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Background: Atopic dermatitis (AD) profoundly impacts quality of life as a chronic inflammatory skin disease. Allergen exposure triggers specific IgE antibodies, initiating allergy symptoms. Cross-reactivity, linked to auto-IgE responses, potentially influences AD severity. Exploring new allergens and self-autoantigens, like Aspergillus fumigatus, enhances knowledge of AD triggers. Our focus was on analyzing molecular mimicry between human AQP3 and A. fumigatus aquaporin, alongside various allergenic sources. Objective: Conduct an in silico assessment of potential molecular mimicry between human aquaporins, A. fumigatus, and diverse allergenic sources. Methods: Amino acid sequences of human AQP3 and A. fumigatus aquaporin were compared through multiple alignments with 25 aquaporins from diverse allergenic sources. Phylogenetic analysis and homology-based modeling were executed, and ElliPro server predicted conserved antigenic regions on 3D structures. Results: Global identity among studied aquaporins was 32.6%, with a specific conserved local region at 71.4%. Five monophyletic clades (A-E) were formed, and Group B displayed the highest identity (95%), including 6 mammalian aquaporins, notably AQP3. A. fumigatus aquaporin exhibited the highest identity with Malassezia sympodialis (35%). Three linear and three discontinuous epitopes were identified in both human and A. fumigatus aquaporins. The Root Mean Square Deviation (RMSD) from overlapping aquaporin structures was 1.006. Conclusion: Identification of potential linear and conformational epitopes on human AQP3 suggests likely molecular mimicry with A. fumigatus aquaporins. High identity in a specific antigenic region indicates potential autoreactivity and a probable antigenic site involved in cross-reactivity. Validation through in vitro and in vivo studies is essential for further understanding and confirmation.

Objetivo: Evaluar el riesgo de sensibilización IgE y síntomas a camarón en una población que ha recibido AIT con extracto polimerizado para ácaros. Métodos: Se incluyeron pacientes con rinitis alérgica sensibilizados a ácaros del polvo (Dermatophogides spp) con indicación de AIT para ácaros. Aquellos pacientes que no habían aún recibido AIT o llevaban menos de seis dosis, fueron incluidos como controles, y aquellos que llevaban más de 24 dosis de AIT, fueron incluidos como casos. Se evaluó la sensibilización a camarón mediante prueba cutánea con extracto completo de camarón y/o IgE específica a camarón. Resultados: En total, 68 pacientes fueron incluidos; 47 casos y 21 controles. Al calcular el odds ratio de la sensibilización de acuerdo al tiempo con la inmunoterapia, observamos que no había diferencias entre el grupo de casos y controles (OR 0,76 95% IC 0,26 a 2,22 p 0,7 por técnica de MacNemar). Factores como el consumo o no de camarón y la frecuencia de consumo, no parecen estar relacionados con el desenlace. Conclusión: A diferencia de lo reportado con extractos acuosos, observamos de AIT con extractos polimerizados para no es un factor de riesgo para la sensibilización a camarón. Es necesario reproducir estos resultados con un mayor tamaño de muestra que permita explorar otros factores.

La planta Hevea brasiliensis se utiliza ampliamente en la industria como fuente de extracción de caucho, un elemento empleado en diversas áreas comerciales y médicas. Los estudios inmunológicos de esta especie indican que es una fuente alergénica importante, que puede provocar sensibilización y alergia. Se han identificado diferentes componentes alergénicos de esta planta, con diversas propiedades inmunitarias y bioquímicas, y estudiado más de diez tipos diferentes de alérgenos, cada uno con distinta capacidad de inducir síntomas alérgicos. En esta revisión informamos los avances actuales en el estudio de Hevea brasiliensis.

Objetivo: Identificar mimetismo molecular entre TPO, eosinofil peroxidasa (EPX), tiroglobulina e IL24 y antígenos de microorganismos. Métodos: A través de análisis in silico, realizamos los alineamientos locales entre los antígenos humanos y de microorganismos con PSI-BLAST. Las proteínas que no presentaban estructura 3D, fueron modeladas por homología a través del servidor Swiss Modeller y se realizó una predicción de epítopes a través de Ellipro. Los epítopes se localizaron en los modelos 3D utilizando el software PYMOL. Resultados: Un total de 38 antígenos de microorganismos (parásitos y bacterias), tuvieron identidades entre 30 y 45%, siendo los más altos con Anisakis simplex. El alineamiento entre dos proteínas candidatas de A. simplex y EPX presentaron valores importantes, con identidades de 43 y 44%. En las bacterias, Campylobacter jejuni presentó la mayor identidad con tiroglobulina (35%). Se predijeron 220 epítopes lineales y conformacionales de antígenos de microorganismos. Las proteínas similares a la peroxidasina de Toxocara canis y Trichinella pseudospiralis presentaron diez epítopes similares a TPO y EPX, como posibles moléculas desencadenantes de una reactividad cruzada. Ningún virus presentó identidad con las proteínas humanas estudiadas. Conclusión: Los antígenos TPO y EPX compartieron potenciales epítopes de reacción cruzada con proteínas bacterianas y nematodos, lo que sugiere que el mimetismo molecular podría ser un mecanismo que explique la relación entre infecciones y la urticaria/hipotiroidismo. Se necesitan trabajos in vitro que demuestren los resultados obtenidos en el análisis in silico.

