Diana Andrea Herrera-Sánchez

OBJECTIVE:To identify the most common endotypes of chronic spontaneous urticaria, as well as the association between disease control and activity according to endotype, at a tertiary care hospital.METHODS:Analytical, observational, cross-sectional, and retrospective studies were conducted in patients older than 18 years with chronic spontaneous urticaria at a tertiary care hospital. Patient characteristics and endotypes were described, and their relationship with disease activity and control was assessed using the UAS7 (Urticaria Activity Score 7) and UCT (Urticaria Control Test). Statistical analysis included linear-by-linear chi-square and bivariate logistic regression analysis.RESULTS:A total of one hundred patients were included, with a mean age of 52 years (SD 13.8); 78% were women. The predominant endotypes were autoallergic (37%), autoimmune (34%), mixed (11%), infectious (7%), combined (8%), and idiopathic (3%). The most frequent comorbidities were systemic arterial hypertension (29%), obesity (32%), hypothyroidism (21%), and allergic rhinitis (24%). No significant differences were found in treatment, disease activity, or disease control according to endotype, nor was there any association with IgE levels or angioedema.CONCLUSIONS:Chronic spontaneous urticaria is a complex and heterogeneous disease. Autoimmune endotypes (Type I and Type IIb) were the most common. These findings highlight the need for longitudinal studies with larger sample sizes and the integration of additional biomarkers to identify more precise predictive profiles.

Background: Common variable immunodeficiency (CVID) is a heterogeneous disorder characterized by defective antibody production and impaired differentiation of B cells. B cell proliferation is an essential step for antibody synthesis. Depending on the nature of the stimulus, their response may be either T-cell-dependent or T-cell-independent. Methods: We studied 23 CVID patients and 14 healthy donors (HD). The patients were categorized based on their percentage of memory B cells. In addition to standard immunophenotyping of circulating human B and T cell subsets, an in vitro CFSE dilution assay was used to assess the proliferative capacity of B cells and to compare the activation of the T cell-dependent and T cell-independent response among the patients. Results: Patients with a reduction in memory B cells exhibited an increase in follicular T cells (Tfh) and showed low proliferation in response to PKW, CpG, and SAC stimuli (Condition II) (p= 0.0073). In contrast, patients with a normal percentage of memory B cells showed a high expression of IL-21R and low proliferation in response to CPG (Condition III); IL-21, CD40L, and anti-IgM (Condition IV) stimuli (p= 0.0163 and p = 0.0475, respectively). Conclusion: Defective proliferation in patients depends on the type of stimulus used and the phenotypic characteristics of the patients. Further studies are necessary to understand the disease mechanisms, which may guide us toward identifying genetic defects associated with CVID.

Hasta el 25% de los pacientes con inmunodeficiencia común variable (IDCV) debutan con autoinmunidad, la cual guarda relación con la clasificación de Freiburg, que se basa en la citometría de flujo. determinar la frecuencia y tipo de enfermedades autoinmunes y su asociación con la clasificación de Freiburg en adultos con IDCV. se realizó un estudio transversal, analítico y observacional con 33 pacientes pertenecientes a la Clínica de Inmunodeficiencias Primarias de un hospital de tercer nivel con diagnóstico de IDCV. Se dividieron en tres fenotipos según la clasificación de Freiburg. de los 33 pacientes estudiados, el 66.6% presentó enfermedades autoinmunes, de ellos 19 (86.3%) tuvieron citopenias. El 42.1% se clasificó en el grupo Ia de Freiburg, el 36.8% en el grupo Ib y el 21% en el fenotipo II. En el 36.6% de los pacientes las citopenias autoinmunes fueron la primera manifestación de IDCV, y hasta el 70% de ellos pertenecen al fenotipo Ia de Freiburg (p = 0.086). Los pacientes con citopenias autoinmunes tuvieron un menor porcentaje de células B de memoria con cambio de isotipo (p = 0.018), sin mayor porcentaje de células B CD21^low (p = 0.226). la clasificación por fenotipos en IDCV permite identificar el perfil del paciente y el tipo de manifestaciones asociadas, lo que es útil para buscar de manera intencionada complicaciones no infecciosas propias de la enfermedad.

El síndrome polen-alimento (SPA) se caracteriza por la sensibilización alérgica a proteínas de pólenes de pastos, malezas y árboles, que producen una reacción de hipersensibilidad de tipo I, asociada a la ingesta de alimentos derivados de plantas, usualmente en forma cruda. Las familias de proteínas que más frecuentemente están asociadas son las profilinas, las PR-10 y las ns LTP; sin embargo, se ha documentado otras, como las taumatinas, isoflavonas reductasas y las B1,2 gluconasas. El síndrome prototipo es el abedul-frutas-vegetales, y de ellos el más común es el abedul-manzana, debido a que más de 70 % de los pacientes sensibilizados al abedul presentan síntomas asociados a la ingesta de alimentos derivados de plantas. Los síntomas están restringidos a la cavidad oral; sin embargo, algunos pacientes pueden presentar síntomas sistémicos, incluso anafilaxia, por lo que es importante identificar el tipo de proteína implicada, ya que de eso depende el tipo de reacción que puede presentar el paciente. Pese a todo, se considera una entidad que puede estar subdiagnosticada debido a su valoración y tratamiento complejos, debido a que el procedimiento en la mayor parte de los casos es dieta de eliminación, ya que aún no está disponible el tratamiento con inmunoterapia. El objetivo de esta revisión es describir la fisiopatología, así como los síndromes polen-alimento más comunes.

