Publications by authors named "Elsy Maureen Navarrete Rodríguez"

9 Publications

  • Page 1 of 1

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort.

Allergy 2021 Feb 20. Epub 2021 Feb 20.

Department of pulmonology, the children's hospital, Zhejiang University school of medicine, national clinical research center for child health, Hangzhou, Zhejiang, China.

Background: The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes.

Methods: The PeARL multinational cohort included 1,054 children with asthma and 505 non-asthmatic children aged between 4-18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control.

Results: During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks and hospitalizations due to asthma, in comparison to the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits or hospitalizations during the pandemic. However, an increased risk of URTIs emerged.

Conclusion: Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.
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February 2021

Global Asthma Network Phase I study in Mexico: prevalence of asthma symptoms, risk factors and altitude associations-a cross-sectional study.

BMJ Open Respir Res 2020 12;7(1)

Allergy and Immunology, Hospital General de Matamoros, Matamoros, Mexico.

Background: Global Asthma Network (GAN) was established in 2012 as a development to the International Study of Asthma and Allergies in Childhood to improve asthma care globally.

Objective: To survey asthma, allergic rhinitis and atopic dermatitis in primary and secondary school children and to investigate and evaluate its prevalence, severity, management and risk factors in Mexico.

Methods: GAN Phase I is a cross-sectional, multicentre survey carried out in 15 centres corresponding to 14 Mexican cities throughout 2016-2019 using the validated Spanish language version of the GAN Phase I questionnaires. The questionnaires were completed by parents of 6-7-year-old primary school pupils (school children) and by 13-14-year-old adolescents.

Results: A total of 35 780 school children and 41 399 adolescents participated. Wheezing ever prevalence was 26.2% (95% CI 25.8% to 26.7%) in school children and 23.9% (95% CI 23.4% to 24.3%) in adolescents. The corresponding frequencies for current wheeze were 10.2% (95% CI 9.9% to 10.5%) and 11.6% (95% CI 11.2% to 11.9%). In school children, the risk factors for current wheeze were rhinitis (OR 4.484; 95% CI 3.915% to 5.134%) and rash symptoms (OR 1.735; 95% CI 1.461% to 2.059%). For adolescents, rhinitis symptoms (OR 3.492; 95% CI 3.188% to 3.825%) and allergic rhinitis diagnosis (OR 2.144; 95% CI 1.787% to 2.572%) were the most significant. For both groups, there was a negative relation with centres' sea level altitude higher than 1500 m above mean sea level (p<0.005).

Conclusions: The most important risk factors for asthma symptoms in both age groups were the presence of rhinitis and rash symptoms or diagnosis. On the other hand, sea level altitude higher than 1500 metres was a protective factor.
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December 2020

Enhancing innate immunity against virus in times of COVID-19: Trying to untangle facts from fictions.

World Allergy Organ J 2020 Nov 9;13(11):100476. Epub 2020 Oct 9.

Medicine Division Chief Hospital Juárez de México, Mexico City, Mexico.

Introduction: In light of the current COVID-19 pandemic, during which the world is confronted with a new, highly contagious virus that suppresses innate immunity as one of its initial virulence mechanisms, thus escaping from first-line human defense mechanisms, enhancing innate immunity seems a good preventive strategy.

Methods: Without the intention to write an official systematic review, but more to give an overview of possible strategies, in this review article we discuss several interventions that might stimulate innate immunity and thus our defense against (viral) respiratory tract infections. Some of these interventions can also stimulate the adaptive T- and B-cell responses, but our main focus is on the innate part of immunity. We divide the reviewed interventions into: 1) lifestyle related (exercise, >7 h sleep, forest walking, meditation/mindfulness, vitamin supplementation); 2) Non-specific immune stimulants (letting fever advance, bacterial vaccines, probiotics, dialyzable leukocyte extract, pidotimod), and 3) specific vaccines with heterologous effect (BCG vaccine, mumps-measles-rubeola vaccine, etc).

Results: For each of these interventions we briefly comment on their definition, possible mechanisms and evidence of clinical efficacy or lack of it, especially focusing on respiratory tract infections, viral infections, and eventually a reduced mortality in severe respiratory infections in the intensive care unit. At the end, a summary table demonstrates the best trials supporting (or not) clinical evidence.

Conclusion: Several interventions have some degree of evidence for enhancing the innate immune response and thus conveying possible benefit, but specific trials in COVID-19 should be conducted to support solid recommendations.
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November 2020

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines.