The Latin American Society of Allergy, Asthma, and Immunology (SLAAI) conducted a systematic search in the Medline and LILACS’ database in order to get articles linked to 10 current questions about dermatitis. The assessment of the quality of the evidence and the strength of the recommendations was made through the GRADE system. The completeness and transparency of the recommendations for this clinical guide were assessed with the AGREE Reports Verification Checklist. The final document was shared with physicians, allergists, dermatologists, and pediatricians, and with patients and academic institutions such as universities and medical scientific societies for external assessment. According to the review, clinical scales should be used to measure the severity of the dermatitis, and some interventions such as the use of probiotics may benefit the patient; nevertheless, more studies are required before this management option can be used in the everyday practice. Other interventions such as dietary restrictions and the use of antihistamines seem to be well-founded only in particular cases and they should not be a general recommendation for all patients. This practical guide presents recommendations for the treatment of atopic dermatitis; these recommendations can be helpful for medical staff, patients, and health systems.

Background: Little is known about the sensitization to shrimp in patients with respiratory allergies who are sensitized to mites and about the clinical relevance of that sensitization in the tropical region. Objectives: To determine the prevalence of sensitization to shrimp in patients with rhinitis or asthma who are sensitized to mites, to explore the route of sensitization, its relevance, and the role of sensitization to tropomyosin. Methods: A cross-sectional study in patients with asthma and rhinitis who are sensitized to mites. Through a survey, it was asked about the consumption of shrimp and the control of asthma or rhinitis. Oral provocation tests were carried out with shrimp on individuals who are sensitized to mites and shrimp without consumption, or consumption greater than six months before, without reaction history. In a subgroup, the sIgE was measured for shrimp, Der p and Lit v 1. The patients who are sensitized to mites and shrimp (cases) were compared to the patients who are sensitized only to mites (controls). Results: Out of 229 patients, 48 (21%) were sensitized to shrimp. There wasn’t a statistically significant difference in the intake of shrimp between cases (54.2%) and controls (49.7%); eight cases showed symptoms on contact with shrimp. No statistically significant differences were found in the sIgE for Der p, Lit v1 and shrimp between cases and controls. A medium change was observed in the size of the effect: 0.45, 0.44 and 0.41 respectively. Conclusions: Sensitization to shrimp in patients with asthma or allergic rhinitis caused by mites is high; in 25% it seems to be clinically relevant, mainly in those with asthma. Intake is not the main route of exposure to tropomyosin; cross-reactivity can explain the frequency of sensitization.

Background: Mites are the main cause of atopy and allergies in the Tropical region. It is necessary to know the phylogenetic relationship of their allergenic proteins in order to determine the best combination of extracts for its use at the clinic. Objective: To assess the phylogenetic relationship between the main allergenic proteins of mites. Methods: Groups 1, 2 and 5 of Glyciphagidae, Pyroglyphidae, Chortoglyphidae and Acaridae families were compared according to the sequence of mRNA and amino acids with the validated sequences of the National Center for Biotechnology Information and through bioinformatic alignment analyses for the construction of the trees, the method of neighbor-joining, with bootstrap support with 500 replications, was used as a measure of reliability and robustness. Results: 15% to 87% of identity was found in the three groups of allergens; the highest was between Der p2 and Der f2 (86.98%) and, the lowest, between Der f 5 and Gly d 5 (17.87%) Piroglyphidae showed the highest relationship between the species. The longest branching distance was identified in Glicyphagidae, especially in Blomia tropicalis. Conclusion: Some allergenic proteins have a high identity between the different species of mites, unlike Blomia tropicalis. These results can be taken into consideration when the diagnosis and treatment of allergic diseases is being defined.

Allergy and food atopy are a consequence of immune responses unadapted to antigens mediated by common and otherwise harmless foods. Food allergy (AF) occurs frequently in children under three years of 3 to 15%, as well as in people over 6 to 8%. AF may be mediated by immunoglobulin E or cellular mechanisms and may present with a wide variety of symptoms in the skin, respiratory and gastrointestinal tracts. Due to its increasing frequency, adverse reactions to food have been the subject of extensive study, especially in North America and Europe, but few studies have been conducted in other areas such as South America, Africa and Asia. The variety of foods and preparation methods are part of the cultural identity of each population, so the main foods that cause symptoms vary between different regions, especially between populations located in the tropics and subtropical populations. This article reviews the available information on the epidemiology of food sensitization and food allergies in tropical regions and explores the different epidemiological data of that region, taking into account the main foods involved, the underlying immune mechanism and the associated symptoms. In addition, we identify possible limitations and questions that arise from studies conducted in tropical countries, which helps generate objectives for future research in the region.

