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Anuncio
Re vista
ARTÍCULO ORIGINAL
Rev Alerg Méx HIYQ\U"!
Mé xic o
Repercusión de la inmunoterapia
con alergenos luego de dos años de
suspensión a pacientes con asma
Jorge Sánchez,1,2 Ricardo Cardona,1 Andrés Sánchez3
Resumen
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Jorge Sánchez,1,2 Ricardo Cardona,1 Andrés Sánchez3
Abstract
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Recibido: 20 de junio 2015
Aceptado: 22 de octubre 2015
Correspondencia
Jorge Sánchez
jotamsc@yahoo.com
ƐƚĞĂƌơĐƵůŽĚĞďĞĐŝƚĂƌƐĞĐŽŵŽ
Sánchez J, Cardona R, Sánchez A. Repercusión de la
inmunoterapia con alergenos luego de dos años de
suspensión a pacientes con asma. Rev Alerg Méx.
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Revista Alergia México
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Correspondence
Jorge Sánchez
jotamsc@yahoo.com
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2016 abril-junio;63(2)
Revista Alergia México
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Revista Alergia México
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REFERENCIAS
1.
ĞŶŶŝƐZ͕ĂƌĂďĂůůŽ>͕'ĂƌĐŝĂ͕ĂďĂůůĞƌŽ͕ƌŝƐƟnjĂďĂů'͕
ŽƌĚŽďĂ,͕ĞƚĂů͘ƐƚŚŵĂĂŶĚŽƚŚĞƌĂůůĞƌŐŝĐĐŽŶĚŝƟŽŶƐŝŶ
Re vista
Sánchez J y col. Impacto de la inmunoterapia con alergenos después de su suspensión
Mé xic o
2.
Vergara C, Caraballo L. Asthma mortality in Columbia. Ann
ůůĞƌŐLJƐƚŚŵĂ/ŵŵƵŶŽů͘ϭϵϵϴ͖ϴϬ;ϭͿ͗ϱϱͲϲϬ͘
18. ŽŵƉĂůĂƟ͕WĂƐƐĂůĂĐƋƵĂ'͕ŽŶŝŶŝD͕ĂŶŽŶŝĐĂ't͘dŚĞ
ĞĸĐĂĐLJŽĨƐƵďůŝŶŐƵĂůŝŵŵƵŶŽƚŚĞƌĂƉLJĨŽƌŚŽƵƐĞĚƵƐƚŵŝƚĞƐ
respiratory allergy: results of a GA2LEN meta-analysis.
ůůĞƌŐLJ͘ϮϬϬϵ͖ϲϰ;ϭϭͿ͗ϭϱϳϬͲϵ͘
3.
EĞīĞŶ,͕ĂĞŶĂͲĂŐŶĂŶŝ͕DĂůŬĂ^͕^ŽůĞ͕^ĞƉƵůǀĞĚĂ
Z͕ĂƌĂďĂůůŽ>͕ĞƚĂů͘ƐƚŚŵĂŵŽƌƚĂůŝƚLJŝŶ>ĂƟŶŵĞƌŝĐĂ͘:
/ŶǀĞƐƟŐůůĞƌŐŽůůŝŶ/ŵŵƵŶŽů͘ϭϵϵϳ͖ϳ;ϰͿ͗ϮϰϵͲϱϯ͘
ϭϵ͘ ďƌĂŵƐŽŶ D:͕ WƵLJ ZD͕ tĞŝŶĞƌ :D͘ /ŶũĞĐƟŽŶ ĂůůĞƌŐĞŶ
immunotherapy for asthma. Cochrane Database Syst Rev.
ϮϬϭϬ;ϴͿ͗ϬϬϭϭϴϲ͘
4.
ĚĞƌt͕ŐĞD:͕ǀŽŶDƵƟƵƐ͘dŚĞĂƐƚŚŵĂĞƉŝĚĞŵŝĐ͘E
ŶŐů:DĞĚ͘ϮϬϬϲ͖ϯϱϱ;ϮϭͿ͗ϮϮϮϲͲϯϱ͘
5.
