Patterns of skin prick test positivity in allergic patients: usefulness of a nationwide SPT chart review

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Moral, J. Garde, T. Toral, M.J. Fuentes, N. Marco" "autores" => array:5 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Moral" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Garde" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Toral" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Fuentes" ] 4 => array:2 [ "nombre" => "N." 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Ciprandi, M. Tosca, D. Fuchs" "autores" => array:3 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Ciprandi" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Tosca" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Fuchs" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030105461100111X?idApp=UINPBA00004N" "url" => "/03010546/0000003900000006/v1_201304101057/S030105461100111X/v1_201304101057/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Patterns of skin prick test positivity in allergic patients: usefulness of a nationwide SPT chart review" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "330" "paginaFinal" => "336" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D.E. Larenas-Linnemann, G.A. Guidos Fogelbach, A. Monteverde Alatorre, A. Arias Cruz, D.D. Hernández Colín, J.A. Luna Pech, A. Medina Hernández, D. Alberto García Imperial, M.L. Cid del Prado, F.J. Linares Zapién, R.E. Huerta, J.A. Ortega Martell" "autores" => array:12 [ 0 => array:4 [ "nombre" => "D.E." "apellidos" => "Larenas-Linnemann" "email" => array:1 [ 0 => "marlar1@prodigy.net.mx" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "G.A. Guidos" "apellidos" => "Fogelbach" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A. Monteverde" "apellidos" => "Alatorre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "A. Arias" "apellidos" => "Cruz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "D.D. Hernández" "apellidos" => "Colín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "J.A. Luna" "apellidos" => "Pech" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "A. Medina" "apellidos" => "Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "D. Alberto García" "apellidos" => "Imperial" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "M.L. Cid del" "apellidos" => "Prado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "F.J. Linares" "apellidos" => "Zapién" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "j" "identificador" => "aff0050" ] ] ] 10 => array:3 [ "nombre" => "R.E." "apellidos" => "Huerta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "k" "identificador" => "aff0055" ] ] ] 11 => array:3 [ "nombre" => "J.A. Ortega" "apellidos" => "Martell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "k" "identificador" => "aff0055" ] ] ] ] "afiliaciones" => array:11 [ 0 => array:3 [ "entidad" => "Hospital Médica Sur, Mexico City, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Allergy, Centro Médico Nacional Siglo XXI, Mexico City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Allergy and Clinical Immunology, Regional hospital of ISSSTE, Hermosillo Sonora, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. José E. González” de la UANL, Monterrey, Nuevo León, Mexico" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Civil Hospital of Guadalajara ‘Juan I Menchaca’, Guadalajara, Jalisco, Mexico" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Private practice, Guadalajara, Jalisco, Mexico" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Autonomous University of Querétaro, Querétaro, Mexico" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Private practice, Querétaro, Querétaro, Mexico" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Head of Allergy and Clinical Immunology Clinic of Toluca, Estado de México, Mexico" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Center for Diagnosis and Treatment of Allergic Diseases and Asthma, Toluca, Estado de México, Mexico" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Autonomous University of the State of Hidalgo, Pachuca, Hidalgo, Mexico" "etiqueta" => "k" "identificador" => "aff0055" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3986 "Ancho" => 3458 "Tamanyo" => 839696 ] ] "descripcion" => array:1 [ "en" => "Skin prick test positivity for 10 to 13 most frequent allergens in Mexican allergic patients living in: 2a) Zone 1, Eastern part of the country, semi-hot, humid, with rainfall all year long. N=100 subjects. 2b) Zone 2. Guadalajara, semi-hot, sub-humid, with rainfall during summer. N=200 subjects. 2c) Zone 3. The centre of the country including Mexico-city, Toluca and Pachuca, temperate temperature, sub-humid, with rainfall during summer. N=1258 subjects. 2d) Zone 4. Querétaro, temperate temperature, semi-dry. N=200 subjects. 2e) Zone 5. Monterrey, semi-hot, semi-dry to dry. N=911 subjects. 2f) Zone 6. Sonora, with temperatures ranging from temperate to very hot, dry. N=1500 subjects." ] ] ] "textoCompleto" => "IntroductionThe only treatment of allergic rhinitis that interferes with the immunological alterations and the natural course of the disease is immunotherapy.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> As such, it may have long lasting and preventive effects<a class="elsevierStyleCrossRef" href="#bib0010">2</a> and lately an indication for its early use in the therapy of allergic rhinitis and asthma has been supported by experts.