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Progesterone is an endogenous hormone, produced by the adrenal cortex, the gonads and in women, its source is the corpus luteum. Progesterone is produced in the late phase of the menstrual cycle, when implantation of the zygote does not occur, the corpus luteum involutes and the release of progesterone is suppressed, thus initiating menstruation. Progestogen Hypersensitivity were initially identified as hormone allergy and were related to endogenous reactions to hormones and alteration of ovarian function. Skin manifestations such as dermatitis or urticaria were initially reported and described as progesterone autoimmune dermatitis, although the immune-mediated mechanism was not clear. Currently there is no standardization for in vivo or in vitro tests for Progestogen Hypersensitivity diagnosis. In this review, we will address the different diagnostic methods of this disease.

Los artículos publicados en este número exponen la fisiopatogenia, epidemiología, causas, clasificación y tratamiento de la alergia alimentaria. La alergia alimentaria es una respuesta anormal del sistema inmunológico a ciertos alimentos, además de un trastorno crónico que afecta a pacientes de cualquier edad. Su prevalencia se ha incrementado en las últimas décadas. Los alimentos más comúnmente relacionados son: leche de vaca, huevo, cacahuate, nueces, trigo, soya, pescado y mariscos. Sin embargo, cualquier alimento puede ser un desencadenante. Las reacciones adversas después del consumo de cualquier alimento son motivo de preocupación y ansiedad, y pueden conducir a una dieta estricta. La gravedad de la reacción puede variar dependiendo del tipo de alimento y mecanismo, y no siempre es fácil diferenciar los diagnósticos de hipersensibilidad, pues algunas veces pueden aparecer simultáneamente. Los síntomas también varían en gravedad, y afectan diferentes sistemas. El diagnóstico de alergia alimentaria suele establecerse mediante la combinación de historia clínica, identificación de síntomas después de la ingesta de ciertos alimentos y exámenes diagnósticos (pruebas cutáneas, pruebas de IgE específicas para alimentos, pruebas de provocación oral, entre otras). El tratamiento es complejo y consiste en restricción alimentaria, desensibilización y control de los síntomas.

La anafilaxia, una reacción potencialmente mortal, se caracteriza por la aparición aguda de síntomas que afectan diversos sistemas y requiere intervención médica inmediata. Aunque la tasa de mortalidad general es baja, la anafilaxia inducida por alimentos y fármacos ha experimentado un aumento. Los alimentos, fármacos y veneno de himenópteros son desencadenantes comunes. La epidemiología varía según la región y la edad, con una incidencia global de 50-112 episodios anuales por cada 100,000 personas. Los alimentos más implicados varían según la edad y la región, y los desencadenantes más comunes son cacahuetes y nueces. Se reconocen dos mecanismos de anafilaxia: mediado por IgE y no mediado por IgE. El diagnóstico se basa en criterios clínicos y niveles de triptasa sérica. El tratamiento incluye epinefrina, oxígeno y líquidos intravenosos. Se aborda la anafilaxia inducida por ejercicio dependiente de alimentos, donde el ejercicio, en combinación con ciertos alimentos, desencadena reacciones anafilácticas. La comprensión y el manejo adecuados son cruciales para mitigar riesgos.

El síndrome de alergia a alimentos y pólenes, también conocido como síndrome polen-alimento o síndrome de alergia oral, se caracteriza por una reacción local en la boca y faringe después de ingerir ciertos alimentos vegetales crudos, en individuos sensibilizados al polen de hierbas, malezas y árboles. El abedul-manzana es el prototipo de este síndrome, siendo la manzana, pera y ciruela los alimentos más comúnmente asociados. Los síntomas suelen limitarse a la cavidad oral, pero pueden incluir reacciones sistémicas, incluida la anafilaxia. La sensibilización a alérgenos de polen, como las proteínas de transferencia de lípidos, profilina y proteínas PR-10, desencadena este síndrome. Su prevalencia varía según la región geográfica y el tipo de polen predominante, afectando entre el 30% y el 60% de las alergias alimentarias. El diagnóstico implica historia clínica, pruebas cutáneas y, en casos ambiguos, pruebas de provocación alimentaria oral. El tratamiento consiste principalmente en evitar los alimentos desencadenantes.

