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BACKGROUND AND OBJECTIVE: Chronic nodular prurigo (CNPG) is a recently defined and currently underdiagnosed disease with a variety of causes. It is associated with multiple comorbidities, and its management and treatment have improved with a better understanding of its pathogenesis. The aim of this study was to describe our experience with a series of patients with CNPG. MATERIAL AND METHODS: Single-center, observational, retrospective study of the sociodemographic and clinical characteristics of patients with CNPG seen at the dermatology department of a tertiary care hospital between 2009 and 2021. RESULTS: We included 74 patients, mostly women (63.5%), with a mean age of 57 years. Overall, 39.2% of patients had a concomitant skin condition, mainly atopic dermatitis (62%). Other comorbidities included endocrine disorders (54.1%), cardiovascular disease (44.4%), and psychiatric disorders (36.5%). Skin biopsy helped confirm the clinical diagnosis in 70% of cases. The mean immunoglobulin E level was higher than normal (516 IU/mL), regardless of atopic predisposition. On average, patients received 3 treatments, the most common choices being methotrexate, antihistamines, and topical and oral corticosteroids. Methotrexate was among the most effective options. CONCLUSIONS: CNPG is a complex disease associated with multiple comorbidities. It requires a multidisciplinary approach, with the dermatologist at the center. Classical treatment approaches are probably insufficient.

BACKGROUND AND OBJECTIVE: Chronic nodular prurigo (CNPG) is a recently defined and currently underdiagnosed disease with a variety of causes. It is associated with multiple comorbidities, and its management and treatment have improved with a better understanding of its pathogenesis. The aim of this study was to describe our experience with a series of patients with CNPG. MATERIAL AND METHODS: Single-center, observational, retrospective study of the sociodemographic and clinical characteristics of patients with CNPG seen at the dermatology department of a tertiary care hospital between 2009 and 2021. RESULTS: We included 74 patients, mostly women (63.5%), with a mean age of 57 years. Overall, 39.2% of patients had a concomitant skin condition, mainly atopic dermatitis (62%). Other comorbidities included endocrine disorders (54.1%), cardiovascular disease (44.4%), and psychiatric disorders (36.5%). Skin biopsy helped confirm the clinical diagnosis in 70% of cases. The mean immunoglobulin E level was higher than normal (516IU/mL), regardless of atopic predisposition. On average, patients received three treatments, the most common choices being methotrexate, antihistamines, and topical and oral corticosteroids. Methotrexate was among the most effective options. CONCLUSIONS: CNPG is a complex disease associated with multiple comorbidities. It requires a multidisciplinary approach, with the dermatologist at the center. Classical treatment approaches are probably insufficient.

Accessibility to more precise diagnostic techniques such as component resolved diagnostics (CRD), provides us with an important advance in diagnostic aspects as well as treatment. The subject of this study aims to better understand the profiles of sensitization to Der p 1, Der p 2 and Der p 23 and to know to what extent their use could help us in optimizing the decision-making for their treatment with Specific Immunotherapy. Cross-sectional study of subjects older than 5 years, diagnosed with allergy to HDM using skin prick test and sIgE, with symptoms of rhinitis and/or asthma. Total and specific IgE was determined to D. pteronyssinus, nDer p 1, rDer p 2 and rDer p 23 using ImmunoCAP. 240 patients were recruited (97.1% rhinitis and 46.25% rhinitis and asthma). Four different phenotypes were observed: positive or negative for sIgE nDer p 1 and/or IgE rDer p 2. 17% of these patients sIgE were double negative for Der p 1 and Der p 2 (increasing with age and with significantly lower sIgE levels than the rest of the groups). Using ROC curves, value less than 2.18 KUA/L for D. pteronyssinus sIgE gave us a sensitivity and specificity of 0.882 and 0.985, respectively, to double negative IgE nDer p 1 and IgE rDer p 2 group. Despite positive SPT and sIgE to D. pteronyssinus, 17% of the studied population is IgE nDer p 1 and IgE rDer p 2 double negative, with a cut-off value of 2.18 KU/L, which is very relevant for taking of decisions in prescription of AIT. The double positive population sIgE nDer p 1 and IgE rDer p 2 is associated with asthma compared to the other groups and this does not seem to be influenced by IgE rDer p 23.

