Rafael Durán

Background: Allergic respiratory diseases, primarily asthma and allergic rhinitis, affect hundreds of millions worldwide. Their rising prevalence reflects complex gene–environment interactions that the exposome framework organizes into external, internal, and social domains shaping the development and progression of respiratory allergic diseases. Methods: Narrative review based on structured searches in PubMed/MEDLINE and Scopus (2015–2025), supplemented with 11 key references; 42 publications were selected from 1015 records. Results: Air pollution showed consistent but modest associations with asthma (HR 1.04–1.12); household dampness and mold showed larger effect sizes on symptom severity (OR 1.48–1.52); and occupational exposures showed the largest effect sizes across studies (RR 3.2–4.3). Systemic inflammation, oxidative stress, and nasal microbiome alterations were identified as internal mediators linking exposures to allergic phenotypes, though mechanistic pathways remain incompletely defined. Social exposome studies suggested context-dependent patterns: socioeconomic advantage correlated with greater sensitization in some settings, while deprivation could amplify disease progression and mortality risk (HR 1.18–1.32). Conclusions: The exposome offers a valuable integrative framework, but clinical translation is limited by scarce longitudinal multi-exposure studies and underrepresentation of low- and middle-income regions. Priorities include life-course cohorts integrating all three domains and targeted interventions in housing and occupational settings.

Background: Respiratory allergic diseases are experiencing changes influenced by genetic factors, environmental shifts, and social and demographic elements. These evolving patterns, together with rapid advances in diagnosis and treatment, require a thorough review of emerging trends. Objective: To examine future directions in managing respiratory allergic diseases, focusing on changing disease patterns, environmental factors, diagnostic innovations, and therapeutic advances toward precision medicine. A literature search was conducted in PubMed and Scopus databases covering 2015–2025. Studies addressing human populations with allergic rhinitis or asthma were included, emphasizing emerging patterns, environmental factors, diagnostic technologies, and therapeutic innovations, while reviews, conference proceedings, case reports, and studies without clinical relevance were excluded. Initial screening identified 52 studies, and 21 additional studies were identified through complementary searches, resulting in 73 studies in the final analysis. Summary of findings: Climate change is a key factor affecting disease patterns, with pollen seasons starting 10–40 days earlier and yearly emissions increasing by up to 200%. Regarding pathogenesis, early-life rhinovirus C infections with IgE sensitization significantly increase asthma risk (HR = 4.06), while severe asthma shows 40–84% eosinophilic patterns, depending on the assessment approach. On the diagnostic front, advances include multiplex platforms, proteomic biomarkers, and microRNAs. Therapeutically, innovations encompass biologics combined with allergen immunotherapy, nanobody-based therapeutics, and microbiota interventions. Conclusions: These developments point toward personalized management of respiratory allergic diseases. However, challenges remain in research with underrepresented populations and accessibility. Moving forward, the key priority is integrating this diverse knowledge into practical strategies that advance precision medicine in respiratory allergic diseases.

Background: Accurate identification of respiratory allergen sensitization is essential for managing asthma and allergic rhinitis (AR). While Skin Prick Test (SPT) and ImmunoCAP are standard diagnostic tools, exploratory comparative data for the novel Allergy Explorer 2 (ALEX‐2) test in Latin American populations remain scarce. While Skin Prick Test (SPT) and ImmunoCAP are standard diagnostic tools with limited allergen panels per test, the novel Allergy Explorer 2 (ALEX‐2) multiplex platform can simultaneously assess multiple allergens. However, exploratory comparative data for ALEX‐2 in Latin American populations remain scarce. Methods: This prospective cross‐sectional study evaluated the concordance between SPT, ImmunoCAP, and ALEX‐2 in detecting respiratory allergen sensitization among 57 patients with asthma or AR recruited consecutively from a private allergy clinic in Lima, Peru. Concordance was assessed using Cohen's κ coefficient. Results: The highest overall agreement was observed between ALEX‐2 and SPT ( κ = 0.5649, p < 0.0001), followed by ALEX‐2 and ImmunoCAP ( κ = 0.4911, p < 0.0001), and ImmunoCAP and SPT ( κ = 0.4688, p < 0.0001). ALEX‐2 and ImmunoCAP aligned on 7 of 10 allergens, while both ImmunoCAP and SPT, as well as ALEX‐2 and SPT, agreed on 5 of 9 allergens. The strongest concordance was found for dust mites, particularly Dermatophagoides farinae ( κ = 0.6323, p < 0.0001) between ALEX‐2 and SPT. Conclusions: ALEX‐2 demonstrates moderate agreement with SPT and ImmunoCAP, with the highest concordance for dust mites, suggesting potential as a complementary diagnostic tool pending validation in diverse populations.

