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Copyright of Revista Alergia de Mexico is the property of Coleg. Mexicano de Inmunologia Clinica y Alergia A.C.; Soc. Lat. de Alergia, Asma e Inmunologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Common variable immunodeficiency (CVID) implies an increased risk of cancer, with an estimated incidence of 11-13%, particularly during the 5th and 6th decade of life. B cell-Hodgkin lymphomas are the more frequent cancer, followed by non-Hodgkin lymphoma and epithelial tumors (gastric, breast, bladder and cervix). Objective: To describe the types of cancers in a cohort of adult patients with CVID. Material and method: An observational, cross-sectional and descriptive study was made in which we reviewed the charts of patients with CVID attending the Primary Immunodeficiencies Clinic at Specialties Hospital Dr. Bernardo Sepulveda, Centro Medico Nacional Siglo XXI, Mexico City. Results: There were included 23 patients with CVID diagnosis, 13 women (56%) and 10 men (44%), with an average age of 36.7 years. Four patients developed malignancies (2 men and 2 women), with a prevalence of 17.3%. The types of cancers in this group of patients were: B cell-Hodgkin lymphoma (1/23), neuroendocrine carcinoma of the pancreas (1/23), myeloid chronic leukemia (1/23) and thyroid papillary carcinoma (1/23). In two of the subjects the diagnosis of cancer was established previous to CVID diagnosis. The average age of diagnosis of cancer was 27 years (19-34 years). Conclusions: In our patients we found different types of malignancies compared to previously described. We consider necessary a screening protocol for an early diagnosis of cancer in these patients. The frequency of cancer in our population was the same as reported in the literature. [ABSTRACT FROM AUTHOR]

Copyright of Revista Alergia de Mexico is the property of Coleg. Mexicano de Inmunologia Clinica y Alergia A.C.; Soc. Lat. de Alergia, Asma e Inmunologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Common variable immunodeficiency (CVID) is the most frequent symptomatic primary immunodeficiency, affecting 1:25,000-75,000 people. It is characterized by the absence or decrease antibody production. Treatment for CVID consists on human immunoglobulin administration, and the intravenous route is the most common route for administration, at 400-800 mg/kg of weight every 3-4 weeks. Adverse effects associated with intravenous immunoglobulin (IVIg) use occur in 25% of all infusions, with severe adverse reactions presenting in less than 1% of all patients. Acute renal failure can occur as a severe adverse reaction, which presents 1-10 days after starting IVIg treatment. In our center we implemented an ambulatory scheme for IVIg administration, which allows its administration in an average of 3 hours, without severe adverse effects. Objectives: To describe adverse effects and to evaluate the frequency of renal failure secondary to ambulatory IVIg administration in patients with common variable immunodeficiency. Material and method: A descriptive and prospective study was done including adult patients con definitive diagnosis of common variable immunodeficiency, receiving IVIg at replacement dose every 3 weeks. All patients were evaluated with clinical exploration, somatometry, serum creatinine, albumin and urea determination, 24 hours creatinine clearance, glomerular filtration rate with CKD-EPI, and immediate renal function associated with accumulated IVIg. Results were analyzed with descriptive statistics. Results: We determined adverse effects in 25 patients with common variable immunodeficiency (15 women and 10 men, average age 36.7 years), during a 10 months period (January-September 2013). During this period 284 IVIg infusions were administered using our scheme, frequency of adverse effects were 12.9%, with 5.2% of early adverse effects and 7.7% late adverse effects, all being mild to moderate, in some cases required analgesic and/or antihistamine administration, without having to stop the IVIg infusion. In the renal function study 19 patients were included (12 women and 7 men, average age 36 years, average weigh 58.74 kg and average height 1.60 m), evaluated from January 2009 to October 2013. Average serum creatinine was 0.76 ± 0.18 mg/dL, average serum urea was 28.6 ± 7.6 mg/dL, none patient presenting acute renal failure. Glomerular filtration rate was determined with CKD-EPI formula, and the average was 116 ± 34 mL/min/1.73 m², finding chronic renal failure in 4 patients. Average 24 hours creatinine clearance was 98.64 ± 22 mL/min/1.73 m², with chronic renal failure data in 6 patients. Conclusions: There were no severe adverse effects with this ambulatory IVIg scheme (anaphylaxis, acute renal failure). We did not find data of acute renal failure secondary to IVIg administration in this population, but we did find data of chronic renal failure secondary to IVIg administration through 24 hours creatinine clearance in 6 patients. No relation was found between accumulated IVIg dose in the last 5 years and decreased glomerular filtration rate. Another benefit worth of mentioning with this scheme is the reduction in costs for the health institution and to the patient. [ABSTRACT FROM AUTHOR]

