Editorial committee

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Importance and usefulness of the ARIA guide

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Electronic system of Revista Alergia México, a new challenge

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Estimation of Glomerular Filtration Rate in Adults with Common Variable Immunodeficiency Treated with Intravenous Immunoglobulin. What formula should we use?

Background: The common variable immunodeficiency (CVID) is characterized by absence of isohemagglutinins and two standard deviations of normal levels of immunoglobulins. His treatment includes administering immunoglobulin, more frequently intravenous (IVIG). A side effect is the possible severe renal insuf ciency secondary to the use of preparations containing sucrose. These patients have weight loss, decreased muscle mass associated with gastrointestinal disorders and bronchiectasis that limit physical activity and other factors. There are different formulas for determining the glomerular ltration rate, we compared the most commonly used to determine the most appropriate in this population. Objective: To determine the correlation between glomerular ltration rate using the MDRD formula, CKD-EPI and Cockcroft-Gault and that obtained through the urine creatinine clearance 24 h in patients with common variable immunode ciency who are treated with IVIG. Patients and method: A transversal, observational and descriptive study that included 19 patients with common variable immunode ciency, 12 women and 7 men, mean age 36 years, was done. Descriptive statistics with mean, median, mode and standard deviation was used. To measure the concordance of the measurements for quantitative variables intra- class correlation coef cient was used and to determine the correlation between the stages of renal function with different formulas kappa index was calculated. Results: The values of the intraclass correlation coef cient showed a good correlation between creatinine clearance in 24 h urine with CKD-EPI, mediocre with MDRD and nil with the Cockroft-Gault formula. Conclusions: Glomerular ltration rate obtained with CKD-EPI proved to be partially most useful, with a good correlation in relation to urine creatinine clearance in 24 h. Its routine use is recommended over other formulas in common variable immunodeficiency patients with suspected renal disease secondary to the use of IVIG

Frequency of sensitization to Mites, Cockroach and Shrimp in Adults with Respiratory Allergy

Background: Sensitization to mites and cockroach are a common cause of respiratory allergy, especially in children. There is little information about its cross-reactivity with shrimp, which is common in adult patients. Objectives: To determine the frequency of sensitization to house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae) and cockroach species Periplaneta americana, in adult patients attending to a third level hospital and to determine the frequency of sensitization to shrimp in patients with positive skin test to house dust mite and/or cockroach, in patients with clinical manifestations suggestive of allergy to shrimp. Material and method: A retrospective study was done in which results were reviewed of 672 patients clinical records, attending to the Al- lergy and Clinical Immunology department in a third level hospital, those patients with positive skin test results to Dermatophagoides and/ or Periplaneta americana were investigated for sensitization to shrimp through Prick-to-Prick test. Results: Data from 672 patients were obtained, 69.8% (469) males, with a mean age of 33.5 years. Dermatophagoides positivity was 72.2% (486/672), and its relationship with other invertebrates that also have tropomyosin was 5.6% (4.9% with cockroach and 0.74% with shrimp). Conclusions: In our population, house dust mite sensitization was similar to that reported in the international literature. There was low positivity to cockroach, probably due to geographical conditions. There is very little information about shrimp’s cross-reactivity with Dermatophagoides, despite its clinical signi cance, which requires more speci c studies such as measurement of speci c IgE to tropomyosin

Desensitization to darunavir in a pediatric patient

Treatment of HIV infection requires the combination of multiple antiretroviral drugs, known as highly active antiretroviral therapy (HAART); however, up to 84% of patients experience adverse drug effects that lead to discontinuation within first months of treatment. Skin manifestations are reported to 22% of patients. The severity of these is variable, such as erythema multiforme, rash, hives and severe skin reactions at less than 2%. Mild rashes, usually transient and self-limiting, while severe reactions require immediately remove the drug involved to prevent progression of the reaction. Only in those cases where the offending drug does not have another alternative and documented the reaction is mediated type I hypersensitivity mechanisms, can be performed desensitization protocol