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Immunotherapy is allergen-specific; as a consequence an adequate diagnosis of the patient's allergies<a class="elsevierStyleCrossRef" href="#bib0020">4</a> is mandatory for immunotherapy to be effective. The composition of the panel with which diagnostic skin prick testing is performed should include all relevant allergens in the region, taking into account cross-reactivity patterns between aeroallergens.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> However, in many regions in the world a full pollen mapping is not yet a reality, making it difficult for the allergists in those countries to adequately select with which allergens to test. The current study shows that a simple retrospective chart-review of previous skin prick test (SPT) results in allergists’ offices can give a clue to the skin test sensitivity of a population in defined climatologic zones.In Mexico, only very recently attempts have been made to map the pollen count in the air of the major cities.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> As a result, a nationwide survey on which allergens are being used by Mexican allergists in SPT showed wide variation among centres. Moreover, some allergens recommended to be used in diagnostic testing in the United States and in Europe were not included.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Climate and race differences between Mexico and other areas might lead to a dissimilar sensitisation pattern and oblige Mexican allergists to adjust their diagnostic allergen panel, but this is hard to accomplish, given the scarce aerobiological data.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Also, at a national level sensitisation patterns could show divergence between regions, because of climatic diversity. Tropical humidity predominates in the Eastern and Southern part, as opposed to hot, dry desert areas in the North of the country. As such, Mexico is divided into different climatic zones by the National Institute for Statistics and Geography (Instituto Nacional de Estadística y Geografía, INEGI).<a class="elsevierStyleCrossRef" href="#bib0050">10</a> This division will be used in our present survey.The objective of our study is dual. In the first place we would like to describe the SPT sensitivity pattern of Mexico as a whole to contrast it with the patterns described in America and Europe. In second place we would like to investigate if differences exist in allergy sensitisation patterns in the various climatic zones within Mexico, as classified by INEGI (see below under methods, <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Materials and methodsThis is an observational, cross-sectional retrospective study of SPT sensitivity in various regions in Mexico carried out from January 2007 to December 2008.Allergists practicing in different regions in Mexico were asked to download into a standardised Excel spreadsheet the results of their last hundred positive SPTs, done during routine workup of clinically allergic patients in their practice, using the panel of allergen extracts, lancets and technique they normally use. Subjects of any age and sex were included, as long as they had a history of allergic rhinitis, conjunctivitis or asthma or allergic skin disease. Patients signed informed consent before the SPT, according to daily routine in each clinic.The study-centres were classified according to the climatological characteristics of their geographical position. In the world map of climates, most of the territory of Mexico is situated in the temperate temperature zone, so the division used in this study is primarily based on humidity and secondary on average temperature, see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The results for Mexico City and its two neighbouring cities, Toluca and Pachuca, will be grouped, as their climates are quite alike.For each centre the demographic data of the patients and SPT results were downloaded into a standardised Excel spreadsheet. Skin test results were tabulated as ‘positive’, ‘negative’ or ‘not done’ according to the physician's report on the clinic's SPT form and per clinic the ratio of SPT positivity was calculated for each allergen. Next, study-centres’ results were electronically grouped per climatic zone (see climatic zone distribution, <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Finally, the frequency of SPT positivity was calculated per zone. Subsequently, an average value was given for the whole country. In some zones more data could be gathered than in other zones, with just one or two study-centres. For the nationwide data, all zones were given the same weight of importance, to avoid over-representation of certain zones with a lot of centres.The routine SPT panel of allergens was used in each clinic, resulting in some allergens being tested in some clinics and not in others, as there is variation in the allergens included in the individual SPT panels of Mexican allergists.