Background: Several reports show deficiencies in the knowledge of physicians about the diagnostic criteria and the treatment of anaphylaxis, a condition that can have fatal consequences. Objective: To evaluate the knowledge of physicians in Colombia on the fundamental aspects of anaphylaxis in diagnosis and treatment. Methods: Analytical cross-sectional study, carried out through a survey of 11 questions that evaluate clinical aspects of anaphylaxis, addressed to general practitioners and specialists in different health areas resident in Colombia. The analysis of the results was based on the correct answers. For approval, a score higher than 70% was needed. Results: A total of 447 non-allergic doctors analyzed were included, of which only 110 (24.6%) approved the questionnaire in both the questions aimed at the diagnosis and in the treatment of anaphylaxis. Among the factors that were associated with the failure of the survey were the age of the doctor (p

In different epidemiological medical tests —specifically the ones tested in tropical regions— a substantial increase has been observed in the prevalence of atopic dermatitis. ISAAC is the largest international test to analyze dermatitis epidemiology, which tested the prevalence of the most prevalence of the most common childhood atopic diseases in almost 200 points in more than 50 countries around the world. According to that test, the prevalence of dermatitis in tropical countries, especially in those from Latin America, was higher in comparison with other regions with a mode of 15%. That percentage among those populations using the same survey suggests that some genetic and environmental factors have an important effect on the development of dermatitis. However, considering that the surveys were completed by participants, it is possible that there was a misidentification of the disease and a tilt made from the patient, therefore comparative tests with cohort studies of the region are needed in order to determine if they are clinically relevant or not. In this article, we compare the prevalence of dermatitis reported by the ISSAC in tropical countries and some studies using other commonly diagnostic methods tested in the region.

Background: In vernal keratoconjunctivitis, traditional treatments are sometimes insufficient for symptom control; the results with omalizumab are promising in resistant cases. Case report: 15-year-old female adolescent with vernal keratoconjunctivitis who had received multiple ophthalmic treatments, immunotherapy and systemic steroids with no clinical response. She attended a clinical immunology and allergy department where she was started on omalizumab 225 mg every 2 weeks. After 6 months, she showed a decrease in pruritus and photophobia; two years later, both papillae and Horner-Trantas dots had disappeared. She remained symptom-free, and the use of ophthalmic drugs was therefore reduced. The patient missed omalizumab application on 4 occasions; however, symptoms recurred, and the papillae reappeared, but remitted upon drug re-initiation. Conclusion: There is a temporal relationship between omalizumab administration and ocular symptom control, with evidence of relapse upon discontinuation.

Allergic diseases are disorders with different clinical manifestations that are present in 20 to 40% of the general population. Since they share a common mechanism, several processes of this type often occur in the same individual, thus generating numerous symptoms and important economic costs for patients and their families. Currently, medical management of these diseases is focused on three main aspects: to identify and avoid the causative agent, acute symptoms’ control through pharmacological treatment and generation of tolerance with immunomodulation or desensitization. However, owing to the different underlying mechanisms, different diagnostic approaches are necessary, which can become a real challenge for the treating physician. In addition, sometimes patients undergo different restrictions and unnecessary treatments, thus limiting their daily activities, modifying their diet and directly affecting their quality of life. A review is made, aimed at answering different concerns arising from daily patient consultation.

Background: The Latin American Society of Allergy, Asthma, and Immunology (SLAAI) presents a document about the use of immunotherapy (IT) in Latin America, where administration patterns, indications and contraindications, effects on health, adverse events and socioeconomic impact are reviewed. Objective: To review publications analyzing the use of IT in Latin America. Methods: A literature review was carried out in order to identify works addressing IT in Latin America. This review was focused on practical scientific information available on IT in the region, and a parallel comparison was made with practices observed in the United States and European countries. Results: Of the 21 Latin American countries included, only 9 had original articles meeting the selection criteria; a total of 82 articles were selected, most of them from Brazil and Mexico. Most widely used allergenic extracts in Latin America tropical and subtropical regions were those of mites and pollen. Conclusion: Although it is true that there are huge challenges for the future of IT in Latin America, studies on subcutaneous IT and sublingual IT are increasing, but most of them are retrospective and some have design bias, and more prospective studies are therefore required, using internationally validated scales for clinical evaluation.