Anandan C, Nurmatov U, van Schayck O, Sheikh A. Is the
ƉƌĞǀĂůĞŶĐĞ ŽĨ ĂƐƚŚŵĂ ĚĞĐůŝŶŝŶŐ͍ ^LJƐƚĞŵĂƟĐ ƌĞǀŝĞǁ ŽĨ
ĞƉŝĚĞŵŝŽůŽŐŝĐĂůƐƚƵĚŝĞƐ͘ůůĞƌŐLJ͘ϮϬϭϬ͖ϲϱ;ϮͿ͗ϭϱϮͲϲϳ͘
20. Jacobsen L, Niggemann B, Dreborg S, Ferdousi HA, Halken
^͕ ,ƆƐƚ ͕ Ğƚ Ăů͘ ^ƉĞĐŝĮĐ ŝŵŵƵŶŽƚŚĞƌĂƉLJ ŚĂƐ ůŽŶŐͲƚĞƌŵ
ƉƌĞǀĞŶƟǀĞĞīĞĐƚŽĨƐĞĂƐŽŶĂůĂŶĚƉĞƌĞŶŶŝĂůĂƐƚŚŵĂ͗ϭϬͲ
LJĞĂƌĨŽůůŽǁͲƵƉŽŶƚŚĞWdƐƚƵĚLJ͘ůůĞƌŐLJ͘ϮϬϬϳ͖ϲϮ;ϴͿ͗ϵϰϯͲϴ͘
ŽůŽŵďŝĂ͗ĂƐƚƵĚLJŝŶϲĐŝƟĞƐ͘ŶŶůůĞƌŐLJƐƚŚŵĂ/ŵŵƵŶŽů͘
ϮϬϬϰ͖ϵϯ;ϲͿ͗ϱϲϴͲϳϰ͘
ϲ͘
Caraballo L, Acevedo N. Allergy in the tropics: the impact
ŽĨĐƌŽƐƐͲƌĞĂĐƟǀŝƚLJďĞƚǁĞĞŶŵŝƚĞƐĂŶĚĂƐĐĂƌŝƐ͘&ƌŽŶƚŝŽƐĐŝ
;ůŝƚĞĚͿ͘ϮϬϭϭ͖ϯ͗ϱϭͲϲϰ͘
7.
Burbach G, Heinzerling L, Edenharter G, Bachert C,
Bindslev-Jensen C, Bonini S, et al. GA(2)LEN skin test study
//͗ĐůŝŶŝĐĂůƌĞůĞǀĂŶĐĞŽĨŝŶŚĂůĂŶƚĂůůĞƌŐĞŶƐĞŶƐŝƟnjĂƟŽŶƐŝŶ
ƵƌŽƉĞ͘ůůĞƌŐLJ͘ϮϬϬϵ͖ϲϰ;ϭϬͿ͗ϭϱϬϳͲϭϱ͘
8.
^ĄŶĐŚĞnj:͕ŝĞnj^͕ĂƌĚŽŶĂZ͘΀&ƌĞƋƵĞŶĐLJŽĨƐĞŶƐŝƟnjĂƟŽŶƚŽ
ĂŶŝŵĂůƐŝŶĂƚƌŽƉŝĐĂůĂƌĞĂ΁͘ZĞǀůĞƌŐDĞdž͘ϮϬϭϰ͖ϲϭ;ϮͿ͗ϴϭͲϵ͘
ϵ͘
Sanchez J, Diez S, Cardona R. Sensibilización a aeroalergenos en pacientes alérgicos de Medellín, Colombia Revista
ůĞƌŐŝĂDĠdžŝĐŽ͘ϮϬϭϮ͖ϱϵ;ϯͿ͗ϭϯϵͲϰϳ͘
10. &ĂƐĐĞ>͕dŽƐĐĂD͕ĂƌŽĸŽD͕KůĐĞƐĞZ͕ŝƉƌĂŶĚŝ'͘ƚŽƉLJ
ŝŶǁŚĞĞnjŝŶŐŝŶĨĂŶƚƐĂůǁĂLJƐƐƚĂƌƚƐǁŝƚŚŵŽŶŽƐĞŶƐŝƟnjĂƟŽŶ͘
ůůĞƌŐLJƐƚŚŵĂWƌŽĐ͘ϮϬϬϳ͖Ϯϴ;ϰͿ͗ϰϰϵͲϱϯ͘
11. ůnjĂŬĂƌZ,͕ůƐĂŵĂƌĂŝD͘ĸĐĂĐLJŽĨŝŵŵƵŶŽƚŚĞƌĂƉLJĨŽƌ
treatment of allergic asthma in children. Allergy Asthma
Proc. 2010;31(4):324-30.