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> For that reason results are given as ratios dividing the total number of positive tests by the total number of tests done with each particular allergen. For figures and calculations only allergens which were tested in more than one study-centre will be taken into account.The data will first be presented nationwide and then per allergen group. Per climatic zone the twelve allergens that give positive SPT with major frequency will be depicted. We will describe detectable trends in SPT sensitivity comparing humid with drier zones of the Mexican Republic. Finally, Pearson's Chi-squares test will be used to calculate if statistically significant differences can be found for SPT sensitivity of some allergens between certain zones and the nationwide data as expressed by the risk ratios and their 95% confidence intervals.ResultsA total of 4169 positive skin prick tests were included.Patient characteristicsPatients’ ages ranged between 2 and 65 years, with some exceptions. 34% of the patients were diagnosed with allergic rhinitis; 17%with asthma; 44%with rhinitis and asthma; and 5% with allergic skin disease.Nationwide resultsThe single allergen which is by far the most important in causing allergic sensitisation in all regions in Mexico is house dust mite, more commonly statistically significant than all other allergens (p<0.0001). For the whole of Mexico the five most important allergens are house dust mite; tree pollen; Bermuda grass; cockroach; and cat (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Although there are marked climate differences throughout Mexico, especially in humidity, this pattern is quite consistent in all zones. Some local differences can, however, be detected.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>ArthropodsLooking at individual groups of allergens, for dust mites the extract that gives skin test positivity most frequently is Dermatophagoides pteronyssinus in all regions. Between 46-70% of all patients present a positive SPT to this allergen, with the exception of one centre in Queretaro, where only 21% of the patients had a positive result, reducing the average for that zone to 29%. Storage mites have shown positive SPT in 23-35% of the patients in one study-centre, but they have not been tested in other centres and therefore were not shown in the global presentation.Trees, grasses, and weedsFor trees, Ash (Fraxinus) and Oak (Quercus) are the two extracts that provoke a positive skin test with major frequency in the humid, sub-humid and semi-dry areas and in one centre Alder (Alnus) was found with very high frequency (52%). However, in the dry areas Ash and Oak are much less important and the most allergenic trees are Mesquite (Prosopis) and Poplar (Populus).The primary grass that sensitises Mexican allergic patients is Bermuda grass (Cynodon dactylon), followed by Kentucky Bluegrass (Poa pratense). Orchard grass (Dactylis glomerata) provoked a positive SPT in 34% of the patients in one centre, but this grass was not tested in other centres, so -as stated above- it was omitted from the global presentation. Grasses are more important in the drier areas of Mexico.False ragweed (Franseria) is the weed with the highest prevalence of SPT positivity, followed by ragweed (Ambrosia). The distribution pattern of this pollen is interesting: it is only of importance in the drier northern regions. Only false ragweed, but not ragweed, is among the 12 most important allergens nationwide, ranked 12.MouldsMoulds are a frequently found allergic sensitiser for patients in hot climates, both humid and dry (respectively, Veracruz-Eastern region and Yaqui valley-Northern region). Of all moulds Aspergillus has the highest percentage of positive skin tests.Other inhalantsOne of the most important allergens causing SPT sensitivity in Mexico are cockroaches, both the American (Periplaneta Americana) and the German (Blatella germanica). This allergen has a clear distribution in big cities and humid areas, where the ratio of sensitised patients is higher than for cat. It is of minor importance in smaller cities with a semi-humid to dry climate (Toluca, Pachuca, Querétaro) where SPT positivity to cat becomes more frequent.Results per climatic zoneIf the regions of the Mexican Republic are divided according to humidity, taking temperature only as a secondary factor (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), the following trends can be observed when analysing results from Zone 1 to Zone 6.Data from the Eastern region of the National Health Security Institute (Instituto Mexicano del Seguro Social), involving mostly the humid state of Veracruz, show house dust mite is the most important allergen, followed by various trees and cockroaches. In this hot and humid climate Zone 1, moulds frequently cause allergy. Only around 10% of the patients are sensitised to weeds and grasses (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>a).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>In the sub-humid zones (Guadalajara, Mexico City, Pachuca, Toluca) apart from house dust mites, trees and cockroaches, grasses become important with Bermuda grass in the first place (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>b-c).Moving on to the semi-dry climate of Queretaro (Zone 4, <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>d) weeds start appearing among the 10 most important allergens, and in still drier climates -apart from the importance of weeds- there is a change in the families of trees that cause a wheal with the SPT, moving away from the Fagaceae (Quercus), Betulaceae (Alnus) and Oleaceae (Fraxinus, Ligustrum) toward trees which are more resistant to drought: Mesquite and Poplar (Zones 5 and 6, <a class="elsevierStyleCrossRef" href="#fig0010">Figs. 2e and f</a>).SPT positivity for Aspergillus is more frequent in the Eastern zone than in the rest of Mexico (with the exception of the North) with statistical significance (p=0.003, Risk Ratio: 2.25; 95% CI: 1.351<R.R.