Copyright of Revista Alergia de Mexico is the property of Coleg. Mexicano de Inmunologia Clinica y Alergia A.C.; Soc. Lat. de Alergia, Asma e Inmunologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Oral allergy syndrome (OAS) is the mildest form of an allergic reaction to foods. It is characterized by the presence of IgE mediated symptoms restricted to oral mucosa after intake of fresh fruits and vegetables. OAS diagnosis is based on suggestive clinical manifestations and can be confirmed with tests such as prick-to-prick skin test with the food implicated, which have a sensitivity > 90%, specificity 30-60%, positive predictive value (PPV) of 40% and negative predictive value (NPV) > 95%. Objective: To know the prevalence of OAS in adult patients attending a third level hospital in southern Mexico City, and also describe the demographics of these patients and comorbidities more frequently associated. Patients and method: We studied 44 patients (40 women and 4 men), with an average age of 33.4 years, with suggestive clinical features of OAS, evaluated with prick-by-prick skin tests with fresh food. Results: There was a predominance of OAS in woman (91%) and a prevalence of asthma and allergic rhinitis of 54% among this population. We found that 60.4% of these patients had positive prick-by-prick skin tests, being the most frequently involved families of foods: rosaceae (60%), crustaceans (25%), musaceae (23%), actinidacea (21%), lauraceae (16%) and cucurbitaceae (16%). Only 5 patients presented adverse reactions with prick-by-prick skin tests, in 4 of the cases with grade 3 and grade 4 anaphylaxis, while testing with banana-watermelon, peach, papaya and peanut, respectively. Conclusions: Oral allegy syndrome affects more women than men, the most frequent comorbidities in patients with oral allergy syndrome are allergic rhinitis and asthma, thus, in patients with asthma and allergic rhinitis, sensitized to pollens we have to ask about symptoms suggestive of oral allergy syndrome. [ABSTRACT FROM AUTHOR]

Background: Sensitization to mites and cockroach are a common cause of respiratory allergy, especially in children. There is little information about its cross-reactivity with shrimp, which is common in adult patients. Objectives: To determine the frequency of sensitization to house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae) and cockroach species Periplaneta americana, in adult patients attending to a third level hospital and to determine the frequency of sensitization to shrimp in patients with positive skin test to house dust mite and/or cockroach, in patients with clinical manifestations suggestive of allergy to shrimp. Material and method: A retrospective study was done in which results were reviewed of 672 patients clinical records, attending to the Allergy and Clinical Immunology department in a third level hospital, those patients with positive skin test results to Dermatophagoides and/ or Periplaneta americana were investigated for sensitization to shrimp through Prick-to-Prick test. Results: Data from 672 patients were obtained, 69.8% (469) males, with a mean age of 33.5 years. Dermatophagoides positivity was 72.2% (486/672), and its relationship with other invertebrates that also have tropomyosin was 5.6% (4.9% with cockroach and 0.74% with shrimp). Conclusions: In our population, house dust mite sensitization was similar to that reported in the international literature. There was low positivity to cockroach, probably due to geographical conditions. There is very little information about shrimp's cross-reactivity with Dermatophagoides, despite its clinical significance, which requires more specific studies such as measurement of specific IgE to tropomyosin. [ABSTRACT FROM AUTHOR]