12. Cox L. Allergen immunotherapy and asthma: efficacy,
ƐĂĨĞƚLJ͕ ĂŶĚ ŽƚŚĞƌ ĐŽŶƐŝĚĞƌĂƟŽŶƐ͘ ůůĞƌŐLJ ƐƚŚŵĂ WƌŽĐ͘
ϮϬϬϴ͖Ϯϵ;ϲͿ͗ϱϴϬͲϵ͘
13. ĂĚLJ ͕ WŽǁĞůů D͕ ,ĂƌďĞĐŬ Z͕ 'ŝĐůĂƐ W͕ DƵƌƉŚLJ :͕ <ĂƟĂů
Z͕ Ğƚ Ăů͘ /Ő' ĂŶƟďŽĚŝĞƐ ƉƌŽĚƵĐĞĚ ĚƵƌŝŶŐ ƐƵďĐƵƚĂŶĞŽƵƐ
ĂůůĞƌŐĞŶ ŝŵŵƵŶŽƚŚĞƌĂƉLJ ŵĞĚŝĂƚĞ ŝŶŚŝďŝƟŽŶ ŽĨ ďĂƐŽƉŚŝů
ĂĐƟǀĂƟŽŶǀŝĂĂŵĞĐŚĂŶŝƐŵŝŶǀŽůǀŝŶŐďŽƚŚ&ĐŐĂŵŵĂZ//
ĂŶĚ&ĐŐĂŵŵĂZ//͘/ŵŵƵŶŽů>ĞƩ͘ϮϬϭϬ͖ϭϯϬ;ϭͲϮͿ͗ϱϳͲϲϱ͘
14. tŝŶŐ <͕ ^ĂŬĂŐƵĐŚŝ ^͘ ZĞŐƵůĂƚŽƌLJ d ĐĞůůƐ ĂƐ ƉŽƚĞŶƟĂů ŝŵmunotherapy in allergy. Curr Opin Allergy Clin Immunol.
ϮϬϬϲ͖ϲ;ϲͿ͗ϰϴϮͲϴ͘
15. Pauli G, Larsen TH, Rak S, Horak F, Pastorello E, Valenta R,
ĞƚĂů͘ĸĐĂĐLJŽĨƌĞĐŽŵďŝŶĂŶƚďŝƌĐŚƉŽůůĞŶǀĂĐĐŝŶĞĨŽƌƚŚĞ
ƚƌĞĂƚŵĞŶƚŽĨďŝƌĐŚͲĂůůĞƌŐŝĐƌŚŝŶŽĐŽŶũƵŶĐƟǀŝƟƐ͘:ůůĞƌŐLJůŝŶ
/ŵŵƵŶŽů͘ϮϬϬϴ͖ϭϮϮ;ϱͿ͗ϵϱϭͲϲϬ͘
ϭϲ͘ ŽƉĞŶŚĂǀĞƌ͕WĂƌŬĞƌ͕WĂƚĐŚ^͘^LJƐƚĞŵŝĐƌĞĂĐƟŽŶƐǁŝƚŚ
ĂĞƌŽĂůůĞƌŐĞŶĐůƵƐƚĞƌŝŵŵƵŶŽƚŚĞƌĂƉLJŝŶĂĐůŝŶŝĐĂůƉƌĂĐƟĐĞ͘
Ann Allergy Asthma Immunol. 2011;107(5):441-7.
17. WĞŶĂŐŽƐD͕WĂƐƐĂůĂĐƋƵĂ'͕ŽŵƉĂůĂƟ͕ĂĞŶĂͲĂŐŶĂŶŝ
͕KƌŽnjĐŽ^͕WĞĚƌŽnjĂ͕ĞƚĂů͘DĞƚĂĂŶĂůLJƐŝƐŽĨƚŚĞĞĸĐĂĐLJ
of sublingual immunotherapy in the treatment of allergic
ĂƐƚŚŵĂŝŶƉĞĚŝĂƚƌŝĐƉĂƟĞŶƚƐ͕ϯƚŽϭϴLJĞĂƌƐŽĨĂŐĞ͘ŚĞƐƚ͘
ϮϬϬϴ͖ϭϯϯ;ϯͿ͗ϱϵϵͲϲϬϵ͘
21. Möller C, Dreborg S, Ferdousi HA, Halken S, Høst A,
Jacobsen L, et al. Pollen immunotherapy reduces the
ĚĞǀĞůŽƉŵĞŶƚ ŽĨ ĂƐƚŚŵĂ ŝŶ ĐŚŝůĚƌĞŶ ǁŝƚŚ ƐĞĂƐŽŶĂů ƌŚŝŶŽĐŽŶũƵŶĐƟǀŝƟƐ ;ƚŚĞ WdͲƐƚƵĚLJͿ͘ : ůůĞƌŐLJ ůŝŶ /ŵŵƵŶŽů͘
ϮϬϬϮ͖ϭϬϵ;ϮͿ͗ϮϱϭͲϲ͘
22. Sánchez J, Restrepo M, Diez S, Cardona R. Comparación
del efecto clínico de la inmunoterapia en pacientes
con asma alérgica según la edad y el patrón de sensibilización. Alergia, Asma e Inmunología Pediátricas.