La alergia alimentaria es una respuesta inmunitaria a las proteínas de los alimentos. Suele afectar al 8% de los niños y al 2% de los adultos en países occidentales. La alergia alimentaria no mediada por IgE afecta, principalmente, el aparato gastrointestinal. Las alergias alimentarias gastrointestinales se clasifican, por su patogenia subyacente, en: mediadas por IgE, no mediadas por IgE, o mixtas. Los síntomas de pacientes con proctocolitis alérgica inducida por proteínas alimentarias se originan por la inflamación local del colon distal, que causa hematoquecia en neonatos. Puede afectar todo el conducto gastrointestinal y provocar síntomas de emesis intratable, con subsiguientes trastornos metabólicos y choque hipovolémico. El síndrome de enterocolitis inducida por proteínas alimentarias es una alergia no mediada por IgE que suele aparecer en la infancia, con vómito prolongado repetitivo, que inicia entre 1 a 4 horas después de la ingestión de alimentos. La manifestación en adultos suele desencadenarse por el consumo de mariscos. Las enfermedades atópicas afectan del 40-60% de los pacientes con síndrome de enterocolitis inducida por proteínas alimentarias, incluso al 40-50% de quienes padecen enteropatía y proctocolitis inducidas por proteínas alimentarias. Los probióticos (Lactobacillus GG) pueden aliviar los síntomas de proctocolitis alérgica inducida por proteínas alimentarias, al alterar la composición de la microbiota intestinal. El trasplante de microbiota fecal (TMF) puede cambiar la microecología intestinal de manera eficiente comparada con los alimentos o probióticos.

lactancia materna exclusiva durante los primeros meses de vida, además de la suplementación con vitamina D y, debido a la importancia de la microbiota, adición de probióticos prebióticos y simbióticos. Actualmente la exposición tardía de los alimentos es controvertida, y se sugiere introducir tempranamente alimentos alergénicos, procurando no exponer la vía cutánea. La aplicación de biológicos en alergia alimentaria es un área de investigación y tratamiento en evolución. Los biológicos se indican en enfermedades evaluadas en diversos estudios, como la dermatitis atópica, y se encuentran aprobados por la FDA para su prescripción; sin embargo, aún se discute su potencial administración en el tratamiento de reacciones alérgicas graves provocadas por alimentos. Estas terapias pueden cambiar la forma en que se aborda la alergia alimentaria en el futuro, pero aún se encuentran en etapas experimentales y no están disponibles ampliamente. La anafilaxia por alimentos es una reacción alérgica potencialmente mortal, que requiere una acción rápida. La prevención implica evitar el alimento desencadenante, conocimiento de los síntomas y la disponibilidad de epinefrina para su administración inmediata en caso de alguna reacción.

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Background. Evidence from across the world suggests that the pediatric population shows different clinical manifestations and has a lower risk of severe presentation of SARS-CoV-2 infection compared to adults. However, Mexico has one of the highest mortality rates in the pediatric population due to SARS-CoV-2 infection. Therefore, our objective was to explore the epidemiological and clinical characteristics associated with a positive confirmatory test in the Mexican pediatric population admitted to a tertiary care hospital in Mexico City. Methods. Clinical, imaging and laboratory data were retrospectively collected from 121 children hospitalized during the period from March 4th, 2020, to August 8th, 2021. The patients were identified as suspicious cases according to the guidelines of the General Directorate of Epidemiology of Mexico. Real-time polymerase chain reaction (RT-PCR) tests were used to confirm SARS-CoV-2 infection. Categorical variables were compared using the Chi-square test, and propensity score matching was performed to determine univariate and multivariate odds ratios of the population regarding a positive vs. negative SARS-CoV-2 result. Results. Of the 121 children, 36 had laboratory-confirmed SARS-CoV-2 infection. The main risk for SARS-CoV-2-associated pediatric hospitalization was contact with a family member with SARS-CoV-2. It was also found that fever and fatigue were statistically significantly associated with a positive SARS-CoV-2 test in multivariate models. Clinical and laboratory data in this Mexican hospitalized pediatric cohort differ from other reports worldwide; the mortality rate (1.6%) of the population studied was higher than that seen in reports from other countries. Conclusion. Our study found that fever and fatigue at hospital presentation as well as an antecedent exposure to a family member with SARS-CoV-2 infection were important risk factors for SARS-CoV-2 positivity in children at hospital admission.

