Caracas, Venezuela
Caracas, Venezuela

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D'Amato G.,High Specialty Hospital A Cardarelli | D'Amato G.,University of Naples Medical School | Holgate S.T.,University of Southampton | Pawankar R.,Nippon Medical School | And 37 more authors.
World Allergy Organization Journal | Year: 2015

The prevalence of allergic airway diseases such as asthma and rhinitis has increased dramatically to epidemic proportions worldwide. Besides air pollution from industry derived emissions and motor vehicles, the rising trend can only be explained by gross changes in the environments where we live. The world economy has been transformed over the last 25 years with developing countries being at the core of these changes. Around the planet, in both developed and developing countries, environments are undergoing profound changes. Many of these changes are considered to have negative effects on respiratory health and to enhance the frequency and severity of respiratory diseases such as asthma in the general population. Increased concentrations of greenhouse gases, and especially carbon dioxide (CO2), in the atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, variability in temperature, increased air pollution, forest fires, droughts, and floods - all of which can put the respiratory health of the public at risk. These changes in climate and air quality have a measurable impact not only on the morbidity but also the mortality of patients with asthma and other respiratory diseases. The massive increase in emissions of air pollutants due to economic and industrial growth in the last century has made air quality an environmental problem of the first order in a large number of regions of the world. A body of evidence suggests that major changes to our world are occurring and involve the atmosphere and its associated climate. These changes, including global warming induced by human activity, have an impact on the biosphere, biodiversity, and the human environment. Mitigating this huge health impact and reversing the effects of these changes are major challenges. This statement of the World Allergy Organization (WAO) raises the importance of this health hazard and highlights the facts on climate-related health impacts, including: deaths and acute morbidity due to heat waves and extreme meteorological events; increased frequency of acute cardio-respiratory events due to higher concentrations of ground level ozone; changes in the frequency of respiratory diseases due to trans-boundary particle pollution; altered spatial and temporal distribution of allergens (pollens, molds, and mites); and some infectious disease vectors. According to this report, these impacts will not only affect those with current asthma but also increase the incidence and prevalence of allergic respiratory conditions and of asthma. The effects of climate change on respiratory allergy are still not well defined, and more studies addressing this topic are needed. Global warming is expected to affect the start, duration, and intensity of the pollen season on the one hand, and the rate of asthma exacerbations due to air pollution, respiratory infections, and/or cold air inhalation, and other conditions on the other hand. © 2015 D'Amato et al.


Thong B.Y.-H.,Tan Tock Seng Hospital | Mirakian R.,University of Cambridge | Castells M.,Brigham and Women's Hospital | Pichler W.,University of Bern | And 8 more authors.
World Allergy Organization Journal | Year: 2011

Objective: To study the diagnostic and treatment modalities used in drug allergy/hypersensitivity among members of the World Allergy Organization (WAO). Methods: A questionnaire comprising 39 questions was circulated electronically to member societies, associate member societies, and regional and affiliate organizations of WAO between June 29, 2009, and August 9, 2009. Results: Eighty-two responses were received. Skin testing was used by 74.7%, with only 71.4% having access to penicillin skin test reagents. In vitro-specific IgE tests were used by 67.4%, and basophil activation test was used by 54.4%. Lymphocyte transformation tests were used by 36.8% and patch tests by 54.7%. Drug provocation tests were used by 68.4%, the most common indication being to exclude hypersensitivity where history/symptoms were not suggestive of drug hypersensitivity/allergy (76.9%). Rapid desensitization for chemotherapy, antibiotics, or biologic agents was used by 69.6%. Systemic corticosteroid was used in the treatment of Stevens-Johnson syndrome by 72.3%, and high-dose intravenous immunoglobulins in toxic epidermal necrolysis by 50.8%. Human leukocyte antigen screening before prescription of abacavir was used by 92.9% and before prescription of carbamazepine by 21.4%. Conclusions: Results of this survey form a useful framework for developing educational and training needs and for improving access to drug allergy diagnostic and treatment modalities across WAO member societies. Copyright © 2011 by World Allergy Organization.


