ALERGOLOGÍA PARA MÉDICOS Y PACIENTES 2021

World Allergy Organization (WAO): Allergic patients during COVID-19 pandemic I have asthma and allergic rhinitis and I am worried about everything I hear about COVID-19; what should I do? https://www.worldallergy.org/UserFiles/file/Allergic_patients_during_COVID-19.pdf

COVID-19 infection: the perspectives on immune responses. Authors: Shi Y1,2, Wang Y3, Shao C4, Huang J4, Gan J4, Huang X4, Bucci E5,6, Piacentini M7, Ippolito G7, Melino G8,9. Author information 1 The First Affiliated Hospital of Soochow University, State Key Laboratory of Radiation Medicine and Protection, Institutes for Translational Medicine, Soochow University Medical College, Suzhou, China. yfshi@suda.edu.cn. 2 Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai, 200031, China. yfshi@suda.edu.cn. 3 Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai, 200031, China. 4 The First Affiliated Hospital of Soochow University, State Key Laboratory of Radiation Medicine and Protection, Institutes for Translational Medicine, Soochow University Medical College, Suzhou, China. 5 Sbarro H...

Steroid Allergy: Clinical Features and the Importance of Excipient Testing in a Diagnostic Algorithm. Authors: Li PH1, Wagner A2, Thomas I3, Watts TJ3, Rutkowski R4, Rutkowski K3. Abstract BACKGROUND: True corticosteroid (CS) allergy is rare. Instead, many patients may be allergic to excipients found in various CS preparations. Excipient testing is frequently overlooked. It might lead to unnecessary CS avoidance or dangerous re-exposure. OBJECTIVE: The objective of this study was to evaluate the clinical characteristics and frequency of excipient allergy in patients with confirmed type I hypersensitivity to systemic CS preparations. METHODS: Patients with a confirmed diagnosis of allergy (positive skin test or drug provocation test [DPT]) or tolerance (negative DPT to CS) over the past 10 years were studied. Patient characteristics, index CS, route of administration, clinical indications, symptoms of index reaction, and outcomes of CS/excipient allergy testing were analyz...

Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-COV-2/COVID-19 en establecimientos de atención de la salud Recomendaciones basadas en consenso de expertos e informadas en la evidencia Coordinador del Consenso Carlos Humberto Saavedra Trujillo. Profesor Titular, Universidad Nacional de Colombia, Bogotá, Colombia.

Tos crónica  Autor: Dr. Jorge A Puerto 

New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19? Authors: Christian A. Devaux , Jean-Marc Rolain , Philippe Colson , Didier Raoult ABSTRACT Recently, a novel coronavirus (2019-nCoV), officially known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in China. Despite drastic containment measures, the spread of this virus is ongoing. SARS-CoV-2 is the aetiological agent of coronavirus disease 2019 (COVID-19) characterised by pulmonary infection in humans. The efforts of international health authorities have since focused on rapid diagnosis and isolation of patients as well as the search for therapies able to counter the most severe effects of the disease. In the absence of a known efficient therapy and because of the situation of a public-health emergency, it made sense to investigate the possible effect of chloroquine/hydroxychloroquine against SARS-CoV-2 since this molecule was previously described as...

Enfermedades ampollosas autoinmunes Autor: Dr. Stiven Fuentes 

SÍNTESIS RÁPIDA. Tratamiento específico de la infección por COVID 19 Unidad de Evidencia y Deliberación para la Toma de Decisiones 25/03/2020 Autores Marcela Vélez, MD, MsC, PhD. Profesora e Investigadora de la Fac. de Medicina, Universidad de Antioquia. Viviana Vélez, MD, MsC (c), Investigadora de la Facultad de Medicina, Universidad de Antioquia Isabel Cristina Marín, MD, MsC (c) Investigadora de la Facultad de Medicina, Universidad de Antioquia David Castaño, MD, MsC (c), Estudiante de maestría en epidemiología clínica, Universidad de Antiquia Pamela Velásquez Salazar, MD, MsC, Investigadora de la Facultad de Medicina, Universidad de Antioquia Claudia Yaneth Vera-Giraldo, MsC, Investigadora de la Facultad de Medicina, Universidad de Antioquia Daniel Patiño, MsC, PhD. Profesor e Investigador de la Facultad de Medicina, Universidad de Antioquia Paola Andrea Ramírez, Bibliotecóloga. Esta síntesis rápida no contiene recomendaciones, solo moviliza la evid...

