Diego Garcia-Calderin

465 Skeeter Syndrome, a Case Report and Literature Review

Background The worldwide prevalence of allergic reaction to mosquito bites is unknown. Some patients who suffer from local reactions have also systemic symptoms. Methods A 3 year old female who suffered from mosquitoes bites in her left lower extremity, had a large local reaction with erythema, edema, itching, pain and blisters of 5 × 6 cm. It was accompanied by fever of 38.5°C and emesis. She had a positive skin prick test for Aedes aegypti with diagnosis of Skeeter Syndrome. The patient was treated with antihistamine during 10 days and analgesics for 3 days. She was given antihistamine treatment for 10 days and analgesics for 3 days. Results Skeeter syndrome is defined as a large local reaction induced by mosquito bites associated with systemic symptoms (fever and vomiting) with specific IgE for mosquito identified by skin testing. The primary management of Skeeter syndrome is prevention of mosquito bites, the use of repellents and protective clothing. It is also important the symptomatic management control of pruritus with the use of antihistamines or if necessary topical steroids. Overall children with Skeeter syndrome remain healthy, except for the recurrence of large local reactions to mosquito Stings. Conclusions The early recognition of Skeeter syndrome is important to give the right management and to prevent unnecessary diagnostic tests and treatments that can increase the risk of adverse reactions and costs.

371 Cutaneous Response to Patch Tests with Dermatophagoides Farinae and Dermatophagoides Pteronyssinus in Patients with Chronic Rhinitis

Background Rhinitis is characterized clinical by chronic runny nose, sneezing, nasal itching, congestion and postnasal discharge, among other symptoms. It´s classified as allergic and non allergic. Skin prick testing is the principal diagnosis method for allergic rhinits. However, there is a group of patients with chronic rhinopathy that have negative skin tests, the objective of this study was to determine the cutaneous response to patch tests with Dermatophagoides farinae and Dermatophagoides pteronyssinus in patients with chronic rhinitis. Methods It was a cross-sectional, observational and descriptive study. We included patients over 18 years old. They were divided into 3 groups; Group A patients who came for the first time with a history of chronic rhinopathy over 18 months of evolution and positive skin tests for aeroallergens; group B patients with chronic rhinitis with at least one year of evolution and negative skin tests; group C healthy volunteers. Patch test with farinae and pteronisyinnus were done in the subjects of all 3 groups, with readings at 48 and 72 hours. Results A total of 37 patients were studied, mean age 26.1 years. Twenty two were male subjects (60%). The mean lenghtof chronic rhinophaty was 10.8 years. Six patients had positive patch test to any of the mites tested; 2 (33%) in group A, 2 (33%) in group B and 2 (33%) of the control group, but it was not statistically significant (P > 0.05). Conclusions Although the results were not statistically significant, there were patients with chronic rhinitis wich had positive patch test for mites. This sensitization could be clinically significant for those patients.

216 Ficus Benjamina Sensitization in Adult Patients with Rhinitis.

Background In Monterrey there are a considerable number of Ficus benjamina trees, but the awareness-related information to this plant is scarce. The objective of this study is to determine the frequency of sensitization to Ficus benjamina in patients with rhinitis who were attended the Regional Centre of Allergy and Clinical Immunology of Monterrey, Mexico. Methods Observational, transversal and descriptive study. We included patients over 18 years old with chronic rhinitis, which completed a questionnaire to assess exposure to Ficus benjamina. Skin prick tests (SPT) to common aeroallergens in our region with extract of Ficus benjamina (Allerstand Company) had done in all subjects. Results A total of 177 patients were included, mean age was 38 years, 65% (115) were female, 135 (76%) reported contact with a Ficus benjamina tree in their home or neighbor. 12 (17%) patients had a positive skin test to Ficus benjamina, but up to 15% (26) had clinical manifestations when they were close to a tree of Ficus benjamina. Most patients with positive skin test to Ficus benjamina (76.9%, 9) had positive test more than one of the aeroallergen tested. The association between Ficus benjamina and sensitization to other aeroallergens, as well as the symptoms associated to the contact with the tree was not statistically significant. Conclusions Sensitization to Ficus benjamina is common and was similar to that reported in European countries. To demonstrate the association between sensitization to Ficus benjamina and symptoms should be made studies with nasal challenge test.

602 Cvid: A Common but Still Underdiagnosed Disease.

Background Among the more than 150 different forms of Primary Immunodeficiency Diseases (PID) the CVID is the most common symptomatic primary immunodeficiency, present mainly in adults. There is a failure of B cells to develop and differentiate into plasma cells; at consequent a reduction of the production of one or more isotypes of antibody can also affected Cell-mediated immunity. Common manifestations included recurrent bacterial infections, that typically involve the upper and lower respiratory tract. Some patients are highly prone to autoimmune manifestations, lymphoid hyperplasia, and tumors. Methods We presented 3 cases of CVID with a variety of clinical presentation, evolution and complications related to delayed diagnosis. Results A 34 year old male presented chronic diarrhea, weight loss, malnutrition and recurrent upper respiratory infections; digestive tract endoscopy and biopsy was reported with villous atrophy, chronic inflammation and low grade non-Hodgkins lymphoma B cell. Unfortunately this patient refused the use of gamma globulin treatment, had a high morbidity, and finally the patient died. The case of a nurse with clinical manifestation of recurrent rinosinusitis and pneumonia, which was diagnosed as IDCV 17 years later, after she developed pulmonary bronchiectasis. Fortunately the disease is under control and she is actually under treatment with intravenous immunoglobulin. Finally, the case of a 44 year old female, who suffered from recurrent upper respiratory infections, additionally had a thyroid gland tumor associated which affecting the thyroid function. Conclusions In the 3 cases had low levels of all immunoglobulin as a hallmark. The clinician must be suspecting this condition in all adults with recurrent infectious disease who have gastrointestinal symptoms or who are detected a malignant disease. Early diagnosis and correct treatment are critical in preventing tissue damage, long-term sequelae and death. Replacement with intravenous gamma globulin and antibiotics are the mainstays in the management of these patients.

463 Efficacy of Immunotherapy With Allergenic Extract of Aedes Aegypti in the Treatment of Large Local Reaction to Mosquito Bites in Children

Background Allergic reactions to insects are a global problem. The objective of this study was to assess the efficacy of immunotherapy with allergenic extract of Aedes aegypti for the treatment of large local reactions (LLR) to mosquito bites in children. Methods Experimental, comparative, prospective, longitudinal and randomized none blinded study was conducted. We included 2 to 15 year old children with a history of large local reactions to mosquito bites. Sensitization was confirmed by a positive prick test. One group was treated with subcutaneous immunotherapy with extract of Aedes aegypti during 5 months and a second group received only antihistamine as needed. Diary symptoms and medication use were recorded in each case. The presence of adverse reactions to immunotherapy was also documented. Results A total of 35 patients from August 2009 to September 2010. Twenty-eight patients completed the study (16 male were included, with mean 7 ± 2.5 years) 15 in the immunotherapy group and 13 in the control group. The immunotherapy group showed a decrease in the diameter of the wheal and flare as well as the duration of the reaction and the use of drugs, from the third month of treatment, compared with the control group (P < 0.001). Conclusions Our results suggest that immunotherapy with extract of Aedes aegypti, could modify the natural history of LLR to mosquito bites in children. Additional studies are needed to determine the optimal length treatment of the scheme and its long-term effects.