Objetivos: Describir las afecciones dermatológicas más frecuentes en los pacientes con la COVID-19 y precisar si su presencia puede ser utilizada para establecer un diagnóstico temprano o para predecir la evolución de la infección. Métodos: Se realizó una revisión en PubMed/MEDLINE y EMBASE de todos los artículos publicados entre enero 1 y noviembre 1 de 2020, con los términos de la búsqueda centrados en “SARS-CoV-2”, “COVID-19” y “Enfermedades cutáneas”. Resultados: Cumplieron los criterios de inclusión 83 estudios. Lesiones de la piel han sido reportadas en 0.2 % de los pacientes. Las erupciones maculopapulares/morbiliformes, la urticaria y el angioedema, el patrón acral parecido a sabañones y las lesiones vesiculares fueron las dermatosis más frecuentemente informadas. Existen diferencias de opinión entre los investigadores, acerca de un posible valor diagnóstico o pronóstico de las afecciones cutáneas asociadas con la infección. Conclusiones: Es recomendable considerar el diagnóstico de la infección por SARS-CoV-2 en pacientes que consultan por presentar lesiones cutáneas, urticaria o angioedema con o sin otros síntomas de la infección y en especial si existe algún antecedente de exposición reciente a otros sujetos infectados.

Background: 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). Method: 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. Results: 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. Conclusion: 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.

Introduction: In light of the current COVID-19 pandemic, during which the world is confronted with a new, highly contagious virus that suppresses innate immunity as one of its initial virulence mechanisms, thus escaping from first-line human defense mechanisms, enhancing innate immunity seems a good preventive strategy. Methods: Without the intention to write an official systematic review, but more to give an overview of possible strategies, in this review article we discuss several interventions that might stimulate innate immunity and thus our defense against (viral) respiratory tract infections. Some of these interventions can also stimulate the adaptive T- and B-cell responses, but our main focus is on the innate part of immunity. We divide the reviewed interventions into: 1) lifestyle related (exercise, >7 h sleep, forest walking, meditation/mindfulness, vitamin supplementation); 2) Non-specific immune stimulants (letting fever advance, bacterial vaccines, probiotics, dialyzable leukocyte extract, pidotimod), and 3) specific vaccines with heterologous effect (BCG vaccine, mumps-measles-rubeola vaccine, etc). Results: For each of these interventions we briefly comment on their definition, possible mechanisms and evidence of clinical efficacy or lack of it, especially focusing on respiratory tract infections, viral infections, and eventually a reduced mortality in severe respiratory infections in the intensive care unit. At the end, a summary table demonstrates the best trials supporting (or not) clinical evidence. Conclusion: Several interventions have some degree of evidence for enhancing the innate immune response and thus conveying possible benefit, but specific trials in COVID-19 should be conducted to support solid recommendations.

La pandemia actual de COVID-19 ha representado un reto mayúsculo para la sociedad y la comunidad médica, no solo por su alta contagiosidad sino por la variabilidad de las manifestaciones clínicas y su comportamiento impredecible bajo diferentes contextos sanitarios. Ante ello, las medidas preventivas específicas son relevantes para evitar o disminuir contagios entre pacientes y personal de las unidades de salud, considerando que el periodo presintomático durante el cual el individuo contagiado ya puede transmitir el virus varía entre cinco y seis o hasta 14 días, según datos de la Organización Mundial de la Salud. Además, un paciente infectado puede estar asintomático, incluso, algunas personas después de haber padecido COVID-19 pueden continuar expulsando virus por algunos días más después de recuperarse.