ICON: Diagnosis and management of allergic conjunctivitis. Authors: Bielory L1, Delgado L2, Katelaris CH3, Leonardi A4, Rosario N5, Vichyanoud P6. Author information Abstract Ocular allergy (OA), interchangeably known as allergic conjunctivitis, is a common immunological hypersensitivity disorder affecting up to 40% of the population. Ocular allergy has been increasing in frequency, with symptoms of itching, redness, and swelling that significantly impacts an individual's quality of life (QOL). Ocular allergy is an often underdiagnosed and undertreated health problem, because only 10% of patients with OA symptoms seek medical attention, whereas most patients manage with over-the-counter medications and complementary nonpharmacological remedies. The clinical course, duration, severity, and co-morbidities are varied and depend, in part, on the specific ocular tissues that are affected and on immunologic mechanism(s) involved, both local and systemic. It is frequently associat...

 Instructivo para la vigilancia en salud pública intensificada de infección respiratoria aguda asociada al nuevo coronavirus 2019 (COVID-19).  Fecha de actualización: viernes 20 de marzo 2020 Versión: 7 1. Introducción El 31 de diciembre de 2019 la Comisión Municipal de Salud y Sanidad de Wuhan (provincia de Hubei, China) informó sobre un agrupamiento de 27 casos de neumonía de etiología desconocida con inicio de síntomas el 8 de diciembre; los casos reportaban antecedente de exposición común a un mercado de mariscos, pescados y animales vivos en la ciudad de Wuhan. El 7 de enero de 2020, las autoridades chinas identificaron como agente causante del brote un nuevo tipo de virus de la familia Coronaviridae, que fue denominado “nuevo coronavirus”, SARS-COV-2 (1). Dado que los casos de coronavirus suelen causar síntomas respiratorios, la Organización Mundial de la Salud (OMS) ha emitido recomendaciones de protec...

The proximal origin of SARS-CoV-2 Authors: 1,2 ✉ Kristian G. Andersen, Andrew Rambaut   3, W. Ian Lipkin4, Edward C. Holmes   5 and Robert F. Garry6,7 1Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA. 2Scripps Research Translational Institute, La Jolla, CA, USA. 3Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK. 4Center for Infection and Immunity, Mailman School of Public Health of Columbia University, New York, NY, USA. 5Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life and Environmental Sciences and School of Medical Sciences, The University of Sydney, Sydney, Australia. 6Tulane University, School of Medicine, Department of Microbiology and Immunology, New Orleans, LA, USA. 7Zalgen Labs, Germantown, MD, USA. ✉e-mail: andersen@scripps.edu To the Editor — Since the first reports of novel pneumonia (COVID-19) in Wuhan, Hubei province, China1,2, there has been...

Perspectives on monoclonal antibody therapy as potential therapeutic intervention for Coronavirus disease-19 (COVID-19) Authors: Balamurugan Shanmugaraj,1,2 Konlavat Siriwattananon,1,2 Kittikhun Wangkanont,3 Waranyoo Phoolcharoen1,2 1 Research unit for Plant-produced Pharmaceuticals, Chulalongkorn University, Bangkok, Thailand 2 Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand 3 Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok, Thailand Abstract Last decade witnessed the outbreak of many life-threatening human pathogens including Nipah, Ebola, Chikungunya, Zika, Middle East respiratory syndrome coronavirus (MERS-CoV), Severe Acute respiratory syndrome coronavirus (SARS-CoV) and more recently novel coronavirus (2019-nCoV or SARS-CoV-2). The disease condition associated with novel coronavirus, referred to as Coronavirus disease (COVID-19). The emergence of ...

Debido al audio de 9:20 min de origen español, que esta circulando y generando pánico, algunos compañeros nos unimos para aclarar algunas cosas sobre COVID-19, tenemos conocimientos sobre biología molecular, inmunología y virología. Queremos evitar la propagación de virus como también la propagación de la desinformación. Seamos claros y piensen un poco. 1. El virus es muy peligroso, por que es muy virulento, es decir puede generar una enfermedad grave. Las infecciones por bacterias y virus no son nuevas para los humanos. Estos microorganismos co-evolucionan con nosotros y los hace menos virulentos, permitiéndoles infectar más personas, sin matar a muchas y así se pueden esparcir más. Este virus, por el contrario, salto de una especie (de armadillo/murciélago puede ser otro tema de discusión: “The proximal origin of SARS-CoV-2 – Nature”) a otra nueva especie. La respuesta tan exagerada es debido a que no hay ninguna inmunidad que lo detenga (nuevo para nosotros) y no por un experi...

