Post-grado de Pediatria Hospital Universitario de Los Andes,Merida-Venezuela.Palabras clave: Asma atopica, control de antigenos inhalables, IgE,farmacoterapia.Resumen. Los conocimientos adquiridos durante la ultima decada deinvestigacion sobre la inmunopatogenia del asma han demostrado que elproceso inflamatorio es un factor preponderante de la enfermedad. Ademasde la herencia, la presencia de desencadenantes inhalables son los elemen-tos predisponentes mas importantes. El presente trabajo constituye un es-tudio clinico terapeutico longitudinal, disenado para valorar el efecto de lacombinacion del uso de farmacoterapia y control medio-ambiental, en 45pacientes asmaticos pediatricos procedentes de la consulta de InmunologiaClinica. Los pacientes admitidos en el estudio, presentaron por lo menosdos crisis asmaticas mensuales durante los ultimos cuatro meses. Al ingre-sar en nuestra consulta, los pacientes recibieron tratamiento farmacologicounico con teofilina (grupo A), beclometasona (grupo B) o salbutamol (grupoC), durante las dos primeras semanas, combinado con medidas especificasde control de desencadenantes inhalables. Despues de un periodo de obser-vacion de 6 meses, se evidencio mejoria clinica estable, asociado a una mo-dificacion favorable del FEV1, CVF y PEF, disminucion significativa de losniveles sericos de IgE en los tres grupos (p<0,02; 0,005 y 0,02 respectiva-mente) independientemente del farmaco utilizado. Durante el estudio semonitoreo la cantidad de

The past decade of research has led to a greater understanding of the pathogenesis of asthma and, in particular, the pivotal role of the underlying inflammatory process. Along with inheritance in atopic patients, the presence of inhaled triggering allergens are considered the predominant predisposing factors in the development of the disease. We have conducted a longitudinal clinical therapeutic study, which included 45 pediatrics patients with asthma, in order to evaluate whether the removal of any potential inhaled triggering factor, could decrease the requirement of drug based anti-inflammatory therapy. Patients admitted in this study presented at least, two monthly asthma attacks during the last four months. A single treatment with theophylline (group A), beclomethasone (group B) or salbutamol (group C), was prescribed during the first 2 weeks, along with specific instructions to avoid inhaled allergens. Regardless of the drug used, patients showed impressive and prolonged clinical improvement during 6 months, reduction of total IgE serum levels in the three groups (p < 0.02; 0.005 and 0.02 respectively) and favorable modification of force expiratory volume at the first second, forced vital capacity and flow expiratory peak. During the observation period a constant monitoring of mites allergens concentrations was performed, showing a decrease of these antigens, associated with clinical improvement, and only in those patients who remained symptomatic (group A 31%, group B 29% and group C 9%), failures performing the measures designed to reduce their exposure to environmental allergens, was demonstrated. These results suggest that reduction of inhaled triggering factors may decrease the requirement of anti-inflammatory drug therapy to control the symptoms in patients with asthma.

BACKGROUND:It has been reported that the concentration of Dermatophagoides sp. population, the main trigger of asthma in sensitized atopic subjects, is inversely related with altitude and probably directly with humidity and that this population are scarcely found over 1750 m above sea level. OBJECTIVE:We studied the presence of Dermatophagoides sp. in a Venezuelan community between 2040 and 2600 m above sea level, and also the IgE response to D. pteronnyssinus and D. farinae in atopic subjects living on that region. METHODS:The presence of Dermatophagoides sp. was determined by microscopic identification of mites in dust, obtained by brushing the mattresses surface in 93 randomly selected houses between 2040 and 2600 m above sea level. The indoor relative humidity was also measured. The specific IgE serum levels were studied in 65 subjects classified as asthmatics, allergic non-asthmatics and non-allergic. RESULTS:A mean concentration of 188 mites/g of room dust was determined in 82.4% of houses with an indoor relative humidity ranging from 89% and 92% independently of altitude. The density of Dermatophagoides sp. was sufficiently high to sensitize the atopic subjects, IgE levels were 6.8 PRU mean value for asthmatic, against 0.38 PRU in non-atopic. CONCLUSIONS:We conclude that: (a) Dermatophagoides sp. can be found up to 2600 m above sea level in a Venezuelan neotropical region where a high indoor relative humidity is characteristic of most dwellings; (b) sensitization by D. pteronyssinus and D. farinae were demonstrated in atopic subjects resident at that region.

Se explora la respuesta inmunológica en la amibiasis intestinal mediante un método inmunoenzimático diseñado para determinar anticuerpos de la clase IgA específica contra Entamoeba histolytica, en 41 muestras de heces provenientes de pacientes con diagnóstico clínico de amibiasis intestinal. El análisis estadístico de los datos reveló que valores de absorbencia igual o mayor a 0.287 son significativos. Se demostró que la prueba es específica y de utilidad para el diagnóstico de amibiasis intestinal.