The high prevalence of allergy to β-lactam antibiotics is a worldwide issue. Accuracy of diagnostic methods is important to prove tolerance or allergy, with skin test considered the best validated in vivo method for diagnosing immediate reactions to β-lactams. Although drug provocation test is the reference standard, it cannot be performed in highly risk reactions or in those with positive skin tests. For skin tests, the inclusion of major and minor determinants of benzylpenicillin (BP) is recommended. Commercial skin test reagents have changed along time, including as minor determinants benzylpenicillin, benzylpenicilloate (BPO), and benzylpenilloate (PO). Major determinants consists of multivalent conjugates of benzylpenicilloyl coupled through amide bond to a carrier polymer, such as penicilloyl-polylysine (PPL) or benzylpenicilloyl-octalysine (BP-OL). The chemical stability of such reagents has influenced the evolution of the composition of the commercial kits, as this requirement is necessary for improving the quality and standardization of the product. In this work, we provide a detailed study of the chemical stability of BP determinants. We observed that those structures suffer from an epimerization process in C-5 at different rates. Butylamine-Benzylpenicilloyl conjugates (5R,6R)-Bu-BPO and (5S,6R)-Bu-BPO were selected as a simple model for mayor determinant to evaluate the role of the different epimers in the immunoreactivity with sera from penicillin-allergic patients. In vitro immunoassays indicate that any change in the chemical structure of the antigenic determinant of BP significantly affects IgE recognition. The inclusion of stereochemically pure compounds or mixtures may have important implications for both the reproducibility and sensitivity of in vivo and in vitro diagnostic tests.

Background Analysis of cross-reactivity is necessary for prescribing safe cephalosporins for penicillin allergic patients. Amoxicillin (AX) is the betalactam most often involved in immediate hypersensitivity reactions (IHRs), and cefadroxil (CX) the most likely cephalosporin to cross-react with AX, since they share the same R1 side chain, unlike cefuroxime (CO), with a structurally different R1. We aimed to analyse cross-reactivity with CX and CO in patients with confirmed IHRs to AX, including sIgE recognition to AX, CX, CO, and novel synthetic determinants of CX. Methods Fifty-four patients with confirmed IHRs to AX based on skin test (ST) and/or drug provocation test (DPT) were included. Serum sIgE to AX and benzylpenicillin was determined by Radioallergosorbent test (RAST). Two potential determinants of CX, involving intact or modified R1 structure, with open betalactam ring, were synthesised and sIgE evaluated by RAST inhibition assay. Results Tolerance to CX (Group A) was observed in 64.8% cases and cross-reactivity in 35.2% cases (Group B). Cross-reactivity with CO was only found in 1.8% cases from Group B. ST to CX showed a negative predictive value of 94.6%. RAST inhibition assays showed higher recognition to CX as well as to both synthetic determinants (66% of positive cases) in Group B. Conclusions Cross-reactivity with CX in AX allergic patients is 35%, being ST not enough for prediction. R1, although critical for recognition, is not the unique factor. The synthetic determinants of CX, 1-(HOPhG-Ser-Bu) and 2-(pyrazinone) are promising tools for determining in vitro cross-reactivity to CX in AX allergic patients. Background Betalactams (BLs) are the drugs most frequently involved in immediate (IgE-mediated) hypersensitivity reactions (IHRs) [1,2,3], which could be explained by their ability to act as haptens due to their high chemical reactivity against proteins [4, 5]. BL chemical structure is formed by a 4-membered ring (the so-called BL ring) that in penicillins is fused to a 5-membered thiazolidine ring, and in cephalosporins to a 6-membered dihydrothiazine ring (Fig. 1). These drugs have a side chain (R1) bound to the BL ring; besides, cephalosporins have a second side chain (R2) bound to the dihydrothiazine ring, whose chemical structures distinguish the different compounds [6, 7]. Yes

Introduction: The aim of the study was to assess the use of faecal calprotectin (FCP) in infants with signs and symptoms of non-IgE-mediated cow's milk protein allergy (CMA) for both diagnosis and prediction of clinical response at the time of withdrawal of milk proteins. Patients and methods: A one year prospective study was conducted on 82 infants between 1 and 12 months of age in the Eastern area of Málaga-Axarquía, of whom 40 of them had been diagnosed with non-IgE-mediated CMA (with suggestive symptoms and positive response to milk withdrawal), 12 not diagnosed with CMA, and 30 of them were the control group. FCP was measured at three different times: time of diagnosis, and one and three months later. ANOVA for repeated measures, nominal logistic regression and ROC curves were prepared using the SPSS.20 package and Medcalc. Results: Differences between diagnostic and control groups were assessed: there was a statistically significant relationship (P

Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; BACKGROUND Multiple sensitization is frequent among pollen-allergic patients. The goal of this study was to determine the diagnostic accuracy of the ImmunoCAP ISAC 112 (ISAC112) microarray in allergy to pollen from several taxa and its clinical utility in a Spanish population. METHODS Specific IgE was determined in 390 pollen-allergic patients using the ISAC112 microarray. Diagnostic accuracy (sensitivity, specificity, predictive values, and area under the ROC curve) was calculated for the diagnosis of allergy to pollen from grass (n=49), cypress (n=75), olive tree (n=33), plane tree (n=63), and pellitory of the wall (n=17) and compared with that of the singleplex ImmunoCAP immunoassay. RESULTS The sensitivity of the ISAC112 microarray ranged from 68.2% for allergy to plane tree pollen to 93.9% for allergy to grass pollen. The specificity was >90%. The AUC for the diagnosis of allergy to plane tree pollen was 0.798, whereas the AUC for the remaining cases was ≥0.876. The accuracy of ISAC112 was higher than that of ImmunoCAP for plane tree pollen and similar for the remaining pollens. The frequency of sensitization to most species-specific allergenic components and profilins varied between the different geographical regions studied. A total of 73% of pollen-allergic patients were sensitized to species-specific components of more than 1 pollen type. CONCLUSIONS The ISAC112 microarray is an accurate tool for the diagnosis of allergy to pollen from grass, cypress, olive tree, plane tree, and pellitory of the wall. The features of the ISAC112 microarray are similar or superior (in the case of plane tree pollen) to those of ImmunoCAP. This microarray is particularly useful for the etiologic diagnosis of pollinosis in patients sensitized to multiple pollen species whose pollination periods overlap. Yes

[ES] Los alérgenos alimentarios pueden provocar reacciones adversas de hipersensibilidad de tipo I. Este proceso presenta una elevada prevalencia que puede afectar a la población sensibilizada vía contacto, ingestión o inhalación del alérgeno. En la actualidad, esta enfermedad afecta al 2% de los adultos y el 6% de los niños, lo que representa un impacto significativo en la calidad de vida y en los costes sanitarios asociados (Iglesias, 2018). Paralelamente, el sector alimentario ha realizado importantes inversiones, esfuerzos y mejoras para implementar programas de control de alérgenos. Desde un enfoque holístico de la alergia alimentaria, es necesario integrar en este control la evaluación del impacto de los alimentos en la salud de los consumidores. La creciente demanda de información de salud sobre los problemas alérgicos genera la necesidad de disponer de mejores métodos de detección no invasivos y sensibles que proporcionen resultados fiables de manera rápida y sencilla (Worm et al., 2018). En este trabajo fin de grado se contribuye al desarrollo de un ensayo multiplexado que permite la determinación simultánea de inmunoglobulinas E e inmunoglobulina G específica en suero sanguíneo para doce alérgenos alimentarios. La aproximación consiste en un biosensado óptico basado en inmunoensayos no competitivos. La inmovilización de los alérgenos en formato de micromatriz se realiza sobre la superficie de un disco compacto mediante un dispensador de bajo volumen y sin contacto. Tras la incubación de la muestra y el revelado de la inmunointeracción, se procede a la lectura de los resultados mediante un lector de discos digitales ópticos en modo reflexión. El procesado de las imágenes capturadas proporciona señales específicas para cada una de las moléculas diana, que pueden ser correlacionadas con su concentración. El ensayo en formato micromatriz tiene buenas prestaciones analíticas, siendo el límite de detección 0,31 UI/mL y de cuantificación 0,41 UI/mL, en el caso de las IgE y de 0,04 y 0,23 ng/µL para el inmunoensayo de IgG, respectivamente. El sistema se ha evaluado mediante el análisis de 37 muestras de suero sanguíneo de pacientes alérgicos y 9 individuos control., [EN] Food allergens can cause adverse reactions of type I hypersensitivity. This process has a high prevalence that can induce a reaction in the person by contact, ingestion or inhalation. Currently, it affects 2% of adults and 6% of children, which represents a significant impact on life quality and associated health costs (Iglesias, 2018). In parallel, the food industry has made significant investments, efforts and improvements to implement allergen control programs. From a holistic approach to food allergy, it is necessary to integrate in this control the evaluation of the food impact on the health of consumers. The growing demand for health information about allergic problems generates the need for better non-invasive and sensitive detection methods that provide reliable results quickly and easily (Worm et al., 2018). The objective of this study is to contribute to the development of a multiplexed method that enables simultaneous detection of specific immunoglobulin E and G for twelve food allergens. The approach consists of an optical biosensing based on non-competitive immunoassays. The immobilization of the probes in microarray format is carried out on the surface of a compact disc by means of a low volume, non-contact arrayer. After the incubation of the sample and the development, the results are read through a digital optical disc reader in reflection mode. The processing of the captured images provides specific signals for each of the target molecules, which can be correlated to its concentration. The assay in microarray format has good analytical performance, with a detection limit of 0.31 IU/mL and a quantification of 0.41 IU/mL, in the case of IgE and 0.04 and 0.23 ng/μL for the IgG immunoassay. The system has been evaluated by analyzing 37 blood serum samples from allergic patients and 9 control individuals., [CA] Els al-lèrgens alimentaris poden provocar reaccions adverses de hipersensibilitat de tipus I. Aquest procés presenta una elevada prevalença que pot afectar a la població sensibilitzada via contacte, ingestió o inhalació de l’al-lergen. En l’actualitat, aquesta enfermetat afecta al 2% dels adults i al 6% dels xiquets, el que representa un impacte significatiu en la qualitat de vida i en els costos sanitaris associats (Iglesias, 2018). Paral-lelament, el sector alimentari ha realitzat importants inversions, esforços i millores per implementar programes de control d'al-lèrgens. Des d'un enfocament holístic de l'al-lèrgia alimentària, cal integrar en aquest control l'avaluació de l'impacte dels aliments en la salut dels consumidors. La creixent demanda d'informació de salut sobre els problemes al-lèrgics genera la necessitat de disposar de millors mètodes de detecció no invasius i sensibles que proporcionin resultats fiables de manera ràpida i senzilla (Worm et al., 2018). A aquest treball final de grau es contribueix al desenvolupament d’un assaig multiplexat que permet la determinació simultània en sèrum sanguini d'immunoglobulines E i immunoglobulina G específica per a dotze aliments al-lergènics. L'aproximació consisteix en un biosensat òptic basat en immunoassaigs no competitius. La immobilització dels al-lèrgens en format de micromatriu es realitza sobre la superfície d'un disc compacte mitjançant un dispensador de baix volum i sense contacte. Després de la incubació de la mostra i el revelat, es procedeix a la lectura dels resultats mitjançant un lector de discos digitals òptics en mode reflexió. El processat de les imatges capturades proporciona senyals específiques per a cada un de les molècules diana, que poden ser correlacionades amb la seua concentració. L'assaig en format micromatriu té bones prestacions analítiques, sent el límit de detecció 0,31 UI/mL i de quantificació 0,41 UI/mL, en el cas de les IgE i de 0,04 i 0,23 ng/mL per el immunoassaig d'IgG. El sistema s'ha avaluat mitjançant l'anàlisi de 37 mostres de sèrum sanguini de pacients al-lèrgics i 9 individus control.