Background: The transfer factor (TF) is the dialyzable extract of leukocytes with cellular immunity transfer properties. Its use has spread in the treatment of a wide range of immunologic, infectious, and even oncological diseases. However, important aspects in their protein profile, component concentrations, and a well-defined action mechanism are not completely unknown. Objectives: To analyze the protein profiles of different transfer factors marketed in Mexico. Methods: 6 TF marketed in Mexico were obtained and analyzed, quantifying protein with thaze Bradford method, by high-performance liquid chromatography (HPLC), and polyacrylamide gel electrophoresis (SDS-PAGE). All samples were analyzed in duplicate. Results: The total protein concentrations of all TF analyzed are less than 0.2 mg/mL. The chromatographic profiles showed differences in some TF. The protein concentration was 6 to almost one thousand times lower compared to reports by some manufacturers. Conclusion: Almost all transfer factors marketed in Mexico lack a labeling and health record that meets the official standards.

Background: Adverse reactions to drugs are increasing and there are few studies for the diagnosis. Objective: To determine the utility of modified basophil degranulation (MBD) test and modified leukocyte migration inhibition factor (MLMIF) test to prove drug hypersensitivity. Methods: 177 patients of both sexes were studied with the diagnosis of drug hypersensitivity, determining MBD, MLMIF, or both, between 2009 and 2014. They were matched with positive and negative controls and the non-allergic population. Applications are issued according to the type of hypersensitivity, considering type I MBD and type IV MLMIF. Results: 170 patients (96.04%) were positive to at least one drug (RR = 4.71). 561 MBD (73.62%) and 201 MLMIF (26.37%) were performed. Female sex was more frequent (64.41%); the average age was 38.5. MBD was positive in 70.23% and MLMIF in 67.16%. The test sensitivity was increased complementarily and with two dilutions. The correlation of MBD and MLMIF was positive and highly significant. Conclusions: Women have more drug reactions. Modified MBD test is useful at any age. Since medications can activate one or other hypersensitivity mechanism, it is important to request the tests simultaneously.

There are four types of histamine receptors. Allergic symptoms, especially those in rhinoconjunctivitis and urticaria, are mainly caused by activation of histamine receptor 1 (H1). Consequently, oral H1-antihistamines form and integral part of the treatment of these diseases. Antihistamines are inverse agonists that stabilize the non-active configuration of the histamine receptor. First generation H1-antihistamines cause a variety of adverse effects via several mechanisms: sedation (accumulation in the central nervous system), dry mouth, urinary retention, weight gain (low selectivity: stimulation of serotonin/muscarinic/alpha-adrenergic receptors) and drug interactions (substrate of CYP450-3A4). Generally second generation H1-antihistamines have a better safety profile. New guidelines on allergic rhinitis and urticaria recommend second generation H1-antihistamines as first line drugs, with –if necessary– four-times updosing to obtain control in urticaria. The enhanced efficacy of quadruple doses in urticaria, while maintaining a good safety profile, has been shown for bilastine, desloratadine and levocetirizine (rupatadine). For ebastine and fexofenadine only the safety of quadruple doses has been shown till now. Extreme precaution should be taken with astemizol and terfenadine that never should be up-dosed, as high serum concentrations can cause potentially fatal ventricular tachycardia. First generation antihistamines are not recommended as first line treatment and updosing is not safe.

Background: Chronic spontaneous urticaria (CSU) is a common condition in adults, especially among women; this entity is frequently associated with autoimmune diseases. Our goal is to assess through laboratory studies whether patients with autoimmune CSU presented data. Material and method: A cross-sectional study of 35 patients was done in the area of Allergy and Immunology at Hospital Juarez de Mexico diagnosed with CSU. We performed the following tests: complete blood count, thyroid antibodies (antiperoxidase and thyroglobulin), antinuclear antibodies, rheumatoid factor, lupus anticoagulant, LE cells Autologous Serum Skin Test (ASST), add (C3 and C4). In addition, we made Helicobacter pylori test, thyroid hormones (T3, T4, TSH) and D-dimer. Results: We evaluated 35 adult patients, 27 female; ASST was positive in 4 patients, negative antinuclear antibodies in all cases, but positive anti thyroid (AAT) antibodies in 4. The LE cell, lupus anticoagulant, complement, dimer D, thyroid and Helicobacter pylori profile were normal or negative and rheumatoid factor was positive in one patient. All AAT-positive patients were women, but 26 of them had negative ASST. The correlation between ASST and AAT was not significant. Conclusion: Most patients were women UCE and only 4 had positive ASST, but this does not correlate with the presence of anti-thyroid antibodies. Most studies were normal, so we suggest not making unnecessary laboratory studies in this disease.