In the article titled “Partial and Transient Clinical Response to Omalizumab in IL-21-Induced Low STAT3-Phosphorylation on Hyper-IgE Syndrome” [1], authors Mario Alberto Ynga-Durand and Julio César Alcántara-Montiel were affiliated to “Universidad Nacional Autónoma de Mexico, Facultad de Estudios Superiores Zaragoza, Facultad de Medicina, Mexico,” which is incorrect.

Background: Chronic urticaria (CU) affects 5 % of the general population and it is associated with thyroid disease in up to 54 % of patients. There is scarce information on the activity of urticaria in patients with and without alterations in the thyroid function.Objective: To compare the activity rate of urticaria using the UAS7 (Urticaria Activity Score 7) in patients with and without hypothyroidism.Methods: A descriptive, cross-sectional, and comparative study of patients with CSU (chronic spontaneous urticaria) who were older than 18 years of age, who were classified into two groups based on their thyroid function: hypothyroid and euthyroid patients. UAS7 was applied to all of them. Results: We analyzed 60 patients with CSU; 30 of them were euthyroid and 30 were hypothyroid. The female sex was predominant (76 %) and the average age was 49.1 years old. The activity in 40 % was moderate, in 25 % was severe, and it was mild in 23 %; only 12 % of them were controlled. In the group with hypothyroidism, the median TSH (Thyroid Stimulating Hormone) was of 6.8 μUI/mL. No statistically significant differences were found in matters of age, body mass index, comorbidities, or in the UAS7.Conclusions: We did not find a statistically significant difference in the Urticaria Activity Index between both groups. Identifying the influencing factors shall improve the quality of life of patients.

Background: The diagnosis of asthma is confirmed with a spirometry: FEV1 ratio (forced expiratory volume in one second)/FVC (forced vital capacity) 12% or 200 mL) after using salbutamol. The peak expiratory flow is cheap and easy to use; it measures the forced expiratory flow, of which reversibility > 20% suggests asthma.Objective: To know the sensitivity, specificity, and the positive and negative predictive values of the flowmeter.Methods: A cross-sectional, observational, comparative study. Individuals aged >18 years without contraindications for spirometry were included. They underwent spirometry and peak expiratory flow, and the ACT (Asthma Control Test) questionnaire was applied to them. Sensitivity, specificity, positive predictive value and negative predictive value of the flowmetry were calculated. ROC curve was carried out in order to know the cut-off point of greater sensitivity and specificity.Results: Of 150 patients, 66% were male; the median age was 38 years. According to the guidelines of GINA 2018 (Global Initiative for Asthma); 58.7% were controlled. The sensitivity of the peak expiratory flow was 47%, and the specificity was 87%, with a positive predictive value of 54.8% and a negative predictive value of 84%. The peak expiratory flow showed higher specificity with FEV1 <59%. The cut-off point of greater sensitivity and specificity was a reversibility of 8%, with an area under the curve of 0.70.Conclusions: The flowmeter has got greater sensitivity in airway obstructions; it is useful when a spirometer is not available.

Background: Contact dermatitis is an eczematous skin reaction that is caused by repeated and direct exposure to an allergen: The prevalence of contact dermatitis to nickel is estimated at 17% in women and 3% in men, and 1-3% of the general population has allergic contact dermatitis to cobalt and chromium. Nickel, which is the leading cause of occupational dermatitis, shows reactivity to other metals; mainly chromium and cobalt.Clinical case: A 47-year old man, with previous sensitization to nickel in childhood, is a worker in the metal industry, with occupational exposure to nickel and cobalt, and showed dermatosis predominantly in the upper limbs.Conclusion: The risk of new sensitizations to metals (such as cobalt) has been increased by his previous sensitization to nickel that happened in childhood and his work in the metal industry.

Background: There is limited epidemiological information on the treatment of atopic dermatitis (AD) from specialist physicians in Mexico.Objective: To know the criteria that is used by specialists in Mexico to diagnose and treat AD.Methods: An observational, descriptive and cross-sectional study, which was authorized by the ethics committee, was carried out through an electronic survey.Results: 114 surveys were carried out; 56% of the participants were allergists, 38% were dermatologists and 5% were pediatricians. It was identified that 54% used clinical criteria for the diagnosis of AD and 42% used the criteria of Hanifin-Rajka as a diagnostic complement; 38% requested total and/or specific IgE, blood biometry and blood chemistry tests. They recount that 90% of patients under the age of 18 had mild AD, 8% had moderate AD and 2% had severe AD; and, in patients over the age of 18, 89% had mild AD, 6% had moderate AD and 5% had severe AD. The patients’ care was multidisciplinary, since 57% of the survey respondents requested assessments combined with ophthalmology, dermatology and allergology.Conclusion: Knowledge of the disease will lead to a better control of the disease. The challenge is to have a patient registry, update treatment guidelines, consider comorbidities and have therapeutic options for its control.