Borges M.S.,Clinica El Avila | Borges M.S.,Centro Medico Docente la Trinidad | Chacon R.S.,Policlinica Metropolitana | Hulett A.C.,Clinica El Avila | And 5 more authors.
Gaceta Medica de Caracas | Year: 2011

Oral mite anaphylaxis is a new syndrome characterized by severe allergic symptoms occurring in allergic patients immediately after the intake of foods made with mitecontaminated wheat flour. This syndrome, which is more common in tropical environments, is triggered more often by pancakes and for that reason it has been designated "the pancake syndrome". Since cooked foods are able to induce the symptoms, it has been suggested that thermoresistant allergens are involved. A variety of this syndrome can occur during physical exercise (dust mite-ingestion associated exercise induced anaphylaxis). In order to prevent mite proliferation and the production of the clinical picture it is recommended to store wheat flours in the refrigerator.


Jares E.J.,Libra Foundation | Sanchez-Borges M.,Clinica El Avila | Cardona-Villa R.,University of Medellín | Ensina L.F.,University of Santo Amaro | And 9 more authors.
Annals of Allergy, Asthma and Immunology | Year: 2014

Background Epidemiologic drug allergy data from Latin America are scarce, and there are no studies on specific procedures focusing on this topic in Latin America. Objective To assess the clinical characteristics and management of hypersensitivity drug reactions in different Latin American countries. Methods An European Network of Drug Allergy questionnaire survey was implemented in 22 allergy units in 11 Latin American countries to report on consecutive patients who presented with a suspected hypersensitivity drug reaction. Each unit used its own protocols to investigate patients. Results Included were 868 hypersensitivity drug reactions in 862 patients (71% of adults and elderly patients were women and 51% of children were girls, P =.0001). Children presented with less severe reactions than adults and elderly patients (P <.0001). Urticaria and angioedema accounted for the most frequent clinical presentations (71%), whereas anaphylaxis was present in 27.3% of cases. There were no deaths reported. Nonsteroidal anti-inflammatory drugs (52.3%), β-lactam antibiotics (13.8%), and other antibiotics (10.1%) were the drugs used most frequently. Skin prick tests (16.7%) and provocation tests (34.2%) were the study procedures most commonly used. A large proportion of patients were treated in the emergency department (62%) with antihistamines (68%) and/or corticosteroids (53%). Only 22.8% of patients presenting with anaphylaxis received epinephrine. Conclusion Nonsteroidal anti-inflammatory drugs and antibiotics were the drugs used in at least 75% of patients. More than half the reactions were treated in the emergency department, whereas epinephrine was administered in fewer than 25% of patients with anaphylaxis. Dissemination of guidelines for anaphylaxis among primary and emergency department physicians should be encouraged.© 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.


Marquez M.-E.,Venezuelan Institute for Scientific Research | Deglesne P.-A.,Venezuelan Institute for Scientific Research | Lopez J.L.,Banco Municipal de Sangre | Costa O.D.,Banco Municipal de Sangre | And 5 more authors.
Leukemia and Lymphoma | Year: 2012

There is insufficient information on the characteristics of chronic lymphocytic leukemia (CLL) in Latin American patients. Immunoglobulin variable-region heavy-chain (IGVH) gene usage and mutation status and prognostic factors were investigated in patients resident in Venezuela. The most frequently used IGVH family genes were: VH3 > VH1 > VH4 > VH5, with a high incidence of IGVH1.69 and IGVH3.21 genes, and 55.2% of IGVH genes were mutated. Analysis of HCDR3 (third complementarity-determining region of the heavy chain) revealed that 24% of Venezuelan HCDR3s belonged to a CLL stereotyped HCDR3. Results for prognostic factors were similar to those reported previously for Caucasian populations. Interestingly, we found an over-representation of people of European extraction among Venezuelan patients with CLL, suggesting the possibility of a higher frequency of susceptibility genes for CLL in Europeans in comparison with Latin American mestizos. © 2012 Informa UK, Ltd.