ϮϬϭϰ͖Ϯϯ;ϭͿ͗ϲͲϭϰ͘
23. ŽƵƐƋƵĞƚ:͕>ŽĐŬĞLJZ͕DĂůůŝŶŐ,:͘ůůĞƌŐĞŶŝŵŵƵŶŽƚŚĞƌĂƉLJ͗
ƚŚĞƌĂƉĞƵƟĐǀĂĐĐŝŶĞƐĨŽƌĂůůĞƌŐŝĐĚŝƐĞĂƐĞƐ͘t,KƉŽƐŝƟŽŶ
ƉĂƉĞƌ͘:ůůĞƌŐLJůŝŶ/ŵŵƵŶŽů͘ϭϵϵϴ͖ϭϬϮ;ϰWƚϭͿ͗ϱϱϴͲϲϮ͘
24. Heinzerling LM, Burbach GJ, Edenharter G, Bachert C,
Bindslev-Jensen C, Bonini S, et al. GA(2)LEN skin test study
/͗';ϮͿ>EŚĂƌŵŽŶŝnjĂƟŽŶŽĨƐŬŝŶƉƌŝĐŬƚĞƐƟŶŐ͗ŶŽǀĞůƐĞŶƐŝƟnjĂƟŽŶƉĂƩĞƌŶƐĨŽƌŝŶŚĂůĂŶƚĂůůĞƌŐĞŶƐŝŶƵƌŽƉĞ͘ůůĞƌŐLJ͘
ϮϬϬϵ͖ϲϰ;ϭϬͿ͗ϭϰϵϴͲϱϬϲ͘
25. ŝĞůĞŶ^͕<ĂƌĚŽƐW͕DĂĚŽŶŝŶŝ͘^ƚĞƌŽŝĚͲƐƉĂƌŝŶŐĞīĞĐƚƐǁŝƚŚ
ĂůůĞƌŐĞŶͲƐƉĞĐŝĮĐŝŵŵƵŶŽƚŚĞƌĂƉLJŝŶĐŚŝůĚƌĞŶǁŝƚŚĂƐƚŚŵĂ͗
a randomized controlled trial. J Allergy Clin Immunol.
ϮϬϭϬ͖ϭϮϲ;ϱͿ͗ϵϰϮͲϵ͘
Ϯϲ͘ <ǁŽŶz^͕KŚ^,͕tƵt,͕ĂĞ'͕>ĞĞ,:͕>ĞĞD'͕ĞƚĂů͘
ĐŚĞŵŽŬŝŶĞƐĂƐƉŽƚĞŶƟĂůŝŵŵƵŶŽůŽŐŝĐŵĂƌŬĞƌƐĐŽƌƌĞůĂƚĞĚ
ǁŝƚŚĐůŝŶŝĐĂůŝŵƉƌŽǀĞŵĞŶƚŽĨĂƚŽƉŝĐĚĞƌŵĂƟƟƐƉĂƟĞŶƚƐďLJ
ŝŵŵƵŶŽƚŚĞƌĂƉLJ͘džƉĞƌŵĂƚŽů͘ϮϬϭϬ͖ϭϵ;ϯͿ͗ϮϰϲͲϱϭ͘
27. ZŽƐƐŝZ͕DŽŶĂƐƚĞƌŽůŽ'͕/ŶĐŽƌǀĂŝĂ͕DŽŝŶŐĞŽŶW͕&ƌĂƟ&͕
WĂƐƐĂůĂĐƋƵĂ'͕ĞƚĂů͘>ĂĐŬŽĨŶĞŽͲƐĞŶƐŝƟnjĂƟŽŶƚŽWĞŶĂϭ
ŝŶƉĂƟĞŶƚƐƚƌĞĂƚĞĚǁŝƚŚŵŝƚĞƐƵďůŝŶŐƵĂůŝŵŵƵŶŽƚŚĞƌĂƉLJ͘
Clin Mol Allergy. 2010;8:4.