El intestino tiene dos funciones principales, la primera es procesar el alimento ingerido para absorber los nutrientes, y la segunda es prevenir la entrada de patógenos al organismo. Para ello, el intestino ha desarrollado la llamada “barrera intestinal”, un sistema defensivo compuesto por diferentes elementos, tanto extracelulares como celulares, que actúan de forma coordinada, a la vez que mantiene el correcto desarrollo de la barrera epitelial, el sistema inmunitario y la adquisición de tolerancia hacia los antígenos de la dieta y a la microbiota intestinal. Una característica crítica del epitelio es la permeabilidad intestinal, ya que debe permitir un paso eficiente de nutrientes y restringir la entrada a moléculas de mayor tamaño, como los antígenos proteicos. Para ello, se reviste la superficie del tracto gastrointestinal de una capa de moco y las células epiteliales presentan uniones intercelulares que realizan un papel fundamental. La organización estructural de estas uniones es dinámica y su permeabilidad varía de un individuo a otro ya que afectan diferentes sustancias como por ejemplo mediadores inflamatorios. La regulación adecuada de la barrera epitelial se basa en múltiples mecanismos fisiológicos e inmunológicos. En personas con alergias alimentarias, se produce una inhibición de la tolerancia oral, lo que conduce a la producción inadecuada de IgE específica alergénica y al reclutamiento de mastocitos en la mucosa gastrointestinal. Las enfermedades alérgicas constituyen una de las patologías más frecuente en los niños, desarrollándose la sensibilización a determinados alimentos en el primero y segundo año de vida. Cualquier alimento puede desencadenar una respuesta alérgica dando lugar a reacciones mediadas por IgE, sin embargo, la mayor parte de dichas reacciones son causadas por un número pequeño de alimentos como son el cacahuete, el huevo, la leche, el pescado, los crustáceos, las nueces y el trigo. Universidad de Sevilla. Grado en Farmacia

