Factores de riesgo para padecer alergia alimentaria Morfin Maciel, Blanca María del Refugio; Álvarez Castelló, Mirta
Revista alergia Mexico (Tecamachalco, Pueblo, Mexico : 1993),
12/2023, Letnik:
70, Številka:
4
Journal Article
Recenzirano
Odprti dostop
La alergia es el resultado de interacciones genéticas y ambientales, incluso de tiempo, ruta y dosis de exposición a alimentos en pacientes susceptibles. Los factores de riesgo pueden ser: 1) ...genéticos y 2) ambientales, y estos, a su vez, se dividen en prenatales, perinatales y posnatales. La alergia alimentaria aparece frecuentemente y depende de múltiples factores de riesgo (genéticos y ambientales), que a su vez se dividen en: factores prenatales, natales y posnatales; participan en la expresión de la enfermedad y no en todos los casos es posible la intervención clínica.
Rationale Novel therapeutic vaccines for allergic asthma, based on House Dust Mite allergens, effective with fewer administration would be a very advantageous alternative over conventional allergy ...vaccines and would allow a greater extension of the immunotherapy approach, reducing the consumption of symptomatic medications. In Cuba and other Caribbean countries the species Dermatophagoides siboney is very relevant as a cause of respiratory allergy.The objective of this research was to perform the first evaluation in humans of the tolerability and safety of a D. siboney allergen vaccine, adjuvanted with Neisseria meningitidis B proteoliposome (PROLINEM-DS).
Nasal provocation test (NPT) is indicated to confirm the diagnosis of allergic rhinitis to house dust mites. Methods An open, non-randomized, controlled clinical trial was carried out in 50 patients ...with allergic rhinitis sensitized to D. siboney mite and 50 non-allergicsubjects.
Rationale A nasal allergen provocation test (NAPT) is performed to confirm the diagnosis of allergic rhinitis to house dust mite, in the situation of discrepancy between the symptoms and the results ...of skin prick test (SPT) and/or serum specific immunoglobulin E. In Cuba, sensitization to house dust mites (Dermatophagoides pteronyssinus (Dp), Dermatophagoides siboney and Blomia tropicalis) is a major cause of allergic rhinitis. Conclusions Nasal allergen provocation test with the Dermatophagoides pteronyssinus is effective and safety by the diagnosis of allergic rhinitis to this mite.
Sensitization to Blomia tropicalis (Bt) is very frequent in the tropics, and particularly in Cuba, being a significant cause of allergic asthma. Allergen immunotherapy (AIT) with Bt can be a ...therapeutic option, however, placebo-controlled clinical trials have not been reported.
To assess the therapeutic effect and safety of AIT for asthma using a standardized allergen vaccine of B. tropicalis by subcutaneous route, in allergic asthmatic patients exposed and sensitized to this mite species.
A double-blind, placebo-controlled Phase II trial was conducted in 35 adults (18 with treatment and 17 with placebo), with mild to moderate asthma, predominantly sensitized to Bt. AIT was administered subcutaneously in increasing doses from 4 to 6000 Biological Units using a locally manufactured standardized extract (BIOCEN, Cuba). Patient assessment was performed using symptom-medication score (SMS), peak expiratory flow and skin reactivity relative to Histamine as measured by skin prick test (SPT).
The 12-month treatment achieved a significant (p < 0.001) decrease of SMS. Symptom score showed only 41% (CI: 26–61) of placebo values, whereas medication was 34.5% (22.4%–63.3%). Treatment was regarded clinically effective in 67% of patients (OR 32; 95%CI: 17 to 102). The effect size on symptoms and medication was higher than has been reported with equivalent allergen dosages of D. pteronyssinus and D. siboney in Cuban asthmatic patients. Skin reactivity to Bt was also significantly reduced (p = 0.0001), increasing 148-fold the allergen threshold to elicit a positive skin test. This desensitization effect was specific to Bt and did not modify the reactivity to Dermatophagoides. The change of specific skin reactivity was significantly (p < 0.05) correlated to clinical improvement. All adverse events were local with a frequency of 2.4% of injections.
Subcutaneous AIT with Blomia tropicalis was effective and safe in asthmatic adults exposed and sensitized to this mite species in a tropical environment.
Cuban Public Registry of Clinical Trials: RPCEC00000026 (WHO International Clinical Trial Registry Platform ICTRP).
Peanut allergy is increasing at an alarming pace in developed countries. Peanut (
) is a common food in Cuba. Nevertheless, reported values of sensitization and symptom severity are usually low. As ...our objective, we carried out an evaluation of allergic sensitivity to perform an assessment of allergic sensitization and IgE specificity profile to peanut allergens in Cuban allergic patients.
The Skin Prick Test (SPT) was performed for each patient, using two glycerinated allergenic extracts, prepared from raw or roasted peanuts. Overall, 316 food allergic patients (159 adults and 157 children) attending allergy services at four hospitals in Havana were included, as well as 303 adult non- allergic volunteers. The IgE binding profile of 26 selected SPT positive patients was further analyzed by immunoblotting.
The prevalence of sensitization to peanut was 4.6% in general adult population, whereas in adult food-allergic patients it was 18.6%. Prevalence rates were even greater in food allergic children achieving 25.8%. Sensitization frequencies were apparently greater for roasted, as compared to raw peanuts, although the difference was not significant (
> 0.05, Mc Nemar's). IgE binding was shown mostly by the 15 and 17 kDa bands, tentatively identified as the major allergens Ara h 2 and Ara h 6. The IgG4 binding profile was similar to IgE, although with more prominence of the bands at 37 and 28 KDa, corresponding to an Ara h 3 fragment and Peanut Agglutinin.