Background: In Latin America there are few data about the factors that influence the control and severity of asthma. Objective: To describe the association between IgE sensitization to intra-home allergens and housing conditions in the severity of asthma. Methods: Sensitization to aero-allergens was evaluated by skin prick test and socio-demographic data by a questionnaire in a population between 6 and 14 years of age with diagnosis of asthma. Asthma control was measured according to spirometric results and to the application of the ACT (Asthma Control Test); the severity and symptom control was evaluated according to the GINA guideline. Results: A total of 150 resident patients from the Aburra Valley (Colombia) were included. The median age of participants was 11 years, 95 (63.3 %) male. 92 % of the patients resided in the urban area. Mite sensitization was the most prevalent in controlled and uncontrolled patients. Sensitization to cockroach and some poverty conditions were risk factors for asthma severity. Conclusion: Poverty conditions appear to favor the development of severe asthma and in turn IgE sensitization to cockroaches. This sensitization could serve as a biomarker of severity.

Background: Real-life impact of guidelines for the management of atopic dermatitis has been poorly studied. Objective: To assess atopic dermatitis clinical control in residents of a tropical area managed according to international consensuses. Methods: Prospective study with a 24-month follow-up. Clinical response was assessed with SCORAD, DLQI and a subjective scale (SS) on severity perception by the patient. Results: Two-hundred and thirty-three patients were stratified according to SCORAD: 53 had mild severity (22%), 116 moderate (49%) and 64 severe (27%). Baseline SCORAD mean was 33 (15-41), for DLQI, it was 14 (11-20), and for the subjective scale, 85% (67-99). At 6 months, there was significant reduction (p

Background: Solar urticaria is a rare type of inducible urticaria characterized by wheal and erythema formation shortly after exposure to sunlight or to an artificial light source; its pathophysiology is not yet entirely understood. The treatment of choice, in addition to exposure avoidance, consists in antihistamine administration. Clinical case: This is the case of a 27-year-old woman with no personal history of allergic diseases and with a 2-year history of erythema and wheals in photo-exposed areas associated with sunlight exposure for periods longer than 10 minutes. A provocation test was carried out; she was started on fexofenadine at 4-fold the standard dose (720 mg/day). Six weeks later, a new challenge was carried out without the antihistamine being discontinued; the reaction was less severe, but she continued with erythema for the first 60 minutes post-exposure. After 3 months on high-dose antihistamines, she referred marked improvement in her quality of life and tolerance to brief sunlight exposure (for less than 15 minutes). Conclusions: Given the knowledge there is about the proposed pathophysiological mechanism for this condition, maybe individuals with solar urticaria could benefit from anti-IgE monoclonal antibody-based therapy.

Background: Much is known about the frequency of sensitization to Blomia tropicalis, Dermatophagoides pteronyssinus and Dermatophagoides farinae, although less is known about sensitization to other species and their possible interactions. Objective: In patients with allergic manifestations, to evaluate the frequency of sensitization to 10 species of mites in a tropical area and their possible interactions. Methods: Cross-sectional study. Sensitization was evaluated by skin tests. A generalized linear Poisson regression model with robust variance was used. Based on the sensitization probability reasons and social networking analysis, explorations of relationship for 10 mites were performed. Results: 147 patients were included. The highest sensitization was found to mites' family Pyroglyphidae (> 70 %) and less frequently was the Glycyphagidae family (< 50 %). Sensitization to any mites significantly increased the likelihood of sensitization to others. Sensitization to Der f or Der p increased, more than 20 times the likelihood of sensitization to other mites of the Pyroglyphidae family and more than 10 times to mites from other families. Sensitization to mites from Glycyphagidae, Chortoglyphidae or Acaridae family also increased the risk of sensitization to other mites but less than 5 times. Conclusion: Sensitization to mites is frequent in tropical area. Pyroglyphidae sensitization is the main risk factor for polysensitization with other mites from Glycyphagidae, Chortoglyphidae or Acaridae. These results must be considered at diagnosis and treatment of allergy diseases.

Currently, the ISAAC (International Study of Asthma and Allergies in Childhood) project is a global approach to assess the prevalence of asthma and other allergies in different latitudes. One of the great advantages of this project is that it compares using the same methodology, the prevalence of asthma in more than 50 cities during the same period of time, nevertheless the reproducibility of these results when compared with other studies of prevalence in each region has not been evaluated. In this review we aim to compare the epidemiological data provided by the ISAAC against the data identified in some regional cohort studies and by means of a critical evaluation to highlight the main similarities and to analyze the differences between these epidemiological data.

