Objective: Report the prevalence and severity of the most common allergic diseases in children living in Monterrey, México. Methods: Cross-sectional multi-center survey on the most common allergic ...diseases, completed by parents of 6-7-year-old children and by 13-14- year-old adolescents in the Monterrey metropolitan area, between January 2018 and December 2019. Results: A total of 3,044 questionnaires were eligible for the analysis. Among children between 6-7 years old, 30.2% (n = 143/473) presented wheezing at any time in their life; with a higher prevalence in the male population. In the adolescent group, 26.4% reported having experienced wheezing at some point in their life, with a slight predominance in the female group (54.9%). Conclusions: Knowing the prevalence of allergic diseases in our population gives us tools to generate strategies that allow us to provide the best quality healthcare to our patients. Keywords: Asthma; Rhinitis; Eczema; Wheezing; Allergy And Immunology; Child.
Objetivo: Reportar la prevalencia y gravedad de las enfermedades alérgicas más comunes en niños residentes en Monterrey, México. Métodos: Encuesta multicéntrica transversal, acerca de las enfermedades alérgicas más comunes, completada por padres de niños de 6 aa 7 años y por adolescentes de 13 a 14 años del área metropolitana de Monterrey, entre enero de 2018 y diciembre de 2019. Resultados: Un total de 3044 cuestionarios fueron elegibles para el análisis. Entre los niños de 6-7 años, 30.2% (n = 143/473) manifestaron sibilancias en algún momento de su vida; con mayor prevalencia en la población masculina. En el grupo de adolescentes el 26.4% refirió haber tenido sibilancias alguna vez en su vida, con un ligero predominio en el grupo femenino (54.9%). Conclusiones: Conocer la prevalencia de las enfermedades alérgicas en la población brinda herramientas para generar estrategias para la mejor calidad asistencial en los pacientes. Palabras clave: Asma; Rinitis; Eczema; Sibilancias; Alergia E Inmunología; Niño.
Choosing the Optimal Self-Injector Epinephrine Macías-Weinmann, Alejandra; González-Díaz, Sandra Nora; Canseco-Villarreal, José Ignacio ...
Current treatment options in allergy,
03/2021, Letnik:
8, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Purpose of review
Anaphylaxis is an acute, systemic, life-threatening allergic reaction, and its choice treatment is epinephrine. Epinephrine may be administered by several routes, but intramuscular ...is the preferred one because of its fast time of action, as well as easy access. Several devices are commercially available for self-administration, with some differences between them. There are concerns about defects or errors in administration when using autoinjectors.
Recent findings
The main factors that determine the correct use of an autoinjector are the length of needle, body mass index, use of clothing, type of device, and training of the person applying epinephrine. Comparing different devices not only highlights some differences between them; but it also finds the similarities in their effectiveness and defects. There are areas of opportunity in the design and route of administration that may be addressed in future research.
Summary
This review focuses on devices for treatment of anaphylaxis like autoinjectors and includes analysis of factors specific to the device, as well as those dependent on the patient and who applies the device. The best device will be the one that is available, together with adequate training of patient/caregiver and health personnel for its correct use.
Objective: Report the prevalence and severity of the most common allergic diseases in children living in Monterrey, México. Methods: Cross-sectional multi-center survey on the most common allergic ...diseases, completed by parents of 6-7-year-old children and by 13-14- year-old adolescents in the Monterrey metropolitan area, between January 2018 and December 2019. Results: A total of 3,044 questionnaires were eligible for the analysis. Among children between 6-7 years old, 30.2% (n = 143/473) presented wheezing at any time in their life; with a higher prevalence in the male population. In the adolescent group, 26.4% reported having experienced wheezing at some point in their life, with a slight predominance in the female group (54.9%). Conclusions: Knowing the prevalence of allergic diseases in our population gives us tools to generate strategies that allow us to provide the best quality healthcare to our patients. Keywords: Asthma; Rhinitis; Eczema; Wheezing; Allergy And Immunology; Child.