The study estimated a relatively high prevalence of peanut sensitization in population. Data reported here suggest that IgE sensitization in Cuban patients is focused mostly on MW bands corresponding to the major allergens Ara h 6 and Ara h 2.
Sensitization to peanut allergen is indeed relatively frequent in Cuba. The IgE profile is congruent to a sensitization pattern by ingestion of roasted peanuts and is directed to well-known major allergens.
La alergia al veneno de abejas provoca reacciones de leves a severas con compromiso para la vida. La inmunoterapia con veneno de himenópteros es un tratamiento eficaz y protege a los pacientes ...alérgicos de sufrir reacciones sistémicas ante nuevas picaduras. Nos propusimos caracterizar los pacientes alérgicos a picaduras de abeja que reciben inmunoterapia. Se realizó un estudio observacional descriptivo de corte longitudinal en pacientes alérgicos a las picaduras de abeja tratados con inmunoterapia de extracto de abeja en el Hospital Universitario “General Calixto García” de La Habana, Cuba. La muestra fue de 17 pacientes que cumplieron los criterios de inclusión. Usamos técnicas de estadística descriptiva: promedio, probabilidad y puntaje estandarizado, así como técnicas de estadística inferencial tales como Chi cuadrado, verificando asociación significativa entre las variables; el nivel de significación empleado fue del 5% (p˂0,05). La tercera década de la vida fue la edad promedio de los pacientes. Se observó predominio del sexo masculino y residencia en zona urbana. Alrededor de la mitad de los pacientes tenían rinitis y antecedentes familiares de asma. Todos los pacientes tuvieron reacciones locales, la mayoría se re-expusieron a la picadura; de ellos, solo el 20% presentaron reacciones alérgicas sistémicas después de la inmunoterapia. Se concluye que la reactividad cutánea al extracto de abeja se redujo con el tratamiento de inmunoterapia.
Las enfermedades alérgicas van en aumento importante en todo el mundo. La rinitis alérgica es una enfermedad inflamatoria crónica de la mucosa nasal IgE mediada, alérgeno-específica con participación ...de diversas células. Nos propusimos caracterizar la rinitis alérgica en pacientes atendidos en el Hospital Universitario “General Calixto García”. Se realizó un estudio observacional descriptivo de corte transversal, no aleatorizado, entre octubre 2016 y octubre 2017. En una muestra de 100 pacientes que cumplieron los criterios de inclusión, se realizó historia clínica alergológica empleando variables como: edad, sexo, antecedentes patológicos personales y familiares, procedencia, manifestaciones clínicas, y prueba cutánea por punción. Predominó el sexo femenino entre 30 y 39 años de edad, de área urbana, antecedentes patológicos familiares y personales de asma y conjuntivitis. La rinitis intermitente leve prevaleció en nuestro estudio, así como la sensibilidad a Dermatophagoides pteronyssinus. La tercera década de la vida fue la edad promedio de los pacientes. Se concluye que los pacientes presentaron una alta sensibilidad a Dermatophagoides pteronyssinus. La rinitis persistente leve, con la mitad de los casos, obtuvo mayor predominio por la duración de los síntomas.
The aim of this work was to review the 20-years Cuban experience developing House Dust Mite AIT for asthma Methods Standardized allergen extracts were developed for the well-known species ...Dermatophagoides pteronyssinus and for the tropical species D.siboney and Blomia tropicalis. Sublingual route has shown similar efficacy as compared to injection, with less systemic side-effects and no life-threatening reactions Conclusions AIT with standardized HDM allergens has shown to be, not only a clinically advantageous treatment, but also an approach able to be extended into a public healthcare system.
Most Latin-American countries use subcutaneous immunotherapy (SCIT) extracts from the United States and Europe and sublingual immunotherapy (SLIT) from Europe, with the exception of Argentina, ...Brazil, Cuba and Mexico. The number of researches on immunotherapy (IT) in Latin America has increased extensively in the last years. Only few Latin American countries have their own guidelines on IT, and, in general, the economic resources for medical research on IT are still low in the area. A global approach for the future of IT in Latin America includes to improve standardization, quality control and the production of allergen products, to develop IT guidelines and clinical investigation by the highest number of countries, to improve the regulatory status for allergens products in the area, and to expand IT accessibility for low-income patients. In Cuba, the first registered allergen vaccines were developed and registered in 2006: a standardized (in biologic units) and freeze dried product for SCIT, with a sublingual version developed in 2009. As much as 23.000 IT treatments were applied in 2011, all provided to patients free of charge. In 2012, Cuban researchers developed an IT vaccine with adjuvant for subcutaneous route, which uses Neisseria meningitidis proteoliposome as an adjuvant, added to the purified Dermatophagoides siboney major allergens: Der s1 and Der s2. Since December 2012, this vaccine is in Phase I clinical trial, evaluating its safety, tolerability and immunogenicity in asthmatic patients sensitized to this allergen. Cuban perspectives on IT includes to work on new indications for IT, to investigate the preventive effect and cost-effectiveness for the current vaccines, to develop new products with mixed formulas of house dust mites for SLIT, to complete the phase I and II clinical study for dust mite plus adjuvant vaccine, to develop allergen vaccines for fungi allergy and to complete the Cuban guideline for allergen IT management.
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