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An increasing number of studies are analyzing the relationship between serum vitamin D levels and the development of sensitization and allergic diseases in genetically predisposed individuals, as well as the impact of vitamin D supplementation. This article reviews the literature on this subject. Clinical trials, meta-analyses and systematic reviews consulted in PubMed, EMBASE, Scopus, Ovid, Wiley Online Library, Springer, Cochrane and manual resources were included, with the keywords: vitamin D, 25 hydroxyvitamin D, cholecalciferol, asthma, rhinitis, allergy, 25-OH-D, 1,25 hydroxyvitamin D, supplementation. The results show a positive linear trend, however, differ. We should keep in mind that in the studies there is heterogeneity of population groups and associated factors, which may modify such studies. It is necessary to increase research to clarify this relationship and to have successful interventions from the patient's approach to the strengthening of pharmacological and immunological treatment of allergic patients with these diseases.Cada vez son más los trabajos que analizan la relación de los niveles séricos de vitamina D y el desarrollo de sensibilizaciones y enfermedades alérgicas en los individuos con predisposición genética, así como el impacto de su suplementación. El presente artículo efectúa una revisión de la literatura acerca de este tema. Se incluyeron ensayos clínicos, metaanálisis y revisiones sistemáticas consultadas en PubMed, EMBASE, Scopus, Ovid, Wiley Online Library, Springer, Cochrane y recursos manuales, con las palabras clave: vitamina D, 25 hidroxivitamina D, colecalciferol, asma, rinitis, alergia, 25-OH-D, 1,25 hidroxivitamina D, suplementación. Los resultados muestran una tendencia lineal positiva; sin embargo, algunos difieren. Debemos tener en mente que en los estudios existe heterogeneidad de los grupos poblacionales y los factores asociados, lo que puede modificarlos. Es necesario incrementar las investigaciones para clarificar esta relación y tener intervenciones exitosas desde el abordaje del paciente hasta el fortalecimiento del tratamiento farmacológico e inmunológico de los pacientes alérgicos con estas enfermedades.

Antecedentes: La inmunoterapia específica es un tratamiento orientado a modificar el curso de la enfermedad alérgica y con la que se han logrado importantes cambios inmunológicos y clínicos.Objetivo: Evaluar eficacia y seguridad de la inmunoterapia subcutánea en pacientes con diagnóstico de alergia respiratoria en el Hospital Universitario de Puebla, México.Métodos: Estudio longitudinal, analítico, cuasiexperimental. Se incluyeron pacientes de cuatro a 65 años con diagnóstico de asma o rinitis alérgica, con sensibilización a aeroalérgenos, que iniciaron tratamiento con inmunoterapia. Para la valoración de la eficacia se utilizó el cuestionario Control of Allergic Rhinitis and Asthma Test (CARAT). La seguridad se evaluó mediante el cuestionario de reacciones adversas de Portnoy.Resultados: Se incluyeron 59 pacientes, 72.9 % fueron mujeres; 23.7 % con diagnóstico de rinitis alérgica y asma y 76.3 % con diagnóstico de rinitis alérgica. La comparación de promedios del cuestionario CARAT al inicio del tratamiento y a los cuatro meses de seguimiento mostró evolución favorable estadísticamente significativa. Se encontró una incidencia de reacciones adversas locales de 9.03 %; no se reportaron reacciones adversas sistémicas.Conclusiones: El esquema de inmunoterapia subcutánea evaluado logra disminuir significativamente los síntomas del asma y la rinitis alérgica, con un conveniente perfil de seguridad.

Background: The skin prick test is recognized as the gold standard for the specific diagnosis of allergy. Objective: To determine the sensitivity and specificity of the epicutaneous patch test that has been modified for the diagnosis of respiratory allergy to Dermatophagoides pteronyssinus. Methods: An observational, interpretative, prolective, and transversal study. The included patients were between 6 and 49 years old, with symptoms of a respiratory allergy, and a skin test was performed on them by using the European standardized prick test and a modified epicutaneous patch test with the variable of the scarification that occurred before the antigen was applied, and its homogenization with a wooden applicator, which occurred after the antigen was applied. The levels of sensitivity, specificity, and prevalence influence and positive and negative predictive values were calculated. Results: 104 patients were included, of which 72 (69.2%) were women. The age category of the patients was 24 ± 11.3 years of age. 78.9% of the patients were diagnosed with allergic rhinitis, 1.9% were diagnosed with asthma, and 19.2% were diagnosed with both rhinitis and asthma. The prevalence of the respiratory allergy to Dermatophagoides pteronyssinus was of 62.5%; 94.23% with a correct diagnosis. The sensitivity and specificity of the test was of 93.85% and 94.87%; the positive and negative predictive values were of 96.83% and 90.24%, and the positive and negative likelihood ratios were of 18.30 and 0.06. Conclusions: The modified epicutaneous patch test was highly sensitive and specific; it decreased the risk of allergen carryover and it lowered the cost of the material that was used.

