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Objective: To evaluate the risk of IgE sensitization and symptoms to shrimp in a population that has received AIT with polymerized mite extract., Methods: Patients with allergic rhinitis sensitized to dust mites (Dermatophogides spp) with an indication for mite AIT were included. Those patients who had not yet received AIT or had received less than 6 doses were included as controls and those who had received more than 24 doses of AIT were included as cases. Sensitization to shrimp was assessed by skin prick test with complete shrimp extract and/or shrimp-specific IgE., Results: A total of 68 patients were included; 47 cases and 21 controls. When calculating the odds ratio of sensitization according to time with immunotherapy we observed that there were no differences between the group of cases and controls (OR 0.76 95% CI 0.26 to 2.22 p 0.7 by MacNemar technique). Factors such as consumption or not of shrimp and frequency of consumption do not seem to be related to the outcome., Conclusion: In contrast to what was reported with aqueous extracts, we observed that AIT with polymerized extracts is not a risk factor for shrimp sensitization. It is necessary to reproduce these results with a larger sample size to explore other factors.

Objective: This study aimed to identify by in silico methods tropomyosin consensus B and T epitopes of shrimp species, house dust mites, insects, and nematodes associated with allergic diseases in tropical countries., Methods: In silico analysis included tropomyosin from mites (Der p 10, Der f 10, Blo t 10), insects (Aed a 10, Per a 7, Bla g 7), shrimp (Lit v 1, Pen m 1, Pen a 1), and nematode (Asc l 3) all sequences were taken from the UniProt database. Linear IgE epitopes were predicted with AlgPred 2.0 and validated with BepiPred 3.0. MHC-II binding T cell epitopes were predicted using the IEDB server, which implements nine predictive methods (consensus method, combinatorial library, NN-align-2.3, NN- align-2.2, SMM-align, Sturniolo, NetMHCIIpan 3.1, and NetMHCIIpan 3.2) these predictions focused on 10 HLA-DR and 2 HLA-DQ alleles associated with allergic diseases. Subsequently, consensus B and T epitopes present in all species were identified., Results: We identified 12 sequences that behaved as IgE-epitopes and B-cell epitopes, three of them: 160RKYDEVARKLAMVEA174, 192ELEEELRVVGNNLKSLEVSEEKAN215, 251KEVDRLEDELV261 were consensus in all species. Eleven peptides (T-epitopes) showed strong binding (percentile rank ≤ 2.0) to HLA-DRB1*0301, *0402, *0411, *0701, *1101, *1401, HLA-DQA1*03:01/DQB1*03:02, and HLA- DQA1*05:01/DQB1*02:01. Only two T-epitopes were consensus in all species: 167RKLAMVEADLERAEERAEt GEsKIVELEEELRV199, and 218EEeY KQQIKT LTaKLKEAEARAEFAERSV246. Subsequently, we identified 2 B and T epitope sequences and reached a consensus between species 167RKLAMVEA174 and 192ELEEELRV199., Conclusions: These data describe three sequences that may explain the IgE cross-reactivity between the analyzed species. In addition, the consensus B and T epitopes can be used for further in vitro investigations and may help to design multiple-epitope protein-based immunotherapy for tropomyosin-related allergic diseases.

Background: High-dose aqueous subcutaneous immunotherapy is a validated and effective administration route for house dust mite and pollen allergens., Objective: A proof-of-concept study using intradermal immunotherapy (IDIT) with low-dose house dust mite allergens (Dermatophagoides pteronyssinnus/Dermatophagoides farinae [Dp/Df] and Blomia tropicalis [Bt]) was carried out in children with allergic rhinitis symptomatic upon exposure to house dust., Methods: Eight immunotherapy-naïve patients with positive prick skin tests and specific serum IgE to a Dp/Df mixture and to Bt were weekly administered 0.05 mL of an IDIT consisting of a phenolyzed albumin-saline preparation containing low-dose dust mites (8.3 AU [5 ng] of Dp/Df and 2.5 DBU of Bt), for 3 months. Nasal (Total Nasal Symptom Score) and facial symptoms (Visual Analog Scale) were recorded 2 weeks prior to treatment and once weekly during its course. Serial dilutions skin prick tests (1/100-1/1.000.000) and serum allergen-specific IgG4 determinations were performed at baseline and at treatment conclusion., Results: Values on the scales suggested clinical improvement. There was a significant decrease in serial dilutions skin prick tests' wheal diameters, as well as an increase in serum IgG4 values at treatment completion. IDIT was well tolerated., Conclusion: If the present results are confirmed by further studies, allergen-specific immunotherapy wider use could be promoted.