Objetivo: Reportar la prevalencia y gravedad de las enfermedades alérgicas más comunes en niños residentes en Monterrey, México. Métodos: Encuesta multicéntrica transversal, acerca de las enfermedades alérgicas más comunes, completada por padres de niños de 6 aa 7 años y por adolescentes de 13 a 14 años del área metropolitana de Monterrey, entre enero de 2018 y diciembre de 2019. Resultados: Un total de 3044 cuestionarios fueron elegibles para el análisis. Entre los niños de 6-7 años, 30.2% (n = 143/473) manifestaron sibilancias en algún momento de su vida; con mayor prevalencia en la población masculina. En el grupo de adolescentes el 26.4% refirió haber tenido sibilancias alguna vez en su vida, con un ligero predominio en el grupo femenino (54.9%). Conclusiones: Conocer la prevalencia de las enfermedades alérgicas en la población brinda herramientas para generar estrategias para la mejor calidad asistencial en los pacientes. Palabras clave: Asma; Rinitis; Eczema; Sibilancias; Alergia E Inmunología; Niño.
There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for ...long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a proliferation of published guidelines which systematically review evidence for the gold-standard management of most allergic disorders. However, this has not necessarily been followed by improved outcomes, partly due to a lack of coordination across the patient pathway. This has become known as the "second translational gap". A proposed solution is the development and implementation of integrated care pathways (ICPs) to optimize patient outcomes, with the notion that evidence-based medicine requires evidence-based implementation. ICP implementation is shown to improve short-term outcomes for acute conditions and routine surgery, including reduced length of hospital stay, improved documentation and improved patient safety. However, this improvement is not reflected in patient experience or patient-centered functional outcomes. The implementation of life-long, cost-effective interventions within comprehensive pathways requires a deep appreciation for complexity within allergy care.
We promote an evidence-based methodology for the implementation of ICPs for allergic disorders in which all stakeholders in allergy care are positioned equally and encouraged to contribute, particularly patients and their caregivers. This evidence-based process commences with scoping the unmet needs, followed by stakeholder mapping. All stakeholders are invited to meetings to develop a common vision and mission through the generation of action/effect diagrams which helps build concordance across the agencies. Dividing the interventions into achievable steps and reviewing with plan/do/study/act cycles will gradually modify the pathway to achieve the best outcomes. While the management guidelines provide the core knowledge, the key component of implementation involves education, training, and support of all healthcare professionals (HCPs), patients and their caregivers.
The pathways should define the level of competence required for each clinical task. It may be useful to leave the setting of care delivery or the specific HCP involved undefined to account for variable patterns of health service delivery as well as local socioeconomic, ethnic, environmental, and political imperatives. In all cases, where competence is exceeded, it is necessary to refer to the next stage in the pathway. The success and sustainability of ICPs would ideally be judged by patient experience, health outcomes, and health economics. We provide examples of successful programs, most notably from Finland, but recommend that further research is required in diverse settings to optimize outcomes worldwide.
Allergy education and training for physicians Barker, Sally; Daniels, Lydia; Chang, Yoon-Seok ...
The World Allergy Organization journal,
10/2021, Letnik:
14, Številka:
10
Journal Article
Recenzirano
Odprti dostop
The increasing prevalence of allergic diseases has placed a significant burden on global healthcare and society as whole. This has necessitated a rapid development of “allergy” as a specialist area. ...However, as allergy is so common and, for most, relatively easy to diagnose and control, all clinicians need to have basic knowledge and competence to manage mild disease and recognize when referral is required. The allergology specialty has not yet been recognized in many countries and even where allergy is fully recognized as a specialty, the approach to training in allergy differs significantly.
In the light of recent developments in allergy diagnosis and management, there is an urgent need to harmonize core competences for physicians, as well as the standardization of core principles for medical education and post-graduate training in allergy. All physicians and allied health professionals must appreciate the multidisciplinary team (MDT) approach to allergy, which is key to achieving the highest standards in holistic care. Due to worldwide variation in resources and personnel, some MDT roles will need to be absorbed by the treating physician or other healthcare professionals. We draw particular attention to the role of psychological input for all allergy patients, dietetic input in the case of food allergy and patient education to support all patients in the supported self-management of their condition on a daily basis. A strong appreciation of these multidisciplinary aspects will help physicians provide quality patient-centered care.