Allergen-specific immunotherapy is an important therapeutic modality for the management of allergic rhinitis and allergic asthma.To assess the effectiveness and safety of allergen-specific subcutaneous immunotherapy in patients with respiratory allergies at the University Hospital of Puebla after twelve months of treatment.A longitudinal, sequential, analytic, quasi-experimental, prolective study. The study was carried out for twelve months with patients of both sexes, aged four to sixty-five years, diagnosed with asthma and/or rhinitis, and with sensitization to aeroallergens. The CARAT and Portnoy questionnaires were collected every two months in order to assess the effectiveness and safety respectively.47 patients were included: 37 (78.7 %) of them were female. The average age was 29.8 years. 76.6 % of them were diagnosed with allergic rhinitis, and 23.4 % of them were diagnosed with both asthma and allergic rhinitis. The comparison of averages of the initial CARAT questionnaire against the final average by means of a student's t-test showed a t-value of -8.86 and a p-value of0.05. A total frequency of local adverse reactions of 19 % and systemic adverse reactions of 2.1 % was reported after 6 and 12 months of treatment.The assessed scheme of immunotherapy, derived from the Mexican clinical practice guidelines of immunotherapy 2011, is effective with a desirable safety profile.Antecedentes: La inmunoterapia específica con alérgenos es una importante modalidad terapéutica para el manejo de la rinitis y asma alérgica. Objetivo: Evaluar la eficacia y seguridad de la inmunoterapia subcutánea con alérgenos en pacientes con alergia respiratoria del Hospital Universitario de Puebla posterior a 12 meses de tratamiento. Métodos: Estudio longitudinal, secuencial, analítico, cuasiexperimental, prolectivo. Durante 12 meses se incluyeron pacientes con asma o rinitis, sensibilizados a aeroalérgenos, de cuatro a 65 años y de ambos sexos; bimensualmente se recolectaron los cuestionarios CARAT y Portnoy para evaluar la eficacia y seguridad, respectivamente. Resultados: Se incluyeron 47 pacientes, 37 (78.7 %) mujeres. La edad promedio fue de 29.8 años. El 76.6 % tuvo diagnóstico de rinitis alérgica y 23.4 % de asma y rinitis alérgica. Al comparar el promedio del CARAT inicial contra el promedio final mediante prueba de t de Student se obtuvo un valor de –8.86 y p0.05. Se reportó una frecuencia total de reacciones adversas locales de 19 % y de reacciones adversas sistémicas de 2.1 % a los seis y 12 meses del tratamiento. Conclusiones: El esquema de inmunoterapia evaluado, derivado de la Guía Mexicana de Práctica Clínica de Inmunoterapia 2011, es eficaz con un conveniente perfil de seguridad.

Background: Allergen-specific immunotherapy is an important therapeutic modality for the management of allergic rhinitis and allergic asthma. Objective: To assess the effectiveness and safety of allergen-specific subcutaneous immunotherapy in patients with respiratory allergies at the University Hospital of Puebla after twelve months of treatment. Methods: A longitudinal, sequential, analytic, quasi-experimental, prolective study. The study was carried out for twelve months with patients of both sexes, aged four to sixty-five years, diagnosed with asthma and/or rhinitis, and with sensitization to aeroallergens. The CARAT and Portnoy questionnaires were collected every two months in order to assess the effectiveness and safety respectively. Results: 47 patients were included: 37 (78.7 %) of them were female. The average age was 29.8 years. 76.6 % of them were diagnosed with allergic rhinitis, and 23.4 % of them were diagnosed with both asthma and allergic rhinitis. The comparison of averages of the initial CARAT questionnaire against the final average by means of a student’s t-test showed a t-value of -8.86 and a p-value of < 0.05. A total frequency of local adverse reactions of 19 % and systemic adverse reactions of 2.1 % was reported after 6 and 12 months of treatment. Conclusions: The assessed scheme of immunotherapy, derived from the Mexican clinical practice guidelines of immunotherapy 2011, is effective with a desirable safety profile.