Background: Allergen immunotherapy has proved effective in the treatment of various allergies, but whether the clinical benefits outweigh the economic costs has been little evaluated. Objective: To explore the economic consequences of immunotherapy in asthma, rhinitis and dermatitis. Methods: Descriptive study. Patients with at least 18 months’ follow-up were selected, whose medical history allowed evaluation of drugs received, manner of use, check-ups, treatment changes, reasons for these, and so on. Patients were classified according to whether they received drug treatment + immunotherapy (active group) or drug therapy alone (control group). Results: 1848 patients were included: 648 in the active group and 1200 in the control. Immunotherapy increased the cost of treatment during the first few months, but after 9 to 12 months drug treatment decreased significantly compared to the control group. In patients with asthma or various diseases, immunotherapy reduced costs of treatment (p < 0.05). The active group saw fewer relapses at 18 months (p < 0.05). Conclusion: Allergen immunotherapy allows the sustained reduction in drug treatment, with medium-term financial savings for the patient and the health system.

Background: Reactions to beta-lactams are frequent and it is difficult to establish the relationship between the drug and symptoms. Objective: To describe the clinical characteristics and explore the immunological mechanisms of patients with suspected adverse reaction to beta-lactams. Methods: Retrospective study of patients with a history of beta-lactam reaction and tests for reactions to drugs. Results: Out of 125 patients, 71 were women (56.8%); 73 had a history of immediate reaction and 52 delayed reaction; 590 allergy tests were done: specific IgE measurement, skin prick, patch, and provocation tests. The drugs most often related were amoxycillin, in 62 patients (49.6%), crystalline penicillin in 17 (13.6%), benzathine penicillin in 15 (12%), and cefalexin in 13 (10.4%). The severity of the reaction was mild in the majority (82%). 7.7% had a history of anaphylaxis and 10.8% sought care for a positive penicillin skin test, without history of reaction. Only 6.7% resulted in a positive test. More than 62% began testing two years after the reaction for which they sought care. Conclusions: The clinical history is insufficient to determine allergy to beta-lactams. In our sample, few patients with a history of beta-lactam reaction had evidence of immune-mediated reactions.

Background: Immunotherapy has proven to be effective in controlling allergic asthma. However, few studies have evaluated whether the control and reduction of drug treatment persist after treatment ends. Objective: To evaluate the effect of immunotherapy with mites in asthma patients after two years of its suspension on drug treatment and number of exacerbations. Material and method: Observational study ambispective with active group (immunotherapy and pharmacotherapy) and control (only pharmacotherapy) group followed up for 5 years divided into two phases: 3 years of application of immunotherapy and two year of follow-up after its suspension. Results: 122 patients in the active group and 384 in the control group were included. Both groups had fewer exacerbations after the sixth month (p = 0.04). After nine months the active group had a significant reduction in the use of inhaled steroids (p = 0.05) compared to the control group. Two years after finished immunotherapy, patients in the active group received a lower inhaler doses than the control group. Children under 14 years mono-sensitized had the best response in all parameters evaluated. Conclusion: The allergen immunotherapy improves asthma control and reduces the required doses of pharmacotherapy. These effects have an important impact on quality of life and perhaps economically for patients with asthma. The beginning at an early age seems to have a major impact.

Background: Asthma and rhinitis are the most frequent chronic respiratory diseases. Their high impact is associated with the loss of working days, as well as a decrease in academic performance. Objective: To assess and compare the impact of rhinitis and asthma as causes of absenteeism and low work performance in a population of children and adults. Material and method: A cross sectional study was performed in 10 schools of two cities in Colombia. The student population between 6 to 17 years, as well as the faculty staff over 18 were invited to participate. All of the participants filled a questionnaire assessing parameters related to clinical background, and a review of scores in Math and Spanish, curriculum vitae and number of missed day during the last academic period completed was performed. Results: A total of 1,413 participants were enrolled. The frequency of asthma and/or rhinitis was 36%, there was a greater frequency of absenteeism in the population of children with respiratory symptoms (2.8 vs 1.2 days/year/patient, p

Background: Lipocalins seem to explain the cross-reactivity between some pets like cat and dog. However, little has been studied its role in other animals and its possible clinical impact in allergy diseases. Objective: Analyzed by bioinformatics techniques, the identity between lipocalin of some animals and explore the clinical impact in allergic diseases. Methods: The search for lipocalin sequences was performed using the BLAST program of NCBI Database. The protein sequences were aligned with CLUSTAL Omega UniProt version 1.2.1 software. The base sequence for alignments were lipocalins dogs and cats. The defined percentage identity was compared with the frequency of sensitization to animals exposed in a population of 288 patients with suspected allergic diseases. Results: Identities between sequences were 10% to 70%. The highest values were found with Can f 6 - Fel d 4 (68%) and Fel d 4 - Equ c 1 (68%). The lower identitiy was found with lipocalin porpurin and retinol binding (

Air pollution affects the origin and evolution of respiratory diseases. The increased frequency of asthma in recent years has been associated with growth air pollutants and small particles produced from the combustion of petroleum or cigarette smoke. Some mechanisms of how these contaminants can influence asthma and other allergic diseases are known: 1) acting as irritating on alveolar epithelial cells, 2) actin as adjuvant for allergens inflammation, 3) and epigenetic mechanisms. In this review, we discuss the pathophysiological mechanisms by which air pollutants become risk factors for the development of asthma and other allergic diseases.