Sanchez-Borges M.,Clinica El Avila | Sanchez-Borges M.,Centro Medico Docente La Trinidad | Capriles-Hulet A.,Centro Medico Docente La Trinidad | Caballero-Fonseca F.,Centro Medico Docente La Trinidad | Gonzalez-Aveledo L.,Centro Medico Of Caracas
Revista Alergia Mexico | Year: 2014

Background: There is little information on urticaria occurring in children, especially in limited resource countries. Objective: To determine the demographic and clinical features of urticaria in children living in a developing country. Patients and method: A prospective study was done in children from two allergy outpatient clinics were prospectively studied. Clinical data was obtained from the medical history and physical examination. Laboratory evaluations and immediate-type skin tests with food and aeroallergen extracts were done in selected cases. Urticaria subtypes were defined according to current EAACI/GA(2)LEN/WAO guidelines. Results: One hundred and twenty-three subjects were studied, 71 with acute urticaria and 52 with chronic urticaria. In patients with chronic urticaria, but not in those with acute urticaria, there was a significant predominance of girls. Triggers of urticaria were more common in acute than in chronic urticaria. Insects, foods, and drugs were the most common inducers of symptoms in acute urticaria, while urticaria induced by skin pressure was referred more often in chronic urticaria. In patients with acute or chronic urticaria there was a higher involvement of the head, upper and lower limbs. In patients with chronic urticaria, generalized urticaria, angioedema, and wheals on pressure sites were more frequent than in patients with acute urticaria. Spontaneous, papular, drug-induced, and dermographic urticaria were the most common subtypes in both groups of children. Conclusions: In children attending allergy services, acute urticaria was more frequent than the chronic type. Symptom triggers were different in acute than in chronic urticaria. Most common subtypes were spontaneous, papular, drug-induced, and dermographic urticaria.


Sanchez-Borges M.,Clinica El Avila | Sanchez-Borges M.,Centro Medico Docente la Trinidad | Caballero-Fonseca F.,Centro Medico Docente la Trinidad | Capriles-Hulett A.,Centro Medico Docente la Trinidad | Gonzalez-Aveledo L.,Centro Medico Of Caracas
Journal of the European Academy of Dermatology and Venereology | Year: 2015

Background A subset of patients with chronic spontaneous urticaria (CSU) experience disease exacerbations after receiving non-steroidal anti-inflammatory drugs (NSAIDs). This condition has been designated as Aspirin-Exacerbated Cutaneous Disease (AECD). Objectives The purpose of this study was twofold: (i) Investigate the demographic and clinical features of patients affected by AECD; (ii) To compare patients with AECD and NSAID-tolerant CSU patients for those characteristics. Methods Patients with AECD and a group of unselected CSU patients tolerant to NSAIDs were studied. Demographic and clinical data were obtained by direct questioning and physical examination. Laboratory investigations and allergen skin prick tests were performed only in selected patients, as guided by the medical history. Results Of 423 CSU patients admitted in the clinics, 52 (12.2%) had AECD. Compared with NSAID-tolerant CSU patients, AECD patients had significantly longer disease duration (57.7 ± 118.4 vs. 24.4 ± 36.6 months, P < 0.05), higher prevalence of angio-oedema (72.7 vs. 30.9%, P < 0.05) and atopy (83.8% vs. 58.4%, P < 0.05) and more frequent involvement of the face and upper respiratory tract (54.5% vs. 29.6%, P < 0.05). Conclusions AECD is a distinct phenotype that should be considered for inclusion as a separate subtype of chronic spontaneous urticaria. © 2014 European Academy of Dermatology and Venereology.


Sanchez-Borges M.,Clinica El Avila | Sanchez-Borges M.,Centro Medico Docente La Trinidad | Caballero-Fonseca E.,Centro Medico Docente La Trinidad | Capriles-Hulett A.,Centro Medico Docente La Trinidad
European Annals of Allergy and Clinical Immunology | Year: 2014

Chronic urticaria (CU) is one of the most puzzling clinical entities confronted by the medical profession. It is a common motive for consultation, and in a sizable proportion of patients no identifiable cause is evident. Since there are relatively few publications regarding CU in developing countries, we performed a prospective 3-year study on the demographic and clinical features of patients with CU. Four hundred and twenty-three subjects were studied, 52 children and 371 adults, 295 females (69.7%), with a mean age of 38.4 ± 17.8years. More often, wheals and angioedema (AE) were present on the head, upper and lower limbs and the trunk. AE was present in 162 patients (38.4%). The most frequent subtypes were chronic spontaneous urticaria, aspirin-exacerbated cutaneous disease, dermographic urticaria, and combinations of various subtypes. A better understanding of the characteristics of patients suffering CU is helpful for clinicians dealing with this ailment, and provides guidance for new investigations on its pathogenesis, which will hopefully result in a better management of this vexing condition. © 2014, EDRA LSWR. All rights reserved.


