Mexican consensus on cow's milk protein allergy Alfonso, Ramírez Mayans Jaime; Rubí, Ignorosa Arellano Karen; Manuel, Toro Monjaraz Erick ...
Allergologia et immunopathologia,
2024, Volume:
52, Issue:
1
Journal Article
Peer reviewed
Open access
The aim of this study is to present the current views of a diverse group of experts on the diagnosis and treatment of Cow's Milk Protein Allergy (CMPA) in children under 2 years of age in Mexico.
The ...study, led by a scientific committee of five experts in CMPA, was divided into six phases, including a modified Delphi process. A total of 20 panelists, all of whom were pediatric specialists, participated in administering a comprehensive 38-item questionnaire. The questionnaire was divided into two blocks: Diagnosis and Treatment (20 items each).
Consensus was reached on all the proposed items, with an agreement rate of over 70% for each of them. As a result, a diagnostic and treatment algorithm was developed that emphasized the reduction of unnecessary diagnostic studies and encouraged breastfeeding whenever possible. In cases where breast milk is not available, appropriate use of hypoallergenic formulas was recommended. In addition, recommendations on treatment duration and gradual reintroduction of cow's milk protein were provided.
The recommendations endorsed by 20 Mexican pediatricians through this study are applicable to everyday clinical practice, thereby enhancing the diagnosis and treatment of children under 2 years of age with CMPA. This, in turn, will foster improved health outcomes and optimize the utilization of healthcare resources.
Background and Purpose
Protective mechanisms of the endogenous cannabinoid system against drug‐induced liver injury (DILI) are actively being investigated regarding the differential regulatory role ...of the cannabinoid CB1 and CB2 receptors in liver fibrogenesis and inflammation.
Experimental Approach
The 2‐arachidonoylglycerol (2‐AG)‐related signalling receptors and enzymatic machinery, and inflammatory/fibrogenic factors were investigated in the liver of a mouse model of hepatotoxicity induced by acute and repeated overdoses (750 mg·kg−1·day−1) of paracetamol (acetaminophen), previously treated with selective CB1 (ACEA) and CB2 (JWH015) agonists (10 mg·kg−1), or lacking CB1 and CB2 receptors.
Key Results
Acute paracetamol increased the expression of CB2, ABHD6 and COX‐2, while repeated paracetamol increased that of CB1 and COX‐2 and decreased that of DAGLβ. Both acute paracetamol and repeated paracetamol decreased the liver content of acylglycerols (2‐AG, 2‐LG and 2‐OG). Human liver samples from a patient suffering APAP hepatotoxicity confirmed CB1 and CB2 increments. Acute paracetamol‐exposed CB2 KO mice had higher expression of the fibrogenic αSMA and the cytokine IL‐6 and lower apoptotic cleaved caspase 3. CB1 deficiency enhanced the repeated APAP‐induced increases in αSMA and cleaved caspase 3 and blocked those of CYP2E1, TNF‐α, the chemokine CCL2 and the circulating γ‐glutamyltransferase (γGT). Although JWH015 reduced the expression of αSMA and TNF‐α in acute paracetamol, ACEA increased the expression of cleaved caspase 3 and CCL2 in repeated paracetamol.
Conclusion and Implications
The differential role of CB1 versus CB2 receptors on inflammatory/fibrogenic factors related to paracetamol‐induced hepatotoxicity should be considered for designing alternative therapies against DILI.
Protective mechanisms of the endogenous cannabinoid system against drug-induced liver injury (DILI) are actively being investigated regarding the differential regulatory role of the cannabinoid CB
...and CB
receptors in liver fibrogenesis and inflammation.
The 2-arachidonoylglycerol (2-AG)-related signalling receptors and enzymatic machinery, and inflammatory/fibrogenic factors were investigated in the liver of a mouse model of hepatotoxicity induced by acute and repeated overdoses (750 mg·kg
·day
) of paracetamol (acetaminophen), previously treated with selective CB
(ACEA) and CB
(JWH015) agonists (10 mg·kg
), or lacking CB
and CB
receptors.