Antecedentes: Se considera que la alergia alimentaria tiene una prevalencia mundial de 2 a 10 %.Objetivo: Determinar la frecuencia de reactividad cutánea hacia alérgenos alimentarios por grupos de edad.Métodos: Estudio observacional, descriptivo, transversal y prolectivo. Se incluyeron pacientes de 2 a 64 años de edad con cuadro compatible de enfermedad alérgica. Se efectuaron pruebas por punción cutánea con alérgenos alimentarios. Se estimaron frecuencias y porcentajes.Resultados: Se incluyeron 191 pacientes, 63.4 % fue del sexo femenino. La edad promedio fue 22.5 años; 19.3 % mostró reactividad cutánea positiva al menos a un alimento. La distribución por grupo etario fue la siguiente: preescolares 13.5 %, escolares 24.3 %, adolescentes 2.7 % y adultos 59.5 %. Los diagnósticos fueron rinitis alérgica 84.3 %, asma 19.4 %, urticaria 14.1 % y dermatitis atópica 8.4 %. La distribución de la frecuencia de reactividad cutánea positiva en orden descendente fue 5.2 % a soya, 4.7 % a durazno, 3.6 % a uva, naranja y manzana, 3.1 % a nuez y 2.6 % a piña, aguacate, tomate y atún.Conclusión: La frecuencia de reactividad cutánea para alérgenos alimentarios fue similar a la informada en la literatura nacional y latinoamericana, pero la sensibilización para cada alérgeno específico varió en cada grupo etario.

The skin prick test is recognized as the gold standard for the specific diagnosis of allergy.To determine the sensitivity and specificity of the epicutaneous patch test that has been modified for the diagnosis of respiratory allergy to Dermatophagoides pteronyssinus.An observational, interpretative, prolective, and transversal study. The included patients were between 6 and 49 years old, with symptoms of a respiratory allergy, and a skin test was performed on them by using the European standardized prick test and a modified epicutaneous patch test with the variable of the scarification that occurred before the antigen was applied, and its homogenization with a wooden applicator, which occurred after the antigen was applied. The levels of sensitivity, specificity, and prevalence influence and positive and negative predictive values were calculated.104 patients were included, of which 72 (69.2%) were women. The age category of the patients was 24 ± 11.3 years of age. 78.9% of the patients were diagnosed with allergic rhinitis, 1.9% were diagnosed with asthma, and 19.2% were diagnosed with both rhinitis and asthma. The prevalence of the respiratory allergy to Dermatophagoides pteronyssinus was of 62.5%; 94.23% with a correct diagnosis. The sensitivity and specificity of the test was of 93.85% and 94.87%; the positive and negative predictive values were of 96.83% and 90.24%, and the positive and negative likelihood ratios were of 18.30 and 0.06.The modified epicutaneous patch test was highly sensitive and specific; it decreased the risk of allergen carryover and it lowered the cost of the material that was used.Antecedentes: La prueba por punción cutánea es el estándar de oro en el diagnóstico específico de alergia. Objetivo: Determinar sensibilidad y especificidad de la prueba epicutánea modificada para el diagnóstico de alergia respiratoria a Dermatophagoides pteronyssinus. Métodos: Estudio observacional, interpretativo, prolectivo y transversal. Se incluyeron pacientes de seis a 49 años de edad, con cuadro clínico de alergia respiratoria, en quienes se realizó punción cutánea con técnica europea y prueba epicutánea con la variante de escarificación previa a la aplicación del antígeno y posterior homogenización del mismo con aplicador de madera. Se calculó sensibilidad, especificidad, influencia de la prevalencia, valores predictivos positivo y negativo. Resultados: Se incluyeron 104 pacientes, 72 (69.2 %) del sexo femenino. La edad fue de 24 ± 11.3 años, 78.9 % tuvo diagnóstico de rinitis alérgica, 1.9 % de asma y 19.2 % de rinitis y asma. La prevalencia de alergia respiratoria a Dermatophagoides pteronyssinus fue de 62.5 %; 94.23 % estaba correctamente diagnosticado. La sensibilidad y especificidad de la prueba fue de 93.85 y 94.87 %, los valores predictivos positivo y negativo de 96.83 y 90.24 % y los cocientes de probabilidades positivo y negativo de 18.30 y 0.91. Conclusiones: La prueba epicutánea modificada fue altamente sensible y específica, disminuyó el riesgo de contaminación por arrastre de alérgenos y los costos en el material utilizado.