Capítulo B07. Aspergilosis broncopulmonar alérgica (ABPA) Authors:  Reto Crameri                                             Abstract   Aspergillus fumigatus is the causative agent involved in allergic bronchopulmonary aspergillosis, an intense inflammatory response of the lung to A. fumigatus allergens. Twenty-tree allergens from the fungus have been cloned, produced as recombinant proteins, and characterized. Component resolved serologic investigations of patient’s sera with the recombinant A. fumigatus allergens of the fungus can aid to confirm a diagnosis of ABPA suspected from clinical signs. EAACI link:  www.eaaci.org

Mast cell disorders and idiopathic anaphylaxis: Evaluation and management. Authors: Khalid MB1, Lieberman P2. Abstract Background: Our understanding of mast cell activation disorders continues to grow, and our management of these syndromes is improving with this increase in knowledge. Despite these advances, there remain some areas of confusion. Conclusion: In this article, we discussed these areas and offered thoughts about establishing the diagnosis and management. DOI:  10.2500/aap.2020.41.190023

Abordaje del paciente con tos crónica (Middleton's Allergy Principles and Practice 9th Edition) Puntos clave: -La tos crónica es definida como la tos que está presente por mas de 8 semanas en adultos y por mas de 4 semanas en niños. -Un abordaje diagnóstico sistemático identifica la causa o causas de la tos crónica en la mayoría de los casos. -Si los rayos X de tórax son normales, relativamente pocas condiciones dan cuenta para la  mayoría de casos de tos crónica en adultos. -El asma y el síndrome de tos de la vía aérea superior están entre las causas mas comunes de tos crónica en adultos, y ambos pueden tener etiología alérgica -La tos crónica frecuentemente está relacionada con múltiples condiciones o factores simultáneos en adultos. -La tos crónica inexplicada en adultos es rara cuando se evitan todos los errores en el diagnóstico y tratamiento. Comentarios de estudiantes: 1. El abordaje del paciente con tos crónica, aunque complejo, se debe...

ACE Inhibitor-Mediated Angioedema Authors: Vincenzo Montinaro  1 , Marco Cicardi  2 Abstract Angioedema (AE) occurring during ACE inhibitor therapy (ACEi-AE) is a rare complication involving between 0.1 and 0.7% of treated patients. AE can also complicate other therapeutic regimens that block the renin-angiotensin aldosterone system. Other drugs, such as immune suppressors, some type of antidiabetics or calcium antagonists, can increase the likelihood of ACEi-AE when associated to ACEi. There is a clear ethnic predisposition, since African-Americans or Hispanics show a higher prevalence of this condition compared to Caucasians. At least in African-Americans the genetic predisposition accounts for a general higher prevalence of AE, independently from the cause. People that experience ACEi-AE may have some recurrence when they are switched to an angiotensin-receptor blocker (ARB); however, epidemiological studies on large cohorts have shown that angiotensin receptor bloc...

Multiple Drug Hypersensitivity Syndrome in a Large Database Authors: Quentin Landry  1 , Shuchen Zhang  2 , Laetitia Ferrando  1 , Jean Luc Bourrain  1 , Pascal Demoly  3 , Anca-Mirela Chiriac  4 Abstract Background: Multiple drug hypersensitivity syndrome (MDHS) is defined as confirmed drug hypersensitivity (DH) to at least 2 chemically and pharmacologically unrelated drugs. Reports of MDHS are scarce and poorly specified, and studies that diagnose MDHS on the basis of positive allergy test results are lacking. Objective: To evaluate retrospectively the frequency and characteristics of patients with MDHS in a large database. Methods: We included all patients who consulted and were tested in our Allergy Unit between September 1996 and February 2018 for a suspicion of DH. Clinical history and allergy workup results compiled in our Drug Allergy and Hypersensitivity Database were reviewed, and data of patients with a diagnosis of MDHS were retriev...

EoE disease monitoring: Where we are and where we are going. Authors: Godwin, Wilkins, Muir A Abstract OBJECTIVE:  To review literature on various methods of monitoring and characterizing eosinophilic esophagitis (EoE) with respect to their validity as well as risk to the patient. DATA SOURCES:  A literature search was performed using PubMed with keyword combinations of EoE and monitoring as well as various techniques used for monitoring, including but not limited to, symptoms, endoscopy, histology, fluoroscopy, FLIP, noninvasive monitoring, and biomarkers. STUDY SELECTIONS:  Case-control studies, observational studies, peer-reviewed reviews and guidelines, and systematic reviews were selected, reviewed, and summarized here. RESULTS:  A wealth of research regarding monitoring of EoE is currently being undertaken and published. Our review highlights those that have been validated and are currently being used, as well as some that show promise for future m...

Los residentes y docentes del servicio de Alergología Clínica de la Universidad de Antioquia, investigamos a fondo y discutimos en una mañana académica los puntos principales acerca del Coronavirus, acá se encuentra la presentación realizada y cuales son los puntos a destacar. 