La dermatitis atópica es una enfermedad cutánea inflamatoria crónica, de diagnóstico esencialmente clínico que se manifiesta en forma de prurito y brotes recurrentes de eccema de localización típica 1 . A nivel celular, es un desorden multifactorial asociado a células CD4 Th2 que pueden sobrepro - ducir diversas citokinas, entre ellas IL-6 2 . Se sospecha que el origen de la enfermedad pueda ser, entre otros, una sensibilización inmunomediada por inmunoglobulina E (Ig E), por ello en algunos casos esta proteína puede estar anormalmente elevada 3 . Una de las complicaciones más severas de esta afectación es la queratoconjuntivitis atópica, una inflamación no infecciosa de la conjuntiva y la córnea que requiere tratamiento inmediato para impedir la pérdida de visión 4 . Las exacerbaciones agudas del eccema se tratan con corticoides tópicos, y cuando estos no responden se requiere de tratamiento sistémico: antihistamínicos, inhibidores de la calcineurina e inmunomodulado - res como azatioprina o anticuerpos antiidiotipo. Atopic dermatitis is a chronic inflammatory skin disorder, typically diagnosed clinically, whose diagnostic hallmark is pruritus and constant, localised eczema outbreaks. On a cellular level, atopic dermatitis is a multifactorial disorder linked to CD4 Th2 cells overproducing diverse cytokines, including IL-6. It is believed, among other theories, that the origin of atopic dermatitis is the immune-mediated action of immunoglobulin E (IgE), resulting in sensitisation, hence this protein being elevated in many cases. One of the most severe complications of the disorder is atopic keratoconjunctivitis, a non-infectious inflammation of the cornea and the conjunctiva that requires immediate treatment in order to prevent vision loss. Topical corticosteroids have proved effective in managing the acute exacerbations of eczema. Whenever topical corticosteroids are not effective, systemic treatment is required: antihistamines, calcineurin inhibitors and immunomodulators such as azathioprine or anti-idiotypic antibodies.

La dermatitis atópica es una enfermedad cutánea inflamatoria crónica, de diagnóstico esencialmente clínico que se manifiesta en forma de prurito y brotes recurrentes de eccema de localización típica 1 . A nivel celular, es un desorden multifactorial asociado a células CD4 Th2 que pueden sobrepro - ducir diversas citokinas, entre ellas IL-6 2 . Se sospecha que el origen de la enfermedad pueda ser, entre otros, una sensibilización inmunomediada por inmunoglobulina E (Ig E), por ello en algunos casos esta proteína puede estar anormalmente elevada 3 . Una de las complicaciones más severas de esta afectación es la queratoconjuntivitis atópica, una inflamación no infecciosa de la conjuntiva y la córnea que requiere tratamiento inmediato para impedir la pérdida de visión 4 . Las exacerbaciones agudas del eccema se tratan con corticoides tópicos, y cuando estos no responden se requiere de tratamiento sistémico: antihistamínicos, inhibidores de la calcineurina e inmunomodulado - res como azatioprina o anticuerpos antiidiotipo. Atopic dermatitis is a chronic inflammatory skin disorder, typically diagnosed clinically, whose diagnostic hallmark is pruritus and constant, localised eczema outbreaks. On a cellular level, atopic dermatitis is a multifactorial disorder linked to CD4 Th2 cells overproducing diverse cytokines, including IL-6. It is believed, among other theories, that the origin of atopic dermatitis is the immune-mediated action of immunoglobulin E (IgE), resulting in sensitisation, hence this protein being elevated in many cases. One of the most severe complications of the disorder is atopic keratoconjunctivitis, a non-infectious inflammation of the cornea and the conjunctiva that requires immediate treatment in order to prevent vision loss. Topical corticosteroids have proved effective in managing the acute exacerbations of eczema. Whenever topical corticosteroids are not effective, systemic treatment is required: antihistamines, calcineurin inhibitors and immunomodulators such as azathioprine or anti-idiotypic antibodies.

Resumen Las reacciones de hipersensibilidad a corticoides son raras en la población general, se dividen en dos categorías: Inmediatas, típicamente mediadas por Inmunoglobulina E (IgE), donde se incluye la anafilaxia luego de la administración de un fármaco en un corto período. Su prevalencia descrita es de 0,3-0,5%. Otra reacción es la ‘no inmediata’, que se manifiesta en un tiempo mayor de una hora después de la administración del fármaco. Se revisó la literatura con el objetivo de mejorar y aclarar el tratamiento en pacientes asmáticos que poseen esta condición. Se encontró que las vías posibles para generar estas reacciones son intranasal, aerosol por inhalador, oral y parenteral. Frente a esta condición se requiere una evaluación estrecha y detallada de la historia clínica, síntomas y reacciones secundarias al fármaco sospechoso. Finalmente, al momento de elegir tipo de corticoide a usar es primordial la seguridad del paciente logrando, además, el control de la enfermedad. Hypersensitivity reactions to corticosteroids are rare in the general population, they fall into two categories: ‘immediate’, typically mediated by immunoglobulin E (IgE), which includes anaphylaxis after administration of a drug in a short period of time. Its reported prevalence is 0.3-0.5%. Another reaction is ‘not immediate’, which manifests itself in a time longer than one hour after the administration of the drug. We reviewed the literature with the aim of improving and clarifying the treatment in asthmatic patients with this condition. It was found that the possible routes to generate these reactions are intranasal, aerosol by inhaler, oral and parenteral. Facing this condition requires a close and detailed evaluation of the clinical history, symptoms and side reactions to the suspected drug. Finally, when choosing which corticosteroid to use, the patient's safety is paramount, and control of the disease is also essential.