Copyright of Revista Alergia de Mexico is the property of Coleg. Mexicano de Inmunologia Clinica y Alergia A.C.; Soc. Lat. de Alergia, Asma e Inmunologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Alergia de Mexico is the property of Coleg. Mexicano de Inmunologia Clinica y Alergia A.C.; Soc. Lat. de Alergia, Asma e Inmunologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Allopurinol is a xanthine oxidase inhibitor used in the treatment of patients with gout. Approximately 2% of patients are affected by adverse reactions to this drug. Severity ranges from mild rashes to severe reactions in up to 0.4% of cases. De-sensitization is carried out by administering increasing doses of the drug., Case Report: Thirty-year old man diagnosed with hypercholesterolemia and hypertriglyceridemia treated with bezafibrate and pravastatin, systemic arterial hypertension treated with losartan and a 10-year history of hyperuricemia with gout. Tophi were found in metacarpophalangeal joints and elbows. Treatment was started with allopurinol 300 mg/day. Two weeks later, he experienced facial erythema with itching and maculopapular lesions on the malar region 1 hour after the medication was ingested. An outpatient drug de-sensitization protocol was initiated, starting with 5 mg, and with gradual dose increases every 4 to 5 days for 59 days until the desired maintenance dose (300 mg) was reached., Conclusions: Experience shows that de-sensitization to allopurinol is a safe alternative when there is hypersensitivity and treatment with this drug is required.

Background: The common variable immunodeficiency (CVID) shows a variable incidence, from 1:15,000 to 1:117,000, without gender predominance. The incidence of gastrointestinal manifestations in these patients ranges from 20-60%, and these may be the first and only clinical manifestation of CVID, while other patients develop gastrointestinal complications during the course of it. In Mexico there is little information regarding the type and frequency of gastrointestinal disorders presented by adult patients with CVID., Objective: To determine the prevalence of gastrointestinal manifestations in adult patients with CVID., Material and Method: A descriptive, cross-sectional and observational study was made including patients with CVID attending Primary Immunodeficiency Clinic of Allergy and Clinical Immunology Department, Specialties Hospital, National Medical Center SXXI, Mexico City. All patients underwent gastrointestinal symptoms questionnaire, laboratory, cabinet, endoscopy and breath test for bacterial overgrowth., Results: We evaluated 17 patients, 8 men and 9 women with an average age of 36 years with a definitive diagnosis of CVID according to international criteria; 59% had abdominal pain, 53% abdominal distension; only 3 patients (17.6%) reported constipation; 47% had chronic diarrhea, of which only 2 (11.8%) had rectal pushing. The diagnoses of gastrointestinal manifestations of this population were: 18% chronic diarrhea, celiac disease and bacterial overgrowth, 24% gastrointestinal functional disorder, 12% constipation and 6% dyspepsia. One patient (6%) had no gastrointestinal symptoms., Conclusions: Prevalence of gastrointestinal diseases in adult patients with common variable immunodeficiency was 94%. There was no gender predominance. It is therefore important that patients with CVID will conduct a study protocol that includes a complete medical history considering gastrointestinal symptoms and signs, in order to determine timely diagnosis and therapeutic approach.

Background: Common variable immunodeficiency (CVID) implies an increased risk of cancer, with an estimated incidence of 11-13%, particularly during the 5th and 6th decade of life. B cell-Hodgkin lymphomas are the more frequent cancer, followed by non-Hodgkin lymphoma and epithelial tumors (gastric, breast, bladder and cervix)., Objective: To describe the types of cancers in a cohort of adult patients with CVID., Material and Method: An observational, cross-sectional and descriptive study was made in which we reviewed the charts of patients with CVID attending the Primary Immunodeficiencies Clinic at Specialties Hospital Dr. Bernardo Sepulveda, Centro Medico Nacional Siglo XXI, Mexico City., Results: There were included 23 patients with CVID diagnosis, 13 women (56%) and 10 men (44%), with an average age of 36.7 years. Four patients developed malignancies (2 men and 2 women), with a prevalence of 17.3%. The types of cancers in this group of patients were: B cell-Hodgkin lymphoma (1/23), neuroendocrine carcinoma of the pancreas (1/23), myeloid chronic leukemia (1/23) and thyroid papillary carcinoma (1/23). In two of the subjects the diagnosis of cancer was established previous to CVID diagnosis. The average age of diagnosis of cancer was 27 years (19-34 years)., Conclusions: In our patients we found different types of malignancies compared to previously described. We consider necessary a screening protocol for an early diagnosis of cancer in these patients. The frequency of cancer in our population was the same as reported in the literature.