Sanchez-Borges M.,Clinica El Avila | Sanchez-Borges M.,Centro Medico Docente La Trinidad | Capriles-Hulett A.,Centro Medico Docente La Trinidad | Caballero-Fonseca F.,Centro Medico Docente La Trinidad
Allergologia et Immunopathologia | Year: 2015

Background: Urticaria is a common cause for consultation in general and specialised medical practices. There is scarce information on the characteristics of patients suffering acute urticaria in Latin America. Objectives: To investigate demographic and clinical features of patients with acute urticaria attending two allergy clinics in Caracas, Venezuela. Methods: A prospective study of all new patients who consulted during a three-year period because of acute urticaria. Information on age, gender, symptom duration, previous medical history, body distribution of wheals and angio-oedema, laboratory investigations, skin prick tests, and pharmacological treatment, was collected. Patients were classified according to their age as children/adolescents and adults. Results: Two hundred and forty eight patients (177 adults and 71 children) were studied. Acute urticaria was more frequent in middle-aged atopic female patients. Lesions more often involved upper and lower limbs and head, and 31% of patients exhibited generalised urticaria. Laboratory investigations, performed only in selected cases, did not contribute to the final diagnosis. Most frequent subtypes of acute urticaria were spontaneous, dermographic, papular, and drug-induced urticaria. Most patients were treated with non-sedating antihistamines, with increased use of cetirizine and levocetirizine in children, while 5.6% of children and 20.3% of adults required the addition of short courses of systemic corticosteroids. Conclusions: Acute urticaria is a frequent cause of consultation for allergists, affecting more often middle-aged female atopic patients. The use of extensive complementary tests does not seem to be cost-effective for this clinical condition. Spontaneous, dermographic, papular and drug-induced urticaria are the most common subtypes. © 2014 SEICAP.


Ramirez-Paesano C.,Clinica El Avila | Ramirez-Paesano C.,Unifertes Fertility Center | Fhima I.B.,Clinica El Avila | Fhima I.B.,Unifertes Fertility Center | And 8 more authors.
Jornal Brasileiro de Reproducao Assistida | Year: 2015

Objective: To evaluate effcacy of Propofol at Cp 2.5 µg/ ml administered by Target Controlled Infusion (TCI) using Marsh Modifed Model, in pre-medicated with midazolam/ fentanil Latin-American women (Venezuelans) during oo-cyte retrieval for In Vitro Fertilization. Methods: Prospective, descriptive study included 72 women, 18-44 years old, ASA I-II, non obese, undergoing oocyte retrieval, pre-medicated with midazolam 0.04 mg/kg and fentanil 2µg/kg and received anesthesia based in Propofol at Cp 2.5µg/ml by Target Controlled Infusion using Marsh Modifed Model. Demographic data, propofol doses, duration of procedure and recovery time was registered using descriptive statistic. Anesthesia effcacy was measured by Biespectral Analysis (BIS), Intra-Operative Movements Scale (0 to 5) graded, Postoperative Pain by Visual Analog Scale (VAS) and nausea/vomits incidence. ANOVA and Pearson Chi2 were used with an error of 0.05. Results: Age average was 33.04±6 years old, procedure average time 18.06±8min, Propofol total doses 146.64±53 mgs, Propofol infusion doses average 155.2±3µg/Kg/min. During procedure, 70.8% of patients had no movement, 22.2% movement Grade I and 6.9% Grade II. (Grade I-II movement did not interfere with procedure continuity). 70.8% achieved BIS 40-50 and 93.1% had BIS equal o less than 60. There was a statistic signifcant correlation between BIS 40-50 and no movements. Recovery post-anesthesia time was 25.2±8 min. 98.6% of patients reported excellent comfort. Conclusion: With midazolam/fentanil pre-medication, Propofol at Cp 2.5µg/ml by TCI using Marsh Modifed Model showed a 93% of effectiveness during oocyte retrieval in Latin-American women subjected to IVF, allowing an ultra-fast recovery time. © 2015(Publisher Name).All rights reserved.

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