For the etiological diagnosis of allergic respiratory diseases skin tests or specific serum IgE determination are used.To determine the correlation between the extent of reactivity to cutaneous prick tests and the levels of pollen specific serum IgE in patients with respiratory allergy.A prolective, descriptive and transversal study was done with patients of both genders, aged 2 to 60 years, who attended for the first time at the service of Allergy and Clinical Immunology of University Hospital of Puebla, Mexico, with presumptive diagnosis of respiratory allergy. All patients underwent clinical history, skin prick tests with standardized allergenic extracts and quantification of pollen specific serum IgE by chemiluminescence method. We estimated the correlation index r using the statistical method Pearson product-moment correlation coefficient; a value r equal to or higher than 0.70 was considered a significant relationship or a high correlation.Nine-one patients were included, of whom 58.2% were female. The diagnoses were: allergic rhinitis (79.1%), asthma and allergic rhinitis (16.5%) and only asthma (4.4%). Only significant correlation was found in patients with allergic rhinitis for Rumex crispus (r = 0.702) and in patients with asthma and rhinitis for Ambrosia trifida (r = 1).Only for Rumex crispus and Ambrosia trifida, the skin prick tests or the determination of specific serum IgE levels are comparable diagnostic methods of allergic respiratory diseases.para el diagnóstico etiológico de las enfermedades alérgicas respiratorias se realizan pruebas cutáneas o determinación de IgE sérica específica.determinar la correlación entre la magnitud de la reactividad a las pruebas cutáneas por punción y las concentraciones de IgE séricaespecífica para pólenes en pacientes con alergia respiratoria. PACIENTES Y MÉTODOS: estudio prolectivo, descriptivo y transversal efectuado en pacientes de uno y otro sexo, con edades de 2 a 60 años, que acudieron por primera vez al servicio de Alergia e Inmunología Clínica del Hospital Universitario de Puebla con diagnóstico presuntivo de alergia respiratoria. A todos los pacientes se les realizó historia clínica, pruebas cutáneas por punción con extractos alergénicos estandarizados y cuantificación de IgE sérica específica para pólenes por método de quimioluminiscencia. Se estimó el índice de correlación r con el método estadístico coeficiente de correlación producto-momento de Pearson, un valor de r igual o mayor de 0.70 se consideró una relación notable o una correlación elevada.se incluyeron 91 pacientes, 58.2% eran mujeres. Los diagnósticos fueron: rinitis alérgica (79.1%), asma y rinitis (16.5%) y únicamente asma (4.4%). Sólo se encontró una correlación significativa en pacientes con rinitis alérgica para Rumex crispus (r = 0.702) y en pacientes con asma y rinitis para Ambrosia trifida (r = 1). CONCLUSIÓN: sólo para Rumex crispus y Ambrosia trifida, las pruebas epicutáneas o la determinación de las concentraciones de IgE sérica específica son métodos equiparables en el diagnóstico etiológico de la alérgica respiratoria.

Antecedentes: para el diagnóstico etiológico de las enfermedades alérgicas respiratorias se realizan pruebas cutáneas o determinación de IgE sérica específica.Objetivo: determinar la correlación entre la magnitud de la reactividad a las pruebas cutáneas por punción y las concentraciones de IgE sérica específica para pólenes en pacientes con alergia respiratoria.Pacientes y métodos: estudio prolectivo, descriptivo y transversal efectuado en pacientes de uno y otro sexo, con edades de 2 a 60 años, que acudieron por primera vez al servicio de Alergia e Inmunología Clínica del Hospital Universitario de Puebla con diagnóstico presuntivo de alergia respiratoria. A todos los pacientes se les realizó historia clínica, pruebas cutáneas por punción con extractos alergénicos estandarizados y cuantificación de IgE sérica específica para pólenes por método de quimioluminiscencia. Se estimó el índice de correlación r con el método estadístico coeficiente de correlación producto-momento de Pearson, un valor de r igual o mayor de 0.70 se consideró una relación notable o una correlación elevada.Resultados: se incluyeron 91 pacientes, 58.2% eran mujeres. Los diagnósticos fueron: rinitis alérgica (79.1%), asma y rinitis (16.5%) y únicamente asma (4.4%). Sólo se encontró una correlación significativa en pacientes con rinitis alérgica para Rumex crispus (r = 0.702) y en pacientes con asma y rinitis para Ambrosia trifida (r = 1).Conclusión: sólo para Rumex crispus y Ambrosia trifida, las pruebas epicutáneas o la determinación de las concentraciones de IgE sérica específica son métodos equiparables en el diagnóstico etiológico de la enfermedad alérgica respiratoria.