Resumen Las reacciones de hipersensibilidad a corticoides son raras en la población general, se dividen en dos categorías: Inmediatas, típicamente mediadas por Inmunoglobulina E (IgE), donde se incluye la anafilaxia luego de la administración de un fármaco en un corto período. Su prevalencia descrita es de 0,3-0,5%. Otra reacción es la ‘no inmediata’, que se manifiesta en un tiempo mayor de una hora después de la administración del fármaco. Se revisó la literatura con el objetivo de mejorar y aclarar el tratamiento en pacientes asmáticos que poseen esta condición. Se encontró que las vías posibles para generar estas reacciones son intranasal, aerosol por inhalador, oral y parenteral. Frente a esta condición se requiere una evaluación estrecha y detallada de la historia clínica, síntomas y reacciones secundarias al fármaco sospechoso. Finalmente, al momento de elegir tipo de corticoide a usar es primordial la seguridad del paciente logrando, además, el control de la enfermedad.

Estudia algunos aspectos epidemiológicos y determina los niveles de Inmunoglobulina E en pacientes pediátricos con síndrome nefrótico en el Instituto Nacional de Salud del Niño atendidos en 2018. El síndrome nefrótico no tiene una causa etiológica propiamente determinada, a pesar de que existen diversos estudios en donde se muestra cierta relación entre síndrome nefrótico y atopía aún no se le puede atribuir como causa directa y única. Al desconocerse el agente desencadenante de esta patología, aún no existen formas de prevenir dicha enfermedad. La asociación que se ha observado entre el síndrome nefrótico y atopía quizás pueda ayudar a conocer más acerca de la etiopatogenia de esta enfermedad. El poder medir la inmunoglobulina E en los pacientes con síndrome nefrótico atendidos en el INSN, contribuiría a determinar si están elevados en dicho grupo de pacientes, si la población en estudio tiene características parecidas a las poblaciones estudiadas en el mundo, si los niveles de inmunoglobulina E varían de acuerdo al curso de la enfermedad y podría ayudar en plantear posibles nuevos manejos preventivos ante dicha enfermedad.

Los alérgenos son antígenos que desencadenan una respuesta inmunológica exagerada en personas sensibles, esta respuesta se ve agravada en exposiciones posteriores al mismo antígeno. Existen diversos tipos de alergias, las alergias a inhalantes exteriores como al polen o a hongos; alergias a inhalantes interiores como a los artrópodos, animales, al polvo y al humo; alergia a la ingesta de alimentos y fármacos; alergias por inoculación, ya sea por picadura de insectos o fármacos y por último, alergias por contacto. De acuerdo con la interacción entre el anticuerpo y el antígeno, puede haber cuatro tipos diferentes de hipersensibilidad: Tipo I, II, III y IV; las diferentes reacciones y procesos que ocurren en cada una de ellas dependerán de la exposición al antígeno y la sensibilización del individuo. Una de las respuestas inmunológicas más estudiadas es la hipersensibilidad tipo I, donde se presenta una alergia mediada por los anticuerpos de tipo IgE que se encuentran unidos a la membrana de los mastocitos y basófilos, al unirse con el antígeno, se liberan diversas sustancias las cuales son las responsables de producir las manifestaciones clínicas características como anafilaxis, urticaria, sinusitis, rinitis, tos, estornudos, vómito, entre otros. Los índices de morbilidad por patologías causadas por alergias van en aumento, condiciones ambientales como el cambio climático, polución y procesos psicosociales como el estrés, permiten que las enfermedades por hipersensibilidad inmunológica se consideren relevantes tanto para clínicos como para investigadores de las ciencias básicas, lo que motiva académicamente la realización de esta revisión.