Despite the growing number of scientific publications reflecting a greater number of people interested in the biomedical sciences, many research groups disappear secondary to poor internal organization. From the review of the available literature, we generate a series of recommendations that may be useful for the creation of a research group or to improve the productivity of an existing group. Fluid communication between its members with a common overall policy framework allows the creation of a good foundation that will lead to the consolidation of the group.

The incidence of atopic dermatitis in Latin America, as in other regions, has been increasing in recent years. The SLAAI consensus is based on a systematic search for articles related to dermatitis, with focus in the pathophysiology and treatment and its impact on Latin America, and reviewed using the Delphi methodology (Revista Alergia Mexico 2014;61:178-211). In this article we highlight the key points of consensus and particular considerations in Latin America.

Background: In Latin America, there are very few epidemiological data on food allergy and sensitization to milk and egg. Objective: To describe the frequency of sensitization to milk and egg in a population with suspicion of IgE mediated diseases. Material and method: A retrospective and descriptive study was made with patients who consulted to our service of Allergy, with suspicion of exacerbation of possible IgE mediated diseases when eat certain foods. All patients had skin prick test including the suspected foods and milk and egg. Each patient had a complete clinical history. Results: Sensitization to at less one food was present in 29.7% of patients. Egg sensitization occurred in 6.1% of patients and it was associated with asthma, rhinitis and gastrointestinal eosinophilia in children younger than five years. Milk sensitization was present in 4.5% and was not associated with any disease. Conclusions: In Colombia, sensitization to milk and egg is relatively low compared to that reported in other studies with population with high risk of sensitization. Because of the association between sensitization of egg and the risk of having respiratory symptoms and gastrointestinal eosinophilia, an egg sensitization could be and early marker of poor prognosis in atopic patients.

As in other regions, the incidence of atopic dermatitis in Latin America has been increasing in recent years. Although there are several clinical guidelines, many of their recommendations cannot be universal since they depend on the characteristics of each region. Thus, we decided to create a consensus guideline on atopic dermatitis applicable in Latin America and other tropical regions, taking into account socio-economic, geographical, cultural and health care system characteristics. The Latin American Society of Allergy Asthma and Immunology (SLAAI) conducted a systematic search for articles related to the pathophysiology, diagnosis and treatment of dermatitis using various electronic resources such as Google, Pubmed, EMBASE (Ovid) and Cochrane data base. We have also looked for all published articles in Latin America on the subject using LILACS (Latin American and Caribbean Literature on Health Sciences) database. Each section was reviewed by at least two members of the committee, and the nal version was subsequently approved by all of them, using the Delphi methodology for consensus building. Afterward, the nal document was shared for external evaluation with physicians, specialists (allergists, dermatologists and pediatricians), patients and academic institutions such as universities and scienti c societies related to the topic. All recommendations made by these groups were taken into account for the nal drafting of the document. There are few original studies conducted in Latin America about dermatitis; however, we were able to create a practical guideline for Latin America taking into account the particularities of the region. Moreover, the integral management was highlighted including many of the recommendations from different participants in the health care of this disease (patients, families, primary care physicians and specialists). This practical guide presents a concise approach to the diagnosis and management of atopic dermatitis that can be helpful for medical staff, patients and their families in Latin America.

Background: Subcutaneous allergen-specific immunotherapy (IT) is a proved, highly effective treatment for respiratory IgE-mediated diseases. However, few studies have explored the immunological mechanisms of IT in patients with atopic dermatitis. Objective: To explore the immune response of atopic dermatitis patients receiving house dust mite (HDM) immunotherapy, according to humoral response and basophil activation. Material and method: An open label study was done which assessed the severity of atopic dermatitis with SCORAD in 20 patients (10 with immunotherapy and 10 without it) every three months during two years. Serum samples were taken before the follow up, and at the rst and second year of study to analyze CD63 basophil expression, total IgE levels and speci c IgE and IgG4 to Der p and Der f. Ten patients with allergic rhinitis receiving IT and 5 non-allergic subjects were used as controls. Results: CD63 expression after basophil stimulation with Der p was higher in atopic dermatitis patients than in rhinitis and non-allergic subjects. After the rst and second year of treatment, CD63 expression was lower in atopic dermatitis active group than in the atopic dermatitis control group. We observed a correlation between SCORAD, IgG4 and CD63 expression. Conclusion: In patients with atopic dermatitis, basophil activation test could be a biomarker of clinical response and basophil modulation can result in a better clinical control.