A high prevalence of sensitization to antigen Mus musculus (mouse) in patients with allergic respiratory diseases has been reported worldwide.To determine the prevalence of skin reactivity to the Mus musculus antigen in patients with asthma and allergic rhinitis in the Department of Allergy and Clinical Immunology, Hospital Universitario de Puebla.We conducted a cross-sectional, observational, prospective and descriptive study in patients of both genders, from 2 to 58 years old. All patients were attending the hospital for the first time, in a period of 6 months with the diagnoses of asthma, allergic rhinitis, or both. Each patient underwent skin prick test with epithelial antigen Mus musculus. Data were analyzed with SPSS-Statistics software, version 18.We included 110 patients, 50% were women, mean age was 24.1 years (SD 16.2); 92.7% were from urban areas and the rest from rural areas. The overall prevalence of skin reactivity to the antigen tested was 1.8%; corresponding to patients with allergic rhinitis 2.4% and the remaining subgroups showed no reactivity. One of the three patients with positive skin tests worked in an animal laboratory, exposed to Mus musculus.We found a low prevalence of positive skin tests with mouse antigen. However, in patients with respiratory allergy symptoms and a strong exposure to mice or rodents we suggest to perform skin tests with mice allergen extracts.

There are documented molecular homologies between mites from the same group, but intergroup characteristics are not. Although mites share the same taxonomic order, there are species antigenically distinct. At the present we dont know clearly the differences in cutaneous reactivity among several house dust mites species.to estimate the correlation of skin reactivity to Dermatophagoides pteronyssinus and Dermatophagoides farinae antigens with that of Blomia tropicalis in patients with allergic rhinitis and asthma.a cross sectional, observational, prolective and interpretive study was performed in patients of both genders, aged 2 to 58 with allergic rhinitis and asthma. All patients underwent skin prick tests with allergenic extracts.One hundred and ten patients were included, with an age average of 24.1 years; 50% were males. There were positive skin tests with mites in 59% of the patients, 24.5% for Blomia t; 10% for D. pteronyssinus plus Blomia t. and 7.29% for D. farinae plus Blomia t. The correlation of the skin reactivity between Dermatophagoides pteronyssinus and Blomia tropicalis (r= 0.36) and between Dermatophagoides farinae and Blomia tropicalis (r= 0.27), was not significant in both cases.We found that most patients with allergic rhinitis and asthma showed positive skin tests with the mite extracts tested. There is a weak correlation between both species of Dermatophagoides and Blomia tropicalis.

Patient's perception about the effect of disease's manifestations on daily activities is called health-related quality of life, and it is used to evaluate the individual response to treatment. At present, there are some questionnaires designed to evaluate it.To evaluate the effect of integral treatment dosage on quality of life in asthmatic adults.A prospective, longitudinal and experimental study was made. We included male and female adult patients, with allergic asthma. A standardized questionnaire of quality of life was applied to all of them in every visit, for eight times. The integral treatment was based on Global Initiative for Asthma judgments.Ten patients were included, 70% of them were women. The media age was 37.4 +/- 15.73 years old. The asthma was diagnosed as intermittent in 10% cases, mild persistent in 20%, moderate persistent in 20% and severe persistent in 50% patients. The group of age most frequently affected was that of 20 to 30 years old. The media index of quality of life was 2.43 +/- 0.91 at the first visit and it was 5.73 +/- 1.11 at eighth visit. It was found a significant difference.Integral treatment improves quality of life in asthmatic adults.