Background: Common variable immunodeficiency (CVID) is the most frequent symptomatic primary immunodeficiency, affecting 1:25,000-75,000 people. It is characterized by the absence or decrease antibody production. Treatment for CVID consists on human immunoglobulin administration, and the intravenous route is the most common route for administration, at 400-800 mg/kg of weight every 3-4 weeks. Adverse effects associated with intravenous immunoglobulin (IVIg) use occur in 25% of all infusions, with severe adverse reactions presenting in less than 1% of all patients. Acute renal failure can occur as a severe adverse reaction, which presents 1-10 days after starting IVIg treatment. In our center we implemented an ambulatory scheme for IVIg administration, which allows its administration in an average of 3 hours, without severe adverse effects., Objectives: To describe adverse effects and to evaluate the frequency of renal failure secondary to ambulatory IVIg administration in patients with common variable immunodeficiency., Material and Method: A descriptive and prospective study was done including adult patients con definitive diagnosis of common variable immunodeficiency, receiving IVIg at replacement dose every 3 weeks. All patients were evaluated with clinical exploration, somatometry, serum creatinine, albumin and urea determination, 24 hours creatinine clearance, glomerular filtration rate with CKD-EPI, and immediate renal function associated with accumulated IVIg. Results were analyzed with descriptive statistics., Results: We determined adverse effects in 25 patients with common variable immunodeficiency (15 women and 10 men, average age 36.7 years), during a 10 months period (January-September 2013). During this period 284 IVIg infusions were administered using our scheme, frequency of adverse effects were 12.9%, with 5.2% of early adverse effects and 7.7% late adverse effects, all being mild to moderate, in some cases required analgesic and/or antihistamine administration, without having to stop the IVIg infusion. In the renal function study 19 patients were included (12 women and 7 men, average age 36 years, average weigh 58.74 kg and average height 1.60 m), evaluated from January 2009 to October 2013. Average serum creatinine was 0.76 ± 0.18 mg/dL, average serum urea was 28.6 ± 7.6 mg/dL, none patient presenting acute renal failure. Glomerular filtration rate was determined with CKD-EPI formula, and the average was 116 ± 34 mL/min/1.73 m2, finding chronic renal failure in 4 patients. Average 24 hours creatinine clearance was 98.64 ± 22 mL/min/1.73 m2, with chronic renal failure data in 6 patients., Conclusions: There were no severe adverse effects with this ambulatory IVIg scheme (anaphylaxis, acute renal failure). We did not find data of acute renal failure secondary to IVIg administration in this population, but we did find data of chronic renal failure secondary to IVIg administration through 24 hours creatinine clearance in 6 patients. No relation was found between accumulated IVIg dose in the last 5 years and decreased glomerular filtration rate. Another benefit worth of mentioning with this scheme is the reduction in costs for the health institution and to the patient.

Background: The prevalence of pollinosis has doubled in the past two decades. Several studies suggest that up to 50% of adult residents of Mexico City can present manifestations of respiratory allergy, and pollens from trees, grasses and weeds are a common cause. To determine the prevalence of their families and antigenic cross-reactivity allows us to offer appropriate diagnoses and treatments., Objective: To know the prevalence of sensitization of pollens to trees, grasses and weeds in adults with respiratory allergy of the South zone of Mexico City from January 2007 to December 2013., Material and Method: A cross-sectional, observational and prospective study was done with patients from Mexico City, referred to the National Medical Center Siglo XXI, IMSS, from 2007 to 2013 with a diagnosis of allergic rhinitis, asthma and conjunctivitis. We analyzed the results of skin prick tests to pollens from trees, grasses and weeds in selected patients. The results were analyzed using descriptive statistics., Results: A total of 672 patients were analyzed, 70% men, the average age was 34 ± 16 years. Regarding occupation 31% were students, 48% employees and 21% housewives. Fifty-three percent had rhinitis, 47% had asthma and 40.5% had both, asthma and rhinitis. Prevalence of sensitization to weeds was 56%, 33% to trees and 11% to grasses., Conclusions: Sensitization to weeds is the first cause of respiratory pollinosis in the south of Mexico City, Amaranthus was the most prevalent pollen in this area. Sensitization to trees is the second cause, with a predominance of trees form Betulaceae, Fagaceae and Oleacea families. Sensitization to grass is the third cause of respiratory pollinosis. The most common are from Pooideae (Lolium perenne), Chloroideae and Cynodon/Dactylon family.