World Allergy Organ J 2020 Aug 21;13(8):100444. Epub 2020 Aug 21.

Institute of Security and Social Services of State Workers (ISSSTE), Regional Hospital, Veracruz, Mexico.

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools.

Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, Supplementary data) concluded the following.

Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50-200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico.

Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.
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August 2020

The burden of asthma in an inner-city area: A historical review 10 years after Isaac.

World Allergy Organ J 2020 Jan 8;13(1):100092. Epub 2020 Jan 8.

Unit of Clinical Research, Cartagena and Department of Paediatrics, University of Murcia, Murcia, Spain.

Background: According to the International Study of Asthma and Allergies in Childhood (ISAAC) methodology, in 2003, the prevalence of asthma symptoms in children 6-7 years old and adolescents 13-14 years old was 11.6% and 13.7%, respectively. Since then, the number of asthma cases has increased worldwide. The study was conducted in several districts in northern Mexico City to evaluate the prevalence of asthma in these age groups and examine possible risk factors. The data were compared to the 2003 results from the same area.

Methods: This was a comparative cross-sectional study following the official Global Asthma Network (GAN) methodology. The parents or guardians of participants completed a questionnaire that explored demographics, asthma symptoms, diagnoses, and possible risk factors. Central tendency measurements were determined for statistical analysis and chi-squared distribution for possible risk factors.

Results: A total of 2515 children aged 6-7 years and 3375 adolescents aged 13-14 years participated in the study. Compared to the ISAAC results, we found a greater prevalence of wheezing in both children (at some time in life, 19.2% vs. 27.1%; over the last year, 6.8% vs. 10.6%) and adolescents (at some time in life, 16.9% vs. 19.7%), and for children with an asthma diagnosis (4.5% vs. 5.1%). For both groups, the most common risk factor associated with wheezing was the presence of rhinitis symptoms.

Conclusions: Asthma symptoms are highly prevalent in Mexico City, occurring in almost 20% of adolescents. Compared to a decade ago, there was a 7.9% increase in the prevalence of asthma symptoms in children. Almost half of the children and adolescents presenting with symptoms had experienced more than four episodes per year. However, less than 50% of children and adolescents with asthma symptoms had been diagnosed with this disorder, suggesting under-diagnosis.
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January 2020

[GUIMIT 2019, Mexican Guideline on Immunotherapy. Guideline on the diagnosis of IgE-mediated allergic disease and immunotherapy following the ADAPTE approach].

Désirée Larenas-Linnemann Jorge A Luna-Pech Noel Rodríguez-Pérez Mónica Rodríguez-González Alfredo Arias-Cruz María Virginia Blandón-Vijil María Carmen Costa-Domínguez Blanca E Del Río-Navarro Alan Estrada-Cardona Elsy Maureen Navarrete-Rodríguez José Antonio Ortega-Martell César Fireth Pozo-Beltrán Herson Brito-Díaz María Rosario Canseco-Raymundo Enrique Emanuel Castelán-Chávez Margarita Gabriela Domínguez-Silva Alberto José Escalante-Domínguez José Luis Gálvez-Romero María Guadalupe García-Reyes Javier Gómez-Vera Sandra Nora González-Díaz María Gracias Belinda Guerrero-Núñez Dante Hernández-Colín Alejandra Macías-Weinmann David Alejandro Mendoza-Hernández Néstor Alejandro Meneses-Sánchez María Dolores Mogica-Martínez Carol Vivian Moncayo-Coello Manuel Montiel-Herrera Patricia O'Farril-Romanillos Ernesto Onuma-Takane Margarita Ortega-Cisneros Lorena Rangel-Garza Héctor Stone-Aguilar Carlos Torres-Lozano Edna Venegas-Montoya Guillermo Wakida-Kusunoki Carlos Macouzet-Sánchez Armando Partida-Gaytán Aída Inés López-García Ana Paola Macías-Robles María Jesús Ambriz-Moreno Amyra Ali Azamar-Jácome Carlos Báez-Loyola Claudia Yusdivia Beltrán-De Paz Chrystopherson Caballero-López Juan Carlos Fernández de Córdova-Aguirre Roberto Fernández-Soto José Santos Lozano-Sáenz José Joel Oyoqui-Flores Roberto Osorio-Escamilla Fernando Ramírez Daniela Rivero-Yeverino María Socorro Orozco-Martínez María Isabel Rojo-Gutiérrez Eric Martínez Miguel Alejandro Medina-Ávalos

Rev Alerg Mex 2019 ;66 Suppl 1:1-105

Fundación Clínica y Hospital Médica Sur, Ciudad de México.