Antecedentes: La anafilaxia inducida por el ejercicio dependiente del trigo es una alteración excepcional, potencialmente mortal, desencadenada por el consumo de trigo después de realizar alguna actividad física. Reporte de caso: Se informan dos casos de pacientes adolescentes de Lima, Perú, diagnosticados con anafilaxia inducida por el ejercicio dependiente del trigo mediante pruebas de punción cutánea y el microarray Allergy Explorer 2 (ALEX-2), donde se identificó gliadina omega-5 (Tri a 19) como alérgeno principal. Aunque ambos pacientes tuvieron episodios de anafilaxia, solo uno requirió la administración de adrenalina. Conclusión: Es importante establecer el diagnóstico de anafilaxia inducida por el ejercicio dependiente del trigo mediante pruebas moleculares para confirmar la enfermedad y llevar a cabo estrategias preventivas (evitar el consumo de trigo antes de cualquier actividad física) y planes de emergencia. Los casos expuesto en este artículo subrayan la necesidad de tener mayor conciencia clínica y mejor acceso a intervenciones para salvar vidas en regiones con recursos y accesos limitados. Palabras clave: Anafilaxia; Hipersensibilidad al trigo; Alergias inducidas por actividad física; Perú; Gliadina omega-5; Alérgeno; Diagnóstico por métodos moleculares; Adrenalina.

Background/Objectives: Recurring infections in children with allergies pose significant clinical challenges, with these conditions often exacerbating each other through complex immunological interactions. This narrative review examines the connection between recurring infections and allergic conditions in pediatric patients, focusing on how immune system dysfunction influences infection susceptibility in respiratory allergies. Methods: A comprehensive literature search across PubMed, Web of Science, and SciELO databases was conducted from January 2014 to May 2024. Studies involving children and adolescents up to 18 years old with diagnosed respiratory allergies were included, while reviews, opinion pieces, case reports, and studies not addressing immune–infection interactions were excluded. Results: Analysis reveals significant immune dysfunction in allergic children, affecting both innate and adaptive immunity components. Children with allergic rhinitis and asthma demonstrate decreased interferon-gamma production, increasing vulnerability to viral infections (particularly rhinovirus) and bacterial infections such as Mycoplasma pneumoniae. Rhinovirus represents the most common pathogen, present in 75% of asthma exacerbations. Atopic children exhibit markedly higher bacterial infection rates, with 27.1% showing Mycoplasma pneumoniae involvement versus 4.9% in non-atopic children. Conclusions: Recurring infections in allergic pediatric patients result from significant immune dysfunction involving altered cytokine production and immune cell function. These complex interactions highlight the need for targeted therapeutic approaches that enhance immune responses and reduce infection risks. Future research should focus on identifying specific biomarkers and immune mechanisms for developing more effective interventions.

Background. The Peruvian Immunoblot panel, together with traditional skin prick tests (SPT), are widely used in vitro allergy tests in Peru. In addition to this, Peruvian allergists are increasingly adopting multiplex tests such as the ALEX‐2 (Macro Array Diagnostics). Previous studies have revealed limited agreement between Immunoblot and SPT results. Therefore, our study aimed to evaluate the concordance between these three tests in patients with allergic rhinitis (AR) in a private center in Arequipa, Peru. Materials and Methods. We enrolled 35 patients, including children over 3 years and adults, with AR. Clinical and demographic data were collected, and patients underwent allergic sensitization testing using the Immunoblot Peruvian panel (32 allergens), ALEX‐2 (295 allergens), and SPT (12 allergens). Concordance was calculated using Cohen’s kappa coefficient and analyzed with IBM SPSS V26. Results. Among the patients, 34.3% exhibited moderate‐to‐severe persistent AR, and 14.3% had asthma. Additionally, 85.7% reported a family history of AR. Sensitization rates varied notably between the SPT and ALEX‐2, particularly for olive pollen (34.3% vs. 17.4%), Blomia tropicalis (11.4% vs. 17.1%), and grasses (11.4% vs. 28.5%). Remarkably, these allergens were not included in the Peruvian Immunoblot panel. Concordance analysis included seven allergens and showed significant concordance between ALEX‐2 and SPT for five allergens, between Immunoblot and SPT for two allergens, and between ALEX‐2 and Immunoblot for two allergens. Conclusion. This preliminary study shows us a better concordance between ALEX‐2 and SPT rather than between Immunoblot and SPT.