28. ĂŶƟůůŽ:&͕WƵĞƌƚĂ>͘΀EĞǁĂƉƉƌŽĂĐŚĞƐĨŽƌĂůůĞƌŐĞŶͲƐƉĞĐŝĮĐ
ŝŵŵƵŶŽƚŚĞƌĂƉLJ΁͘ŝŽŵĞĚŝĐĂ͘ϮϬϭϬ͖ϯϬ;ϯͿ͗ϰϰϬͲϱϯ͘
Ϯϵ͘ ^ŝŵŽĞŶƐ^͘dŚĞĐŽƐƚͲĞīĞĐƟǀĞŶĞƐƐŽĨŝŵŵƵŶŽƚŚĞƌĂƉLJĨŽƌ
ƌĞƐƉŝƌĂƚŽƌLJĂůůĞƌŐLJ͗ĂƌĞǀŝĞǁ͘ůůĞƌŐLJ͘ϮϬϭϮ͖ϲϳ;ϵͿ͗ϭϬϴϳͲϭϬϱ͘
30. DĞĂĚŽǁƐ͕<ĂĂŵďǁĂ͕EŽǀŝĞůůŝE͕,ƵŝƐƐŽŽŶ͕&ƌLJͲ^ŵŝƚŚ
͕ DĞĂĚƐ ͕ Ğƚ Ăů͘ ƐLJƐƚĞŵĂƟĐ ƌĞǀŝĞǁ ĂŶĚ ĞĐŽŶŽŵŝĐ
ĞǀĂůƵĂƟŽŶ ŽĨ ƐƵďĐƵƚĂŶĞŽƵƐ ĂŶĚ ƐƵďůŝŶŐƵĂů ĂůůĞƌŐĞŶ ŝŵŵƵŶŽƚŚĞƌĂƉLJŝŶĂĚƵůƚƐĂŶĚĐŚŝůĚƌĞŶǁŝƚŚƐĞĂƐŽŶĂůĂůůĞƌŐŝĐ
ƌŚŝŶŝƟƐ͘,ĞĂůƚŚdĞĐŚŶŽůŽŐLJƐƐĞƐƐŵĞŶƚ͘ϮϬϭϯ͖ϭϳ;ϮϳͿ͘
31. Bruggenjurgen B, Reinhold T, Brehler R, Laake E, Wiese G,
DĂĐŚĂƚĞh͕ĞƚĂů͘ŽƐƚͲĞīĞĐƟǀĞŶĞƐƐŽĨƐƉĞĐŝĮĐƐƵďĐƵƚĂŶĞŽƵƐŝŵŵƵŶŽƚŚĞƌĂƉLJŝŶƉĂƟĞŶƚƐǁŝƚŚĂůůĞƌŐŝĐƌŚŝŶŝƟƐĂŶĚ
allergic asthma. Annals of allergy, asthma & immunology:
121
Revista Alergia México
ŽĸĐŝĂů ƉƵďůŝĐĂƟŽŶ ŽĨ ƚŚĞ ŵĞƌŝĐĂŶ ŽůůĞŐĞ ŽĨ ůůĞƌŐLJ͕
ƐƚŚŵĂ͕Θ/ŵŵƵŶŽůŽŐLJ͘ϮϬϬϴ͖ϭϬϭ;ϯͿ͗ϯϭϲͲϮϰ͘
32. Hankin CS, Cox L, Bronstone A, Wang Z. Allergy immunotherapy: reduced health care costs in adults and
ĐŚŝůĚƌĞŶ ǁŝƚŚ ĂůůĞƌŐŝĐ ƌŚŝŶŝƚŝƐ͘ : ůůĞƌŐLJ ůŝŶ /ŵŵƵŶŽů͘
ϮϬϭϯ͖ϭϯϭ;ϰͿ͗ϭϬϴϰͲϵϭ͘
33. ,ĂŶŬŝŶ ^͕ Ždž >͘ ůůĞƌŐLJ ŝŵŵƵŶŽƚŚĞƌĂƉLJ͗ ǁŚĂƚ ŝƐ ƚŚĞ
evidence for cost saving? Curr Opin Allergy Clin Immunol.
ϮϬϭϰ͖ϭϰ;ϰͿ͗ϯϲϯͲϳϬ͘
122
2016 abril-junio;63(2)
34. Reinhold T, Ostermann J, Thum-Oltmer S, Bruggenjurgen B.
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