Background: In Mexico, allergen immunotherapy (AIT) and immunotherapy with hymenoptera venom (VIT) is traditionally practiced combining aspects of the European and American school. In addition, both types of extracts (European and American) are commercially available in Mexico. Moreover, for an adequate AIT/VIT a timely diagnosis is crucial. Therefore, there is a need for a widely accepted, up-to-date national immunotherapy guideline that covers diagnostic issues, indications, dosage, mechanisms, adverse effects and future expectations of AIT (GUIMIT 2019).

Method: With nationwide groups of allergists participating, including delegates from postgraduate training-programs in Allergy/Immunology-forming, the guideline document was developed according to the ADAPTE methodology: the immunotherapy guidelines from European Academy of Allergy and Clinical Immunology, German Society for Allergology and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology were selected as mother guidelines, as they received the highest AGREE-II score among international guidelines available; their evidence conforms the scientific basis for this document.

Results: GUIMIT emanates strong or weak (suggestions) recommendations about practical issues directly related to in vivo or in vitro diagnosis of IgE mediated allergic diseases and the preparation and application of AIT/VIT and its adverse effects. GUIMIT finishes with a perspective on AIT modalities for the future. All the statements were discussed and voted on until > 80 % consensus was reached.

Conclusions: A wide and diverse group of AIT/VIT experts issued transculturized, evidence-based recommendations and reached consensus that might improve and standardize AIT practice in Mexico.
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January 2020

[Knowledge of asthma: educational intervention with the 2014 GINA guide in primary care physicians].

Rev Alerg Mex 2016 Oct-Dec;63(4):358-364

Secretaría de Salud, Hospital Infantil de México Federico Gómez, Departamento de Alergia e Inmunología Clínica Pediátrica. Ciudad de México, México.

Background: Asthma is a public health problem in the world, so updating the guidelines for the diagnosis and treatment of asthma is based primarily on the practice of primary care physicians. Educational interventions are useful for increasing knowledge.

Objective: To compare the level of knowledge of asthma before and after an educational intervention.

Methods: A quasi-experimental prospective study was conducted in general and family practitioners and pediatricians who attended a training workshop on general aspects of asthma and current guidelines for diagnosis and treatment (GINA 2014). A questionnaire consisting of 11 multiple choice questions relating to fundamental aspects of the disease and diagnosis, classification, treatment and management of attacks, was used in two assessments, baseline and post-intervention.

Results: A total of 178 patients participated in the study, with knowledge pre-intervention at 25.5 points and post-intervention at 97.5 points on a scale of 100, with p < 0.05.

Conclusion: Educational interventions are inexpensive and effective tools to increase the knowledge of health professionals, and they have an impact on improving patient care.
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December 2018

[Food allergy diagnosis in patients with elimination diet history. Preliminary report].

Rev Alerg Mex 2014 Oct-Dec;61(4):298-304

Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Infantil de México Federico Gómez, México, DF.

Background: Food allergy diagnosis is performed by a double blind placebo controlled challenge; however, in a lot of patients, it is only based on clinical history, skin prick tests, or parents' perception. There is a high frequency of elimination diets without an adequate approach.

Objectives: To analyze the results of diagnostic tests in a group of children with elimination diet-based on suspected food allergy and verify such studies with double blind placebo-controlled test challenge.

Material And Method: An observational, analytical and prospective study was done in a group of patients with elimination diet for suspected food allergy. We performed prick test, Prick-to-Prick test and patch test and the positive ones were verified by double-blind placebo-controlled challenge.

Results: Fourty-three patients were included within a total of 1,935 tests. Both approach for immediate and late sensitivity had not statistically significant relationship between a positive test and the elimination of food. Until now, we had 4 (8%) positive challenges out of 50.

Conclusions: The frequency of allergy proved by double-blind placebo-controlled test in 50 challenges was of 8% (4/50), thus, in the preliminary report we found a high frequency of elimination diets without adequate support. It is very important that food allergy diagnosis is accurate and based on an appropriate approach; since the implementation of an elimination diet in pediatric population can have a negative influence on their growth and development.
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December 2014