El objetivo fue caracterizar el contenido de sodio en preparaciones de consumo frecuente fuera del hogar en tres zonas de Lima Metropolitana. Se realizó un estudio transversal para el cual se identificaron veinte preparaciones de consumo frecuente según el lugar de expendio. La determinación del contenido de sodio se obtuvo mediante espectroscopía de absorción atómica en preparaciones recolectadas en el 2019. La mediana del contenido de sodio en productos de venta ambulatoria fue 492,36 mg/100 g (RIQ: 83,93 - 918,78); 471,37 mg/100 g, en preparaciones tradicionales y típicas (RIQ: 76,04 - 765,39); y 471,06 mg/100 g (RIQ: 115,31 - 695,18), en comidas rápidas. El 65% de las preparaciones fueron consideradas altas en sodio según los parámetros peruanos, mientras que el 30% de las preparaciones también presentaron un alto contenido, de acuerdo con los parámetros del Reino Unido. La mayoría de las preparaciones expendidas y consumidas fuera del hogar presentan un elevado contenido de sodio. Es esencial involucrar a todos los actores que participan en la preparación de alimentos para el consumo fuera del hogar, con el fin de sensibilizarlos e incluirlos en la promoción de políticas enfocadas en la reducción delconsumo de sodio.

Introduction: Anemia is a condition in which there is a low concentration of hemoglobin (Hb) levels. Although many causes of anemia have been identified, there are few studies in which they are related to epidemiological factors in the first months of life. Objective: To determine the factors associated with hemoglobin levels in children under 6 months of age hospitalized in a specialized pediatric center in Peru. Methods: To determine the factors associated with hemoglobin levels in children under 6 months of age hospitalized in a specialized pediatric center in Peru. Results: 61.4% of the infants were women, and only 6.7% of the proportion of the studied population was less than 1 month old. 6.7% had a low birth weight, and 53.2% had a normal delivery. The level of anemia in hospitalized children under 6 months of age is 66.7%.. Conclusions: The factors associated with hemoglobin levels were age, nutritional status, weight for length, and hospital causes. Likewise, an association was found between age and the median Hb in boys and girls aged 0 to 5 months.

Ensayos sobre la pandemia reúne las experiencias y miradas de cinco destacados profesionales quienes, desde sus distintas áreas, reflexionan sobre las consecuencias personales de la pandemia. El escritor Juan Manuel Chávez y su testimonio desde la perspectiva del difícil reencuentro de un limeño residente en España, con su caótica ciudad natal en plena pandemia; la docente Giancarla Di Laura nos revela sobre el impacto que ha sido para las mujeres la propagación del Covid 19, siendo durante el confinamiento el período más terrible en el incremento de sus obligaciones y sobre exigencias físicas, mentales y emocionales; el educador venezolano Félix José Colina nos escribe sobre la vida del migrante en plena crisis sanitaria, asumiendo un punto de vista desde los valores humanos y lo espiritual; el comunicador Jorge Paredes Laos, explica sobre la obligada reinvención del ejercicio periodístico, para así lograr sobrevivir en medio de la más fuerte crisis mundial de la historia moderna; y Rafael Duran Galdo, ganador del concurso de ensayos sobre la pandemia convocada por nuestra universidad, hace un análisis crítico desde la fragmentación del sistema sanitario y la importancia de la revalorización de las ciencias sociales, con el fin de crear políticas públicas que promuevan un cambio en la salud de acuerdo con cada realidad y contexto histórico.