MeDALL (Mechanisms of the Development of ALLergy; EU FP7-CP-IP; Project No: 261357; 2010-2015) has proposed an innovative approach to develop early indicators for the prediction, diagnosis, prevention and targets for therapy. MeDALL has linked epidemiological, clinical and basic research using a stepwise, large-scale and integrative approach: MeDALL data of precisely phenotyped children followed in 14 birth cohorts spread across Europe were combined with systems biology (omics, IgE measurement using microarrays) and environmental data. Multimorbidity in the same child is more common than expected by chance alone, suggesting that these diseases share causal mechanisms irrespective of IgE sensitization. IgE sensitization should be considered differently in monosensitized and polysensitized individuals. Allergic multimorbidities and IgE polysensitization are often associated with the persistence or severity of allergic diseases. Environmental exposures are relevant for the development of allergy-related diseases. To complement the population-based studies in children, MeDALL included mechanistic experimental animal studies and in vitro studies in humans. The integration of multimorbidities and polysensitization has resulted in a new classification framework of allergic diseases that could help to improve the understanding of genetic and epigenetic mechanisms of allergy as well as to better manage allergic diseases. Ethics and gender were considered. MeDALL has deployed translational activities within the EU agenda.

JOURNAL ARTICLE; The high-affinity IgE receptor (Fcε RI) is a heterotetramer of three subunits: Fcε RIα, Fcε RIβ, and Fcε RIγ (αβγ2) encoded by three genes designated as FCER1A, FCER1B (MS4A2), and FCER1G, respectively. Recent evidence points to FCERI gene variability as a relevant factor in the risk of developing allergic diseases. Because Fcε RI plays a key role in the events downstream of the triggering factors in immunological response, we hypothesized that FCERI gene variants might be related with the risk of, or with the clinical response to, selective (IgE mediated) non-steroidal anti-inflammatory (NSAID) hypersensitivity. From a cohort of 314 patients suffering from selective hypersensitivity to metamizole, ibuprofen, diclofenac, paracetamol, acetylsalicylic acid (ASA), propifenazone, naproxen, ketoprofen, dexketoprofen, etofenamate, aceclofenac, etoricoxib, dexibuprofen, indomethacin, oxyphenylbutazone, or piroxicam, and 585 unrelated healthy controls that tolerated these NSAIDs, we analyzed the putative effects of the FCERI SNPs FCER1A rs2494262, rs2427837, and rs2251746; FCER1B rs1441586, rs569108, and rs512555; FCER1G rs11587213, rs2070901, and rs11421. Furthermore, in order to identify additional genetic markers which might be associated with the risk of developing selective NSAID hypersensitivity, or which may modify the putative association of FCERI gene variations with risk, we analyzed polymorphisms known to affect histamine synthesis or metabolism, such as rs17740607, rs2073440, rs1801105, rs2052129, rs10156191, rs1049742, and rs1049793 in the HDC, HNMT, and DAO genes. No major genetic associations with risk or with clinical presentation, and no gene-gene interactions, or gene-phenotype interactions (including age, gender, IgE concentration, antecedents of atopy, culprit drug, or clinical presentation) were identified in patients. However, logistic regression analyses indicated that the presence of antecedents of atopy and the DAO SNP rs2052129 (GG) were strongly related (P < 0.001 and P = 0.005, respectively) with selective hypersensitivity to ibuprofen. With regard to patients with selective hypersensitivity to ASA, men were more prone to develop such a reaction than women (P = 0.011), and the detrimental DAO SNP rs10156191 in homozygosity increased the risk of developing such hypersensitivity (P = 0.039). Yes

Para determinar la seroprevalencia de la infección por Toxocara canis en la población de La Laguna, estado Anzoátegui, se realizó un estudio prospectivo. Previo consentimiento informado, se aplicó una encuesta para la recolección de datos clínicos, epidemiológicos y socioeconómicos. Se tomaron muestras de sangre para realizar análisis hematológico, detectar anticuerpos específicos IgG anti-T. canis mediante ELISA y niveles séricos de IgE. Se evaluó una muestra de 146 personas. El 29,5% presentó anticuerpos IgG anti-T. canis, con predominio entre los 0-5 años (13,7%); no hubo diferencias por género ni edad (p > 0,05). Las familias con ingresos más bajos fueron las más afectadas (72,1%) y en su mayoría las viviendas no tenían aceras (21,0%; p = 0,018). Sólo la desparasitación de los perros estuvo asociada con infección por T. canis (p = 0,034). Los títulos de IgE se acompañaron de una discreta eosinofilia, lo que sugiere una posible infección parasitaria. Se demuestra que existe una elevada seroprevalencia de infección por T. canis en la población evaluada, por lo cual la infección debe ser considerada en niños con riesgo, como aquellos en contacto con perros, que viven en casas que carezcan de aceras, que están en contacto con el suelo y con déficit de higiene personal. Se destaca la importancia que las autoridades sanitarias deben asignar a esta infección, que habitualmente no se reconoce como un problema de salud pública. To determine the seroprevalence of Toxocara canis infection in the town La Laguna, Anzoátegui state, a prospective study was performed. After informed written consent was obtained from participants, the subjects were surveyed to collect clinical, epidemiological and socioeconomic data. Blood samples were obtained for hematological analysis, in order to detect specific anti-T. canis IgG antibodies by ELISA and serum IgE levels. A sample of 142 persons was evaluated. An estimate of 29.5% had IgG antibodies against T. canis predominantly between 0-5 years (13.7%); there were no differences either by gender or age (p > 0.05). Families with lowest income were mostly affected (72.1%) and most of their houses lacked sidewalks (21.0%; p = 0.018). Only deworming of dogs was associated with T. canis infection (p = 0.034). IgG titers are accompanied by slight eosinophilia, suggesting a possible parasitic infection. A high seroprevalence of T. canis infection was found in the population evaluated, hence the infection should be considered in children at risk, such as those in contact with dogs, living in houses that lack sidewalks, those in contact with soil and have poor personal hygiene. The importance that health authorities should allocate to this infection in underlined, which usually is not recognized as a public health concern.