Background: Pet avoidance is commonly recommended to allergic patients, even if an IgE-mediated sensitization has not been demonstrated. This management is difficult to accomplish by patients with emotional attachment to their pets and the effectiveness is controversial. Objective: To assess the sensitization to different animals among patients with asthma, rhinitis, conjunctivitis and/or dermatitis. Patients and method: A retrospective study was performed with 300 previously reported patients with asthma, rhinitis, conjunctivitis and/ or dermatitis; we organized two groups: Group 1 included patients who were tested skin sensitization to both dog and cat. Group 2 was comprised of all patients with skin testing droppings or feathers of birds (canary, parrot, pigeon or hen). Results: Sensitization to cat and especially to dog was high (7% and 47%, respectively). The co-sensitization to dog was high among patients sensitized to cat (85%). Sensitization to other epithelia (horse, hamster, rabbit, cow) was low. About birds, there was a greater sensitization to proteins contained in the feces than in the feathers, pigeon sensitization was the most frequent. We observed no differences in the pattern of sensitization among patients according to age, gender or allergic symptoms. Conclusions: The frequency of co-sensitization with cat and dog was high, which may be explained by shared proteins between the two species as lipocalins. About birds, the proteins in pigeon droppings were the main cause of sensitization; however, it does not seem to share cross-reactivity with other birds and the frequency was relatively low compared with epithelia allergens.

Antecedentes: La alergia a camarón tiene prevalencias variables entre las regiones. La sensibilización puede darse por exposición directa o por reactividad cruzada, pero poco se conoce sobre el mecanismo más preponderante, especialmente en países del trópico con alta sensibilización a ácaros, con los cuales el camarón comparte reactividad cruzada por proteínas comunes. Objetivo: Determinar la prevalencia de sensibilización a camarón en pacientes sensibilizados a ácaros y explorar la forma de sensibilización: consumo versus reactividad cruzada. Métodos: En un grupo de pacientes con asma o rinitis alérgica con sensibilización a ácaros evaluamos la sensibilización a camarón por prueba de punción cutánea y mediante encuesta se obtuvo información sobre el consumo de camarón y la presencia de síntomas con este alimento. Resultados: Fueron incluidos 213 pacientes, 46 (21.6 %) estuvieron sensibilizados a camarón. No hubo diferencia significativa en el consumo de camarón entre los sensibilizados (53 %) versus los no sensibilizados (49 %) (p = 0.5), lo que indica que el consumo de camarón no es el único factor determinante en la sensibilización; 45.7 % de los pacientes sensibilizados no había consumido camarón previamente pero estaba sensibilizado a ácaros y hubo una correlación estadísticamente significativa entre el tamaño de las erupciones de la prueba cutánea entre camarón y ácaros, lo que indica que posiblemente la sensibilización ocurrió por reactividad cruzada y no por consumo. De 105 pacientes que reportaban haber consumido camarón, 15 señalaron la presencia de síntomas y 10 tenían prueba cutánea positiva a camarón (2/3 p

Background: Numerous epidemiological studies have shown that children who grow up on traditional farms are protected from asthma, rhinitis and allergic sensitization. However, less is known about if the environment influences the pharmacotherapy in these patients. Objective: To compare the treatment of asthmatic and rhinitis children from urban and rural areas in Medellín, Colombia. Methods: For 1 year, we follow up a group of children (6 to 14 years) with diagnostic of asthma living for more than 5 years in urban or rural area. A questionnaire with sociodemographic characteristics, pharmacotherapy treatments, was obtained each 3-months. Atopy evaluation, spirometry and ACT, ARSQ were done at the beginning and one year. Results: 382 (86.4 %) patients completed the follow-up (rural n = 134, urban n = 248). Atopy (p

Antecedentes: La queratoconjuntivitis vernal es una enfermedad multifactorial con inflamación crónica de la superficie ocular que puede llevar a pérdida de la agudeza visual. Los tratamientos oculares tradicionales a veces no son suficientes para controlar los síntomas. Objetivo: Describir a un paciente con queratoconjuntivitis vernal resistente a los tratamientos convencionales y con buena respuesta al omalizumab. Reporte de caso: Adolescente de 15 años de edad con queratoconjuntivitis vernal desde los cinco años, sensibilizada a los ácaros del polvo, que había recibido múltiples tratamientos oftálmicos, incluyendo esteroides, inmunoterapia y esteroides sistémicos, sin respuesta clínica. Fue valorada en 2012 y se inició 225 mg de omalizumab cada dos semanas. A los seis meses mostró mejoría del prurito y fotofobia; dos años después, resolución de papilas y nódulos de Trantas, por lo que se decidió disminuir la dosis. Como permanecía libre de síntomas, redujo el uso de medicamentos oftálmicos. La paciente suspendió la aplicación de omalizumab por razones personales en cuatro ocasiones, con reaparición de los síntomas y recurrencia de papilas, que desaparecían con el reinicio del omalizumab. Conclusión: Existe relación dosis-respuesta entre la administración de omalizumab y el control sintomático de la queratoconjuntivitis vernal, con evidencia de recaídas luego de suspender el tratamiento y recuperación al reiniciarlo.