Acute paracetamol increased the expression of CB
, ABHD6 and COX-2, while repeated paracetamol increased that of CB
and COX-2 and decreased that of DAGLβ. Both acute paracetamol and repeated paracetamol decreased the liver content of acylglycerols (2-AG, 2-LG and 2-OG). Human liver samples from a patient suffering APAP hepatotoxicity confirmed CB
and CB
increments. Acute paracetamol-exposed CB
KO mice had higher expression of the fibrogenic αSMA and the cytokine IL-6 and lower apoptotic cleaved caspase 3. CB
deficiency enhanced the repeated APAP-induced increases in αSMA and cleaved caspase 3 and blocked those of CYP2E1, TNF-α, the chemokine CCL2 and the circulating γ-glutamyltransferase (γGT). Although JWH015 reduced the expression of αSMA and TNF-α in acute paracetamol, ACEA increased the expression of cleaved caspase 3 and CCL2 in repeated paracetamol.
The differential role of CB
versus CB
receptors on inflammatory/fibrogenic factors related to paracetamol-induced hepatotoxicity should be considered for designing alternative therapies against DILI.
OBJECTIVETo adapt the ICU Mobility Scale (IMS) to the area of intensive care units (ICU) in Spain and to evaluate the metric properties of the Spanish version of the IMS (IMS-Es). METHODDescriptive ...metric study developed in two phases. Phase 1, adaptation to Spanish of the IMS by a team of nurses and physiotherapists (translation, pilot, backtranslation and agreement). Phase 2, analysis of metric properties (convergent, divergent and predictive validity, interobserver reliability, sensitivity and minimum important difference) of the IMS-Es. Patient characteristics (Barthel, Charlson, BMI, sex), sedation/agitation level (RASS), ICU and hospital stays, survival, quality of life (SF-12), muscle weakness (MRC-SS) and mobility (IMS-Es) were recorded in the patients of the MOviPre national multicentre study. RESULTSAfter obtaining the IMS-Es, it was implemented in 645 patients from 80 Spanish ICUs between April and June 2017. Convergent validity: moderate correlation between IMS-Es and MRC-SS (r=.389; P<.001) and significant comparison between groups with and without ICU-acquired weakness (P<.001). Divergent validity: no correlation between IMS-Es and BMI r (95%CI): -.112 (-.232 to .011), weight r (95%CI): -.098 (-.219 to .026), Charlson r (95%CI): -.122 (-.242 to .001) and Barthel r(95%CI): -.037 (-.160 to .087) and no differences between sexes (P=.587) or BMI categories (P=.412). Predictive validity: moderate and significant correlations with post-ICU hospital stay r (95%CI): -.442 (-.502 to -.377) and physical component of SF-12 (PCS) r (95%CI): .318 (.063 to .534); patients without active mobilisation in ICU increased risk of hospital mortality OR (95%CI): 3.769 (1.428 to 9.947). Interobserver reliability: very good concordance between nurses CCI (95%CI): .987 (.983 to .990) and nurse-physiotherapist CCI (95%CI): .963 (.948 to .974). Sensitivity to change: small effect on discharge from ICU (d=.273) and moderate effect at 3months after hospital discharge (d=.709). Minimal important difference: 2-point difference cut-off point, 91.1% sensitivity and 100.0% specificity. CONCLUSIONSThe IMS-Es is useful, valid and reliable for implementation by ICU nurses and physiotherapists in assessing the mobility of critical patients.
In Mexico, allergen immunotherapy (AIT) and immunotherapy with hymenoptera venom (VIT) is traditionally practiced combining aspects of the European and American school. In addition, both types of ...extracts (European and American) are commercially available in Mexico. Moreover, for an adequate AIT/VIT a timely diagnosis is crucial. Therefore, there is a need for a widely accepted, up-to-date national immunotherapy guideline that covers diagnostic issues, indications, dosage, mechanisms, adverse effects and future expectations of AIT (GUIMIT 2019).
With nationwide groups of allergists participating, including delegates from postgraduate training-programs in Allergy/Immunology-forming, the guideline document was developed according to the ADAPTE methodology: the immunotherapy guidelines from European Academy of Allergy and Clinical Immunology, German Society for Allergology and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology were selected as mother guidelines, as they received the highest AGREE-II score among international guidelines available; their evidence conforms the scientific basis for this document.
GUIMIT emanates strong or weak (suggestions) recommendations about practical issues directly related to in vivo or in vitro diagnosis of IgE mediated allergic diseases and the preparation and application of AIT/VIT and its adverse effects. GUIMIT finishes with a perspective on AIT modalities for the future. All the statements were discussed and voted on until > 80 % consensus was reached.
A wide and diverse group of AIT/VIT experts issued transculturized, evidence-based recommendations and reached consensus that might improve and standardize AIT practice in Mexico.
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