Background: Allergic sensitization is dependent on the geographical and climatic conditions in each region; therefore, identify agents most commonly sensitized children with asthma is important for planning prevention measures., Objective: To determine the prevalence of the sensitization to allergens in children with asthma., Material and Method: This cross-sectional and prolective study includes children from ages 6 to 14, who have asthma, attended for the first time in an allergy service. The patients were recruited consecutively between the months of January 1st 2014 to December 31st 2014. The frequency of the allergen sensitization was estimated., Results: This study included 186 children, the median age was 7 years olds, the male group was 104/186 (55.9%) The median of the positive results was 5 and monosensitized were 47/186 (2.2%). The most common category of allergens was the indoor (90.3%), then trees (71.0%), and finally the fungi (9.7%). Individually, the house dust mites were more common in between the interior allergens, followed by the epithelial; in the tree pollen were oaks (31.7%) and ashes (28.0%), in weeds was mugwort (21.5%), in grasses was Zea mays (18.3%) and in the fungi was Cladosporium spp. (6.5%)., Conclusion: The high prevalence of the sensitization to house dust mites and epithelial in children with asthma, stimulates to implement methods of environmental control for contributing a better control of the disease.

The diagnosis of food allergy requires a proper anamnesis and diagnostic testing with skin prick tests with fresh foods and/or standardized allergen, or specific IgE tests. The risk of systemic reactions is of 15-23 per 100,000 skin tests performed by prick method, specifically anaphylaxis at 0.02%. This paper reports the case of four patients, who while performing prick to prick test with fresh food presented anaphylactic reaction. Implicated foods were fruits of the Rosaceae, Anacardiaceae and Caricaceae families. The severity of anaphylaxis was: two patients with grade 4, one patient grade 2 and one grade 3, all with appropriate response to drug treatment. The risk factors identified were: female sex, personal history of atopy, previous systemic reaction to Hymenoptera venom, prior anaphylaxis to prick tests to aeroallergens. We found that a history of positive skin test for Betulla v, can be a risk factor for anaphylaxis in patients with oral syndrome. During testing prick to prick with food anaphylaxis can occur, so it should be made with aerial red team on hand. The history of positivity Betulla v is an additional risk factor in these patients.

Background: Mites are the most common cause of respiratory allergy. Sensitization to house dust mites is estimated at 30%. Families Euroglyphus and Dermatophagoides, are the most important. Recently, storage mites, from the families Acaridae and Glyciphagidae, have become more important as a cause of allergic respiratory diseases., Objective: The aim of this study was to identify sensitization to house dust and storage mites by skin tests in adult patients with allergic respiratory diseases., Methods: This is a descriptive study in patients with asthma and/or allergic rhinitis, with the approval of the local research committee 2009-3601-46. Patients underwent skin prick tests, with seven standardized extracts of mites (IPI ASACR). The results were analyzed with descriptive statistics., Results: A total of 150 patients, 109 women and 41 men, with an average age 31 years (±11) were studied. The more common allergic diseases in this group of patients were: asthma and rhinitis 72 and 26%, respectively, and asthma plus rhinitis 3.2%. Positive skin tests for Dermatophagoides pteronyssinus and Dermatophagoides farinae were 82.1% 71.5%, respectively, and for storage mites: A. siro 51.7%, Tyrophagus 47.4%, Glycyphagus 47.7%, B. tropicalis 39.7% and Lepidoglyphus 39.1%. Storage mites produced greater sensitization than house dust mites, 32% vs 10%., Conclusions: The results show that adult patients with respiratory allergy, in southern Mexico City, have a higher rate of sensitization to storage mites than the one reported in the literature.