Oral allergy syndrome, also known as pollen-food syndrome, is an alteration that manifests itself when people who are sensitive to certain pollens experience allergic reactions when consuming some foods. The allergic response is caused by the structural similarity of the proteins in pollens and those in certain foods (fruits, vegetables, and nuts), that is, it involves cross reactions between pollens and foods. The most common symptoms include itching of the mouth, lips and throat, inflammation, erythema and, rarely, difficulty breathing. Furthermore, environmental pollution plays an important role in intensifying allergy symptoms in general and food allergy specifically. Exposure to environmental contaminants (external and internal), allergens, microbes, and diet characterize this part of the exposome. Exposure to toxic fuels, PM, detergents, and other factors favor the deterioration of the intestinal epithelial barrier. As a result, the development and exacerbation of various allergic diseases increases, including food allergies, related to the food we eat, the air we breathe, the clothes we wear and the cleaning products we use, constituting a major problem for human health. planet. [ABSTRACT FROM AUTHOR]

Preventing food allergies is key to reducing the incidence of the disease. Exclusive breastfeeding is recommended during the first months of life, in addition to supplementation with vitamin D and, due to the importance of the microbiota, addition of probiotics, prebiotics and symbiotic. Currently, late exposure to foods is controversial, and it is suggested to introduce allergenic foods early, trying not to expose the cutaneous route. The application of biologics in food allergy is an evolving area of research and treatment. Biologics are indicated in diseases evaluated in various studies, such as atopic dermatitis, and are approved by the FDA for prescription; However, its potential administration in the treatment of severe allergic reactions caused by food is still debated. These therapies may change the way food allergy is addressed in the future, but they are still in experimental stages and not widely available. Food anaphylaxis is a life-threatening allergic reaction that requires quick action. Prevention involves avoiding the triggering food, awareness of symptoms, and availability of epinephrine for immediate administration in case of a reaction. [ABSTRACT FROM AUTHOR]

Background: Urticaria is a disease that a fth of the population shall suffer once in a lifetime. Recent clinical guidelines have proposed some fundamental changes in the diagnosis and treatment of urticaria, making the development of a national, multidisciplinary guideline, with wide acceptability among different professional groups –both specialists and primary health care workers–, necessary in Mexico. Material and method: Internationally recognized tools for guideline- development were used. An interdisciplinary group of clinical experts (some of them knowledgeable in methodology of guideline develop- ment) determined the objectives and scope of the Evidence Based Clinical Practice Guideline with SCOPE. It was decided to adapt and transculturize international guidelines on the diagnosis and treatment of urticaria. With AGREE-II three high-quality guidelines (Zuberbier 2014, Sánchez-Borges 2012, Powell 2007) were selected to function as basic guidelines (BG). A set of Clinical Questions was formulated that lead to recommendations/suggestions, based on these BG, taking into account the cultural and economic background of Mexico, according to GRADE recommendation development. Results: By a formal process of discussion and voting during several working-sessions, experts and rst level healthcare physicians deter- mined the wording of the nal guideline, taking particularly care of developing a document, adjusted to the reality, values and preferences of the Mexican patients. The use of oral second generation, non-sedating antihistamines as rst line treatment is emphasized. Conclusion: This document is an Evidence Based Clinical Practice Guideline for the diagnosis and treatment of acute and chronic urticaria, based on three, high quality, international guidelines. It was developed by a multidisciplinary group. Tables and algorithms make the guideline user-friendly for both, rst line health care physicians and specialists

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