeter Telescope (LMT)/AzTEC 1.1 mm observations of ∼100 luminous high-redshift dusty star-forming galaxy candidates from the ∼600 sq.deg Herschel-ATLAS survey, selected on the basis of their SPIRE red far-infrared colours and with S500μm=35−80 mJy. With an effective θFWHM ≈ 9.5arcsec angular resolution, our observations reveal that at least 9 per cent of the targets break into multiple systems with signal-to-noise ratio ≥4 members. The fraction of multiple systems increases to ∼23 per cent (or more) if some non-detected targets are considered multiples, as suggested by the data. Combining the new AzTEC and deblended Herschel photometry, we derive photometric redshifts, infrared luminosities, and star formation rates. While the median redshifts of the multiple and single systems are similar (zmed ≈ 3.6), the redshift distribution of the latter is skewed towards higher redshifts. Of the AzTEC sources, ∼85 per cent lie at zphot > 3 while ∼33 per cent are at zphot > 4. This corresponds to a lower limit on the space density of ultrared sources at 4 −7Mpc−3 with a contribution to the obscured star formation of ≳8×10−4M⊙yr−1Mpc−3⁠. Some of the multiple systems have members with photometric redshifts consistent among them suggesting possible physical associations. Given their angular separations, these systems are most likely galaxy over-densities and/or early-stage pre-coalescence mergers. Finally, we present 3 mm LMT/RSR spectroscopic redshifts of six red-Herschel galaxies at zspec = 3.85−6.03, two of them (at z ∼ 4.7) representing new redshift confirmations. Here, we release the AzTEC and deblended Herschel photometry as well as catalogues of the most promising interacting systems and z > 4 galaxies

Local dew-point temperature, water vapor pressure, and millimeter-wavelength opacity at the Sierra Negra volcano

Aims. Some astronomical facilities are in operation at the Sierra Negra volcano (SNV), at ∼4.5 km over the sea level (o.s.l.) in Mexico. We asses whether it is possible to estimate the opacity for millimeter-wavelength observations based on the meteorological parameters at the site. A criterion for allowing astronomical observations at SNV depends on the atmospheric opacity at 225 GHz, which has to be τ225 ≤ 0.30 Nepers. The correlation of the opacity at SNV, measured with a radiometer at 225 GHz, τ225, with the local dew point temperature, TDP, the water vapor pressure, PH2O and the water vapor content (WVC) at SNV is studied with the aim to determine whether these parameters can be used to estimate the opacity at similar high-altitude locations for astronomical observations at millimeter wavelengths. Methods. We used radiosonde data taken in various decades in Mexico City (MX) and Veracruz City (VR) to compute the WVC in 0.5 km altitude (h) intervals from 0 km for VR and from 2.0 km for MX to 9.5 km o.s.l. to study the altitude profile WVC(h) at SNV by interpolating data of MX and VR. We also fit exponential functions to observed WVC (WVCobs(h)), obtaining a fit WVC (WVCftd(h)). The WVCobs(h) and WVCftd(h) were integrated, from lower limits of hlow = 2.5–5.5 km to the upper limit of 9.5 km as a measure of the input of WVCobs(h ≥ hlow) to the precipitable water vapor. Results. The largest differences between WVCobs and WVCftd values occur at low altitudes. The input of WVCobs(h) to the precitpitable water vapor for h ≥ 4.5 km ranges from 15% to 29%. At 4.5–5.0 km, the input is between 4% and 8%. This means that it is about a third of the WVC (h ≥ 4.5 km). The input above our limit (from 9.5–30.0 km) is estimated with WVCftd(h) and is found to be lower than 1%. The correlation of τ225 with TDP, PH2O, and WVCSNV takes values between 0.6 and 0.8. A functional relation is proposed based on simultaneous data taken in 2013–2015, according to which it is possible to estimate the opacity with the TDP, PH2O, or WVCSNV at the site. Conclusions. With local meteorological parameters, it is possible to know whether the opacity meets the condition τ225 ≤ 0.30 Nepers, with an uncertainty of ±0.16 Nepers. The uncertainty is low for low opacities and increases with increasing opacity

The SKA Aperture Array Verification System: Measured Digitally-Beam-Formed Radiation Patterns

The Aperture Array Verification System stimulated extensive test activities towards the development of the low-frequency instrument (50-350 MHz) of the Square Kilometer Array. This paper discusses radiation patterns measurements carried out on a 16-element array prototype with full digital beam-forming. A micro Unmanned Aerial Vehicle was adopted as the automatic positioner for the test source