Background: Allergic diseases constitute a worldwide health problem and mites are among the main etiological agents., Objective: To characterize the sensitization to the mites Dermatophagoides pteronyssinus, Dermatophagoides siboney, and Blomia tropicalis, by skin tests in a children allergic sample from Cuba., Methods: This is a descriptive transversal investigation that included 103 allergic children, with ages ranging from 3 to 15 years, who underwent skin prick tests with D. pteronyssinus, D. siboney, and B. tropicalis allergenic extracts. For the analysis of the results, sex, place of residence and degree of exposure to house dust were considered., Results: The greater sensitization was to D. pteronyssinus (36,9%), followed by D. siboney (35%) and B. tropicalis (33%). The greater geometric mean of the wheal diameter was 5,14 mm for D. pteronyssinus (IC95%: 4.52-5.76 mm); 4.82 mm for D. siboney (IC95%: 4.22-5.43 mm) and 4.25 mm for B. tropicalis (IC95%: 3.93-4.58 mm). Fifty six children (54.3%) were not sensitive to none of the three mites. In 45.7% we found sensitization at least to one mite, and 21.4% were sensitive to the three mites. There were no significant differences (p >0.05) in the sensitization according to sex, place of residence and degree of exposure to house dust. The percentage of sensitive patients with rhinitis plus asthma was more significant (p < 0.001), and in them, the geometric mean of the wheal diameter was significant for D. pteronyssinus (p=0.028) and D. siboney (p=0. 027)., Conclusions: A third of our studied child population, residing in a non-industrialized tropical area, presented sensitization to one or some of the three tested mites. There was a different pattern of sensitization with mites in relation to gender. Patients with asthma plus rhinitis showed more sensitization concerning the number and intensity of the skin tests.

Background: Skin tests for specific diagnosis of allergies require high quality extracts, which can be measured by the determination of allergenic potency, utilizing different concentrations of extracts from a manufacturer., Objetive: To compare allergenic mite extracts manufactured by laboratories in Spain, Argentina, and Cuba by skin prick test response., Methods: A cutaneous puncture was performed on 56 patients aged 2 to 15 years with asthma and allergic rhinitis with extracts of Dermatophagoides pteronyssinus (Dp), Dermatophagoides farinae (Df), Dermatophagoides siboney (Ds) and Blomia tropicalis (Bt) produced by DIATER (Argentina), ALK- AbellÛ (Spain) and BIOCEN (Cuba)., Results: In 84.6% of patients there was an association of symptoms with seasonal changes and house dust exposure. The diameter of wheals from ALK allergen extract was larger than extracts from other sources, but without any significant difference (p > 0.05). The ratio between wheals and allergen concentration with BIOCEN products showed lineal dependence between the diameter averages and the concentration logarithm, ranging from 4000 to 100 000 UB/mL. The skin prick tests with diameters =3mm showed a larger proportion of Dp and Df from ALK in comparison to BIOCEN and DIATER., Conclusions: We found that dust mite extracts produced and standardized by DIATER, ALK-Abello and BIOCEN were similar with respect to allergenic potency.

Background: Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998., Objectives: To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system., Methods: The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related to the questions and grading of its quality according to GRADE., Results: Based on the regional consensus, 116 articles and the safety, patient acceptance/ comfort and cost clinical recommendations and suggestions were developed on basic aspects of skin testing, subcutaneous and sublingual immunotherapy (patient preparation, vial preparation and application schedules) and the treatment of eventual adverse reactions., Conclusions: A clinical guideline was developed respecting particular methodology, validated by CMICA and COMPEDIA for its implementation among Mexican allergists. Several aspects deserve further study to improve scientific evidence., Keywords: Allergen immunotherapy, subcutaneous immunotherapy, sublingual immunotherapy, skin testing, allergy diagnosis, rhinitis, asthma, atopic dermatitis, house dust mite, pollens, anaphylaxis, adrenaline, Mexico.

Background: House dust mites are important airborne allergens worldwide, particularly in the tropical environment., Objective: To assess sensitization of allergic patients to different mite species in the Cuban city of Camaguey; as well as to compare standardized allergen extracts from different sources by skin prick tests., Patients and Method: Skin prick tests were performed in 60 patients with asthma and/or allergic rhinitis and in 60 non-allergic volunteers, ranging from 2 to 76 years old. In both groups, Diater-Prick lancets were used, together with Valergen extracts (Biocen, Cuba) at 20,000 BU/mL and Diater extracts (Argentina) at 50,000 UBE/PNU/mL., Results: The highest values of sensitization prevalence using Diater extracts were seen in Dermatophagoides pteronyssinus (Dp), Dermatophagoides farinae (Df), and Blomia tropicalis (Bt) in allergic patients and in non-allergic controls. Diagnostic sensitivity values were: Dp, 79; Df, 84; Bt, 84 and B. kulagini, 83%. Specificity varied from 72 to 85%. On the other hand, with Biocen extracts, the highest positivity was noted in Dp and D. siboney (Ds). Sensitivity values were 78% (Dp); 78% (Ds) and 82% (BT). Specificity values ranged from 79 to 82%., Conclusions: The standardized allergen extracts from the assessed laboratories induced similar values of sensitivity and specificity.