Background: Sensitization to mites and cockroach are a common cause of respiratory allergy, especially in children. There is little information about its cross-reactivity with shrimp, which is common in adult patients., Objectives: To determine the frequency of sensitization to house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae) and cockroach species Periplaneta americana, in adult patients attending to a third level hospital and to determine the frequency of sensitization to shrimp in patients with positive skin test to house dust mite and/or cockroach, in patients with clinical manifestations suggestive of allergy to shrimp., Material and Method: A retrospective study was done in which results were reviewed of 672 patients clinical records, attending to the Allergy and Clinical Immunology department in a third level hospital, those patients with positive skin test results to Dermatophagoides and/or Periplaneta americana were investigated for sensitization to shrimp through Prick-to-Prick test., Results: Data from 672 patients were obtained, 69.8% (469) males, with a mean age of 33.5 years. Dermatophagoides positivity was 72.2% (486/672), and its relationship with other invertebrates that also have tropomyosin was 5.6% (4.9% with cockroach and 0.74% with shrimp)., Conclusions: In our population, house dust mite sensitization was similar to that reported in the international literature. There was low positivity to cockroach, probably due to geographical conditions. There is very little information about shrimp's cross-reactivity with Dermatophagoides, despite its clinical significance, which requires more specific studies such as measurement of specific IgE to tropomyosin.

Background: Oral allergy syndrome (OAS) is the mildest form of an allergic reaction to foods. It is characterized by the presence of IgE mediated symptoms restricted to oral mucosa after intake of fresh fruits and vegetables. OAS diagnosis is based on suggestive clinical manifestations and can be confirmed with tests such as prick-to-prick skin test with the food implicated, which have a sensitivity > 90%, specificity 30-60%, positive predictive value (PPV) of 40% and negative predictive value (NPV) > 95%., Objective: To know the prevalence of OAS in adult patients attending a third level hospital in southern Mexico City, and also describe the demographics of these patients and comorbidities more frequently associated., Patients and Method: We studied 44 patients (40 women and 4 men), with an average age of 33.4 years, with suggestive clinical features of OAS, evaluated with prick-by-prick skin tests with fresh food., Results: There was a predominance of OAS in woman (91%) and a prevalence of asthma and allergic rhinitis of 54% among this population. We found that 60.4% of these patients had positive prick-by-prick skin tests, being the most frequently involved families of foods: rosaceae (60%), crustaceans (25%), musaceae (23%), actinidacea (21%), lauraceae (16%) and cucurbitaceae (16%). Only 5 patients presented adverse reactions with prick-by-prick skin tests, in 4 of the cases with grade 3 and grade 4 anaphylaxis, while testing with banana-watermelon, peach, papaya and peanut, respectively., Conclusions: Oral allergy syndrome affects more women than men, the most frequent comorbidities in patients with oral allergy syndrome are allergic rhinitis and asthma, thus, in patients with asthma and allergic rhinitis, sensitized to pollens we have to ask about symptoms suggestive of oral allergy syndrome.

Corticosteroid hypersensitivity is a complex phenomenon in which many factors interact, such as idiosyncrasy, intolerance or allergic reactions. The prevalence of immediate hypersensitivity reactions to corticosteroids is 0.2%-0.5%. Corticosteroids have major therapeutic implications; thus, when hypersensitivity is suspected, in-vitro and/or in-vivo testing can be performed to confirm diagnosis, being the drug challenge the gold standard. After definitive diagnosis, cross-reactivity among the different corticosteroid groups should be considered, to choose wisely if corticosteroid therapy is still required. In Coopman classification, steroids belonging to groups A, B and D2 have high cross-reactivity, however, more studies are needed to determine the degree of cross-reaction among these drugs. This paper presents the case of a woman, in who hypersensitivity to hydrocortisone succinate was confirmed by drug challenge test.

DRESS syndrome (Drug rash with Eosinophilia and Systemic Symptoms) is an idiosyncratic reaction (type B), characterized by peripheral eosinophilia and systemic symptoms, such as fever, rash, lymphadenopathy, hepatitis, atypical lymphocytes and elevation of liver enzymes at least twice its normal level or increase of alanine amino transferase (ALT) >100 U/L. Its incidence is of 1/1,000 to 10,000 exposures and its mortality is of 10%-20%. Treatment is based on steroids and on the suspension of the suspect drug. This paper reports the cases of six patients with DRESS syndrome attended at Centro Medico Nacional Siglo XXI, Mexico City, from September 2012 to September 2013, which accounted for 12.5% of patients attended with adverse reactions to drugs.