Treatment of Chronic Spontaneous Urticaria: a Focused Update in Omalizumab Authors: Whitney A. Blackwell MD & David A. Khan MD  Abstract Chronic spontaneous urticaria (CSU) is a common disease in the general population that causes significant effects on quality of life and a financial burden on the health care system. Guidelines are essential to assure patients are being managed appropriately, although given the rigor to develop these reviews they are not as up to date as cutting-edge scientific evidence. This review details the most recent phase II, III, and IV clinical trials that have been published since the development of the US practice parameters. Recent findings Phase II, III, and IV clinical trials, ASTERIA I, POLARIS, X-ACT, MoA, and CTEND-CIU, demonstrate safety, long-term efficacy, and improvement in patient’s quality of life by decreasing disease-burdened days and severity of disease in comparison with placebo, as well as transcriptional level changes in ...

Update on the Management of Nonsteroidal Anti-Inflammatory Drug Hypersensitivity. Authors: Yeung WYW1, Park HS2. Author information 1Division of Rheumatology, Department of Internal Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. 2Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea. hspark@ajou.ac.kr. Abstract The clinical phenotypes of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity are heterogeneous with various presentations including time of symptom onset, organ involvements, and underlying pathophysiology. Having a correct diagnosis can be challenging. Understanding their respective mechanisms as well as developing a comprehensive classification and diagnostic algorithm are pivotal for appropriate management strategy. Treatment modalities are based on the subtypes and severity of hypersensitivity reactions. Insights into the phenotypes and endotypes of hypersen...

Capítulo B06. Alergia a gato, perro y caballo Authors:   Marianne van Hage, Christiane Hilger                                            Abstract   Mammalian furry animals are an important indoor allergen source. Sensitisation to mammalian furry animals is common and a risk factor for the development of allergic rhinitis and asthma Cat, dog and horse contain cross-reactive molecules such as serum albumins and some lipocalins. Co-sensitization to furry animals can be distinguished from cross-sensitization by allergen component testing. EAACI link:  www.eaaci.org

Recent developments and highlights in food allergy. Authors: Eiwegger T1,2,3, Hung L1,2, San Diego KE1, O'Mahony L4, Upton J1,3. Abstract The achievement of long-lasting, safe treatments for food allergy is dependent on the understanding of the immunological basis of food allergy. Accurate diagnosis is essential for management. In recent years, data from oral food challenges have revealed that routine allergy testing is poor at predicting clinical allergy for tree nuts, almonds in particular. More advanced antigen-based tests including component-resolved diagnostics and epitope reactivity may lead to more accurate diagnosis and selection of therapeutic intervention. Additional diagnostic accuracy may come from cellular tests such as the basophil activation test or mast cell approaches. In the context of clinical trials, cellular tests have revealed specific T-cell and B-cell populations that are more abundant in food-allergic individuals with distinct mechanistic features. A...

The rash that presents as target lesions. Authors:  Wolf R1, Parish JL2, Parish LC3. Abstract We have explored the rash that appears as target lesions, with the central and dominant diseases belonging to the Stevens-Johnson syndrome/toxic epidermal necrolysis group. After presenting the clinical patterns of an individual target lesion and classifying them into different types of lesions, the contribution has been organized with groups characterized by such specific findings according to the type of lesion: flat or raised, typical or atypical, presence or absence of fever, presence or absence of mucosal ulcerations, presence or absence of arthralgias, and/or internal organ involvement. Other specific features, such as histologic appearance, immunofluorescence findings, and laboratory changes, are considered. We provide clinicians with an algorithmic, systematic, and logical approach to diagnose the condition of the patients who present with targetoid lesions, and enable them t...

Drug Hypersensitivity and Anaphylaxis in Cancer and Chronic Inflammatory Diseases: The Role of Desensitizations Authors: Castells M. Abstract Drug allergy is a rising problem in the twenty-first century which affects all populations and races, children, and adults, and for which the recognition, diagnosis, management, and treatment is still not well standardized. Classical and new chemotherapy drugs, monoclonal antibodies (MoAbs), and small molecules to treat cancer and chronic inflammatory diseases are aimed at improving quality of life and life expectancy of patients, but an increasing number of reactions including anaphylaxis precludes their use in targeted populations. Women are more affected by drug allergy and up to 27% of women with ovarian and breast cancer develop carboplatin allergy after multiple cycles of treatment. Carriers of BRCA genes develop drug allergy after fewer exposures and can present with severe reactions, including anaphylaxis. Atopic patients are at inc...