Background: Sensitization to three allergic mite species (Dermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis) from house dust in Cuba has been reported in different studies., Objective: To assess allergic sensitization to these mites in a north coast area of Havana city., Patients and Methods: A total of 210 allergic patients were selected, classified in two groups: from 1 to 14 years, and from 15 to 55 years. Skin Prick Test (SPT) was performed on all patients using standardized allergenic extracts VALERGEN-BT (B. tropicalis), VALERGEN-DS (D. siboney) and VALERGEN-DP (D. pteronyssinus) manufactured by BIOCEN, Cuba. The test was considered positive when the average wheal diameter was greater or equal to 3 mm., Results: Both groups showed higher sensitization to D. pteronyssinus (>78%), while for the remaining mites it was below 60%. In patients older than 14 years, the sensitization was apparently higher, although not statistically significant (p > 0.05). Nevertheless, the skin reactivity in this group was significantly greater (p < 0.05) for the three allergens. Unusually, mean wheal size in both groups was significantly superior toward B. tropicalis (p < 0.05)., Conclusions: In spite of being D. pteronyssinus the mite showing the highest sensitization, Blomia tropicalis showed to be also an important aeroallergen with more than 50% sensitization and greater skin reactivity. Therefore, in our population it would be advisable to perform SPT with the three mites extracts, simultaneously and to combine it in allergen-specific immunotherapy.

Environmental fungi, moulds and yeasts could reach the nasal cavity with the inhaled air causing respiratory symptoms in atopic subjects, but little is known about the fungal flora of this site. In the present study samples of the nasal cavities of 135 subjects aged 18-35 years (48 allergic patients to fungi, mites and/or cat fur and from 87 normal subjects--healthy, control group) were cultured. All of them lived in the metropolitan area of Barcelona. Fungi were isolated from 41.5% of healthy people and in 14.8% of allergy patients (p = 0.011). Morphologically, 50.4% of the isolates were located within 4 genera: Cladosporium, Penicillium, Aspergillus and Alternaria, fungi which are considered the most allergenic. The most prevalent species were: Cladosporium herbarum and C. cladosporioides (23.6%). Alternaria alternata was isolated only in 8.8% of samples from the allergic group, although most subjects were sensitive to this species. There were not differences in the isolation rate between genera and smoking-no-smoking groups. The lower prevalence of nasal fungi from allergic patients could be related to the nasal insufficiency, the hypersecretion and the larger use of handkerchiefs.

Background: It has been demonstrated that specific immunotherapy, in addition to its preventive properties, is an effective and safe therapeutic resource for allergic asthma, allergic rhinitis and allergy to insect's venom; however, its use in patients younger than five years has been limited due to the risk of systemic reactions., Objectives: To know the frequency and severity of systemic reactions in children younger than five years and to know if a greater risk of systemic reactions in this group of age is real., Patients and Methods: We included 239 patients from one to five years of age with diagnosis of allergic disease and verified its specific sensitivity with skin tests or RAST and were treated with specific immunotherapy. A detailed registry of the application of specific immunotherapy was kept from every patient, with special attention to any symptom present during the first 30 minutes post application of specific immunotherapy or skin test., Results: From January 1996 to June 2005, 6,689 injections were applied to 239 patients. Only one patient of 36 months of age presented with a delayed systemic reactions characterized by generalized hives, itching, runny nose, water eyes, 90 minutes post injection. The patient was under treatment with Dermatophagoides farinae and pteronissinus (house dust mites) with a dose of 1AU for allergic rhinitis. The systemic reactions were treated easily and without complications with a single dose of intramuscular epinephrine (0.15cc, 1:1000) and oral antihistamine., Conclusion: Patients younger than five years are not in greater risk of systemic reactions from specific immunotherapy or skin tests than the older children or adults and the treatment of those systemic reactions does not imply greater difficulty. Because of its preventive properties, safety and effectiveness in lowering the severity of symptoms of allergic diseases, we concluded that specific immunotherapy should be considered at early age, prescribed and administered only by specialist in pediatric allergy and in optimal conditions of safety.