We consider that harmonization of allergy components within undergraduate curricula is crucial to ensure all physicians develop the appropriate allergy-related knowledge and skills, particularly in light of inconsistencies seen in the primary care management of allergy. This review from the World Allergy Organization (WAO) Education and Training Committee also outlines allergy-related competences required of physicians working with allergic patients and provides recommendations to promote harmonization of allergy training and practice worldwide.
Specific IgE against
can be found in approximately 40% of patients with allergies, also in patients without allergies because they may be sensitized. These antibodies are functional, and they can ...induce histamine release contributing to chronic pruritus which can worsen disease severity. The objective of this study was to compare levels of specific IgE against
toxins in those populations.
A cross-sectional, comparative non-blinded survey was made at the Regional Center for Allergy and Clinical Immunology. Ninety-nine adults between 18 and 70 years of age with allergic rhinitis (AR) and without allergic rhinitis (wAR) were recruited. A clinical history and demographic data, and allergic sensitization patterns to 35 aeroallergens were obtained, and participants were classified according to their severity using the Allergic Rhinitis and Its Impact on Asthma (ARIA) classification. Specific IgE levels were determined using ImmunoCAP™ 100 platform.
The median age (IQR) of the participants was 23 (20-33.7); 56.2% were women. The most frequent comorbidities were asthma and obesity. Of the patients with AR, 46.7% were classified as mild intermittent and 25% as moderate persistent. IgE levels against staph toxins A, B, and TSST were significantly higher in the AR group vs the wAR group median IQR 0.01 (0.01-0.03) vs. 0.01 (0-0.02), p = 0.01; 0.02 (0.01-0.03) vs. 0.01 (0-0.02), p= 0.02; 0.04 (0.02-0.09) vs. 0.01 (0-0.04), p=0.002, respectably. A significant difference was found in serum IgE levels against Staph B toxin between severity subgroups.
People with AR have higher IgE levels against staph toxins A, B and TSST than wAR subjects. However, it is not possible declare that the IgE titers were related to disease severity.
With statistic significance p=0.05. ...values are statistically significative in patients with respiratory allergy vs controls on T3 which correlates with inflammation of the periferic respiratory ...tract. Conclusions The measurement of exhaled breath fraction temperature in patients with respiratory allergy is a non-invasive measurement method which can relate to the level of inflammation of the respiratory tract in allergic patients
The most implicated microorganism in allergic rhinitis (AR) is Staphylococcus aureus (S. aureus), which sets super-antigens free that activate T cells, causing higher inflammatory response, that can ...lose control and may not respond to treatment. Conclusions Our data suggest that AR patients have higher levels of specific IgE for S. aureus. ...it is necessary to identify in patients who present with frequent exacerbations
Chronic urticaria and thyroid pathology Gonzalez-Diaz, Sandra Nora; Sanchez-Borges, Mario; Rangel-Gonzalez, Diana Maria ...
The World Allergy Organization journal,
03/2020, Letnik:
13, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Urticaria is defined as the sudden appearance of erythematous, itchy wheals of variable size, with or without angioedema (AE) (swelling of the deeper layers of the skin). Its classification depends ...on time course of symptoms and the presence of eliciting factors. When it lasts less than 6 weeks it is classified as acute urticaria (AU), and if the symptoms persist for more than 6 weeks, it is classified as chronic urticaria (CU). Current International Guidelines also classify CU as chronic spontaneous urticaria (CSU) and inducible urticarial, according to the absence or presence of environmental triggering factors. CSU is defined as urticaria and/or angioedema in which there is no evidence of a specific eliciting factor. CSU is associated with autoimmunity in 30–45% of the cases, sharing some immunological mechanisms with other autoimmune diseases, and is associated with autoimmune thyroid disease (ATD) in about 4.3%–57.4% patients. Several studies suggest that adequate therapy with anti-thyroid drugs or levothyroxine in early stages of ATD and CSU, may help to remit the latter; but there is still a lack of double-blind, placebo-controlled studies that support this hypothesis in patients without abnormal thyroid hormone levels. The objective of this review is to describe the pathophysiology of chronic spontaneous urticaria and its association with autoimmune thyroid disease.
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