Oral Allergy Syndrome in Adults of a Third Level Hospital

Background: Oral allergy syndrome (OAS) is the mildest form of an allergic reaction to foods. It is characterized by the presence of IgE mediated symptoms restricted to oral mucosa after intake of fresh fruits and vegetables. OAS diagnosis is based on suggestive clinical manifestations and can be con rmed with tests such as prick-to-prick skin test with the food implicated, which have a sensitivity > 90%, speci city 30-60%, positive predictive value (PPV) of 40% and negative predictive value (NPV) > 95%. Objective: To know the prevalence of OAS in adult patients attending a third level hospital in southern Mexico City, and also describe the demographics of these patients and comorbidities more frequently associated. Patients and method: We studied 44 patients (40 women and 4 men), with an average age of 33.4 years, with suggestive clinical features of OAS, evaluated with prick-by-prick skin tests with fresh food. Results: There was a predominance of OAS in woman (91%) and a prevalence of asthma and allergic rhinitis of 54% among this population. We found that 60.4% of these patients had positive prick-by-prick skin tests, being the most frequently involved families of foods: rosaceae (60%), crustaceans (25%), musaceae (23%), actinidacea (21%), laura- ceae (16%) and cucurbitaceae (16%). Only 5 patients presented adverse reactions with prick-by-prick skin tests, in 4 of the cases with grade 3 and grade 4 anaphylaxis, while testing with banana-watermelon, peach, papaya and peanut, respectively. Conclusions: Oral allegy syndrome affects more women than men, the most frequent comorbidities in patients with oral allergy syndrome are allergic rhinitis and asthma, thus, in patients with asthma and allergic rhinitis, sensitized to pollens we have to ask about symptoms suggestive of oral allergy syndrome

Wiskott-Aldrich Syndrome. A Report of a New Mutation

Wiskott-Aldrich syndrome was rst reported clinically in 1937, and in 1954 the classic triad was identified: eccema, recurrent infections and thrombocytopenia with an X-linked transmission. Its incidence is estimated at 1 to 10 in one million live births per year. Wiskott Aldrich syndrome is caused by mutations in a gene in the short arm of chromosome X that encodes the Wiskott-Aldrich syndrome protein (WASp), which identi cation and sequencing was rst performed in 1994, and since then about 300 mutations have been reported. This paper describes the case of a boy with Wiskott-Aldrich syndrome, with clinical and genetic diagnosis, with a considerable diagnostic delay attributable to an atypical presentation misdiagnosed as immune thrombocytopenia

Study of Quality of Life in Adults with Common Variable Immunodeficiency by Using the Questionnaire SF-36

Background: Quality of life is a multidimensional concept that includes physical, emotional and social components associated with the disease. The use of tools to assess the Quality of Life Health Related (HRQOL) has increased in recent decades. Common variable immunode ciency (CVID) is the most commonly diagnosed primary immunode ciency. Objective: To evaluate the quality of life in patients with CVID using the questionnaire SF -36. Patients and method: A descriptive cross-sectional survey included 23 patients diagnosed with CVID, belonging to the Immunode ciency Clinic Service of Allergology and Clinical Immunology in CMN Siglo XXI, IMSS. The questionnaire SF- 36 validated in Spanish was applied. Statistical analysis: descriptive statistics with simple frequencies and percentages, inferential statistics: Fisher exact test and ANOVA to compare means. Results: The study involved 23 patients, 14 women (60%) and 9 men (40%), mean age 38.6 ± 14.7 years. The highest score was obtained in 83% emotional role. Dimensions with further deterioration in both gen- ders were: 54% general health, vitality 59% and physical performance 72%. No differences were found regarding gender. The only issue in which statistically signi cant differences were found in patients with more than 3 comorbidities was change in health status in the past year (p=0.007). Patients with severe comorbidities, such as haematological-oncological (leukemias, lymphomas, neoplasms), and pulmonary (severe bronchiectasis) showed further deterioration in the aspects of physical performance 73% and 64% emotional role. 65% of patients reported an improvement in health status in 74% in the last year. Conclusions: Adult patients with CVID show deterioration in different dimensions, particularly in the areas of general health, vitality and physi- cal performance. Patients with severe comorbidities such as leukemia, lymphomas, malignancies and severe bronchiectasis show further deterioration in some aspects of quality of life, especially in physical performance and emotional role. A higher number of comorbidities was signi cantly associated with a lower score in changing health. The questionnaire SF-36 is useful for evaluating the quality of life of our patients with CVID