Background: The continuous exposure to high levels of environmental allergens, as dust mite, gets worse the reactivity of the airways as mentioned in previous studies. In other international studies, it has been determined the levels of house dust mite antigen needed to sensitize asthmatic patients, but few studies in Mexico have measured the concentration of house dust mite antigen before the initial treatment and correlated the sensitization to it with the levels of total IgE and the skin test., Objective: To determine the minimum concentration of house dust mite antigen required to sensitize patients with asthma at the Distrito Federal and if it exists a correlation between the different concentration of the antigen, the results of the skin test and the total IgE., Material and Methods: Thirty patients with asthma and positive skin test to Dermatophagoides pteronyssinus took part in the study. We made a home visit to measure the concentration of Der p2 and Der f2 in house dust and we scheduled a visit at our hospital to measure the IgE total level. We did a statistical analysis with the chi square test and the correlation coefficient of Pearson and we found that the lower level needed to sensitize was 0.2 micrograms of antigen per gram of house dust. It did not exist a correlation between the total IgE levels and the concentration of the mite antigen., Conclusion: To a higher level of the house dust mite antigen we found more sensitization to it, as shown by the skin test but without direct relation with the total IgE levels in patients with asthma.

Background: Sublingual immunotherapy is based on the treatment of distinct pathologies. It is not exempt from discomfort and hazards; thus, alternative approaches for therapy are being tested., Objective: To assess the effectiveness of sublingual immunotherapy, with Dermatophagoides pteronyssinus in asthmatic children., Material and Methods: Fifty pediatric patients of both sexes between 5 and 15 years were randomly divided into two groups. The first group received sublingual immunotherapy with Dermatophagoides pteronyssinus in concentrations of 500, 1000, 2000, 5000, 8000 and 10,000 biological units. Both groups received conventional therapy, and spirometry and total IgE were measured every 30 days. The use of bronchodilators and steroids was assessed before and during the test., Results: Peak expiratory flow improved in the study group with a remarkable difference (p < 0.05). There were not significant differences in the control group (p > 0.05); however, at the end of the study an increase of 80% was observed. In urgency services, patients who received immunotherapy had relative risk (RR) = 0.36 and confidence interval (CI) of 95%, 0.15, 0.84. The use of steroids equally decreased in patients receiving immunotherapy RR = 0.27, CI 95%, 0.10, 0.69., Conclusions: Sublingual immunotherapy does reduce the risk for asthma episodes in children.

Allergic diseases are triggered when individuals genetically predisposed to developing an allergy (atopy) are exposed to sensitizing allergens. These allergens are captured and processed by antigen-presenting cells (APC) which presents them to T lymphocytes. Some of these allergens have a significant influence on the development of this type of disease and cause most of the symptoms in allergic individuals around the world. They are found in the feces of house dust mites, which have diverse and varied origin in several species, for example the Blomia tropicalis (Bt) mite. In Cartagena (Colombia), this highly prevalent mite has been a central object of study by the Institute of Immunological Research of the University of Cartagena, where several of its allergens have been cloned, sequenced and expressed as recombinant allergens. Moreover, their capacity to bind to IgE and the frequency of this process has been studied. The aim of the present study was to analyze the lymphoproliferative response of peripheral blood mononuclear cells (PBMC) in healthy and allergic individuals to one of the recombinant allergens of B. tropicalis, BtM. This response was studied in PBMC from six patients with allergy to Bt (positive cutaneous test to Bt extract), using a cellular proliferation technique, with incorporation of 3H thymidine at days 3 and 6 days of culture, and at three different concentrations of BtM. Notable among the results was the high proliferation produced by cells from patient JF018 at 3 days of stimulus (41.7 IE), with the lowest concentration of protein (100 microg/mL). Moreover, in all the experiments this concentration was the cause of most of the cell proliferation. In addition, some response to control LAC012 against glutathione-S-transferase (GST) was induced. In conclusion, the results of the present study demonstrate that the recombinant allergen BtM is able to induce a cellular response in the PBMC of patients allergic to Bt. Moreover, it is able to induce a response similar to that produced by natural allergens, because its pattern of response is similar to that shown by cells stimulated with Bt extract. These results also show that a process of anergy can be produced in cells when excess antigen is present. In some individuals (both allergic and nonallergic), GST is able to cause a proliferative response, indicating its sensitizing potential in these individuals.