Antecedentes: La vacunación es la intervención en salud pública más efectiva de todos los tiempos, reduce las muertes y las morbilidades de múltiples enfermedades infecciosas. En muchas ocasiones la aplicación de las vacunas es retrasada por el temor a reacciones alérgicas, esto es frecuente entre los pacientes con alergia a huevo que requieren la vacuna triple viral. Objetivo: Evaluar la frecuencia de reacciones posterior a la aplicación de la vacuna triple viral (rubeola-sarampión-parotiditis) en una población alérgica al huevo. Métodos: Estudio multicéntrico retrospectivo (2014-2016) que incluyó pacientes con alergia al huevo que acudieron a un centro de alergología y requerían la aplicación de la vacuna triple viral. Resultados: 94 pacientes cumplían los criterios de selección; 68.2 % tuvo síntomas cutáneos, 22.3 % reacción anafiláctica, 5.3 % síntomas gastrointestinales y 4.2 % síntomas respiratorios con huevo. Todos los pacientes, independientemente de la gravedad de su reacción con el huevo, recibieron la vacuna triple viral y en 100% fue bien tolerada. Conclusiones: Aunque la alergia al huevo es frecuente en la edad infantil, el riesgo de reacciones alérgicas desencadenadas por la vacuna triple viral en esta población es similar al de la población general, por lo que no se debe diferir, ni siquiera en pacientes con antecedente de reacciones graves al huevo.

Antecedentes: Los ácaros son una importante fuente de alérgenos en el trópico. Otras fuentes potenciales de alérgenos prevalentes en la zona, como los insectos, han sido poco estudiadas. Objetivo: Evaluar la exposición y sensibilización IgE a cucaracha, mosquito, hormiga y su interacción con la sensibilización a ácaros. Métodos: Se incluyeron pacientes con pruebas de alergias para Blatella germánica, Aedes aegyptis, Solenopsis invicta, Blomia tropicalis, Dermatophagoides farinae y Dermatophagoides pteronyssinus. Se evaluó la frecuencia de sensibilización IgE y número de insectos en las casas, al igual que su relación con los niveles de IgE séricos. Resultados: 186 pacientes fueron incluidos, 73 (39.2 %) estuvieron sensibilizados a un insecto (21 % a Blatella germánica, 29 % a Aedes aegypti, 26.3 % a Solenopsis invicta); entre ellos, 71 (97.2 %) tuvieron cosensibilización a ácaros, mientras que de los 148 pacientes sensibilizados a un ácaro solo 47.9 % estaba a un insecto. Fueron evaluadas 109 casas: 74 % tuvo cucarachas, 22 % hormigas y 52 % mosquitos. Entre los pacientes sensibilizados a insectos, el número de insectos por casa estuvo directamente relacionado con el tamaño de la erupción y el nivel de IgE sérica generado durante la prueba cutánea: cucaracha, R = 0.781 y p

Antecedentes: La urticaria solar (US) representa menos de 1 % de todas las formas de urticaria. Se manifiesta con erupciones y eritema posterior a la exposición a luz solar o artificial. Su fisiopatología es poco comprendida, pero se han postulado mecanismos IgE mediados. El diagnóstico se basa en historia clínica y pruebas de provocación. Su importancia radica en el impacto negativo en la calidad de vida y elevado costo económico. El manejo consiste en evitación y antihistamínicos. Objetivo: Describir el caso de una paciente con urticaria solar que no mejoraba con dosis convencional de antihistamínicos. Reporte de caso: Mujer de 27 años que presenta eritema y erupciones en áreas fotoexpuestas, de dos años de evolución, después de exposición solar mayor de 10 minutos con resolución menor de 24 horas y sin lesiones residuales. Previamente recibió antihistamínicos en dosis convencional: cloroquina y fototerapia, sin mejoría. Se confirmó el diagnóstico con fototest a 280 J durante 25 minutos en espalda, con eritema y múltiples erupciones. Se inició manejo con antihistamínico a dosis cuádruple y se realizó nuevo reto a las seis semanas, en el que observó reacción de menor severidad. Conclusiones: El diagnóstico con fotoprovocación permitió la evitación específica del verdadero agente causal en la urticaria solar. El uso de antihistamínicos a dosis altas favorece el control de las manifestaciones clínicas y permite cierto grado tolerancia a la luz solar, contribuyendo a la calidad de vida de los pacientes.