Las enfermedades alérgicas son las inmunopatologías que con mayor prevalencia se presentan en el mundo. Pueden o no estar mediadas por anticuerpos IgE, sin embargo estas últimas son las que más intensamente se han estudiado por el riesgo que presentan para la vida del paciente. Si bien el único tratamiento que logra revertir estos mecanismos es la no exposición al alergeno, esto no siempre es posible. Por esta razón, y a partir del mayor conocimiento alcanzado del sistema inmune de mucosas junto al desarrollo de modelos animales de alergia, existe un marcado interés en la especialidad para el desarrollo de inmunoterapias que controlen y reviertan el estado de alergia. A partir de los ensayos pre-clínicos en animales y la aplicación de protocolos terapéuticos en ensayos clínicos, se han desarrollado terapias mucosales que logran inducir mecanismos de tolerancia específicos del alergeno, los cuales son capaces de revertir la sensibilización alérgica. Dado que el principal escollo siguen siendo las reacciones adversas inducidas durante el tratamiento, se requiere profundizar los estudios para desarrollar protocolos terapéuticos más seguros. En este punto la medicina traslacional encuentra un campo próspero para fortalecer las interacciones entre la ciencia básica, la aplicada y la clínica., Allergic diseases are the most prevalent immunopathologies worldwide. Although different mechanisms –IgE-independent or IgE-dependent– can be involved in the immunopathogenesis, the latter are the most studied reactions since they can be life-threatening. Nowadays, allergen avoidance is the unique effective treatment for allergic patients. However, this is rather difficult to implement. For this reason, and based on the new insights into the mucosal immune system and the development of animal models of allergy, there is an increasing interest in developing novel therapies to control or reverse allergic disorders. Pre-clinical studies and clinical trials have been successful to prove that immunotherapies may accomplish mucosal mechanisms of allergen-specific tolerance, which are able to revoke the allergic sensitization. Since the main obstacle in these therapies still has adverse reactions induced during treatment, further studies are required to explore safe and effective therapeutic protocols. At this point, translational medicine is a flourishing field in the areas of basic science, applied science, and clinical research., As doenças alérgicas são as imunopatologias mais prevalentes em todo o mundo. Embora possam estar mediadas ou não por anticorpos IgE, estas últimas são as reacções mais intensamente estudadas, devido ao risco que apresentam para a vida do paciente. Ainda que o único tratamento eficaz para reverter este mecanismos seja a não exposição dos pacientes ao alergeno, isto nem sempre é possível. Por este motivo, e com base nas novas perspectivas sobre o sistema imune de mucosas, junto com o desenvolvimento de modelos e para o animais de alergia, existe um interesse crescente na especialidade para o desenvolvimento de imunoterapias que controlem e revertam o estado de alergia. A partir de estudos pré-clínicos em animais e a aplicação de protocolos terapêuticos em ensaios clínico, foram desenvolvidas terapias mucosas que conseguem induzir mecanismos de tolerância específicos do alergeno, que são capazes de reverter a sensibilização alérgica. Devido a que o principal obstáculo nestas terapias continuam sendo as reações adversas induzidas durante o tratamento, é necessário realizar mais estudos para desenvolver protocolos terapêuticos mais seguros. Neste ponto, medicina translacional é um campo próspero para fortalecer as interações entre a ciência básica, a aplicada e a clínica., Instituto de Estudios Inmunológicos y Fisiopatológicos