<3.757). In the Northern dry and hot zone both Aspergillus (p < 0.0001; Risk Ratio: 3.36; 95% CI: 2.8039PolysensitisationMost of our study-subjects presented polysensitisation, with monosensitised patients varying between zero (Civil Hospital of Guadalajara ‘Juan I Menchaca’, Guadalajara) and 10.4% (Hospital Juarez, Mexico City).DiscussionWith the current survey we showed that a simple well-structured chart-review of SPT positivity in multiple clinics can result in useful data on sensitisation in allergic patients, which are in line with the climatic conditions reported by national institutes.For the allergic patients in Mexico the most frequent allergen causing SPT sensitivity is Dermatophagoides pteronyssinus, followed by trees, and cockroaches. Some patterns can be detected in SPT sensitivity according to the different climatic zones in Mexico, varying from tropical humid, through sub-humid temperate to hot dry desert climates. Statistically significant differences can be found between the frequencies with which certain allergens cause SPT sensitivity in some zones in comparison with others.The present investigation is a retrospective study in which each clinic was allowed to use their own SPT routine, without standardising between centres. As such, allergen panels, quality of the allergens used for SPT and skin prick test technique varied between centres.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> These are probably confounding factors. To reduce bias, the allergens that were tested in one only study-centre were not taken into account for the presentation of the global data. In some cases, however, their SPT positivity was over 20%. Those cases have been mentioned in the results section, as they might present important exploring areas for the future: for example the storage mites and Orchard grass.Two zones had a very high number of patients, which might skew the nationwide results if they had been given a weight according to the number of patients included. To avoid this confounding factor it was decided to give the same weight to all zones for the calculation of the nationwide data and only average the percentages.Even though our study has the methodological shortcomings of being a retrospective, observational study, some interesting points can be learnt from the present work. Despite the fact that there are large climate differences throughout the Republic of Mexico, in all tested areas Dermatophagoides pteronyssinus is the most important allergen. Three previous studies in Mexico City pointed at this same allergen<a class="elsevierStyleCrossRef" href="#bib0060">12</a> (Espinosa Leal, personal communication; Cariño, personal communication). This is in accordance with the findings of both a pan-European<a class="elsevierStyleCrossRef" href="#bib0065">13</a> and an American<a class="elsevierStyleCrossRef" href="#bib0070">14</a> study on the prevalence of SPT sensitivity, and of a very recent study in France,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> all reporting that the main allergen causing sensitisation is house dust mite. However, the second most important allergen found in Mexico is Ash tree pollen, as opposed to grass pollen in the pan-European, American and French reports. In Italy, grass pollen was far more important than perennial allergens.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> The third allergen in the NHANES III survey in the US was ragweed, immediately followed by cockroach; in the pan-European survey;<a class="elsevierStyleCrossRef" href="#bib0065">13</a> and the French<a class="elsevierStyleCrossRef" href="#bib0075">15</a> study it was cat. In Mexico, cockroach and cat sensitisations were also frequent, coming in fifth and sixth places, preceded by Bermuda grass and Alder.Looking at individual groups of allergens we find that the specific skin test sensitivity to grass differs in Mexico from the US and Europe. In Mexico, Bermuda grass sensitisation is by far the most frequent, while in the US the prime grass allergen is Lolium perenne and in Europe it is Phleum pratense, two species with high cross-reactivity, which they do not share with Bermuda grass.<a class="elsevierStyleCrossRefs" href="#bib0020">4,6</a> The most important trees causing skin sensitisation in allergic patients in Mexico were Ash (Fraxinus), Alder (Alnus) and members of the Cupressaceae family, all trees growing in moist to wet soil. They are somewhat related to Oak and Birch, the most frequent skin sensitisers in the US and Europe, respectively, but have definitely their own allergens and should as such be skin prick tested separately.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> In the semi-dry to dry climate zone in the North of Mexico these trees can hardly be found. The few trees still thriving under these conditions are trees resistant to droughts, adapted to arid soil due to an extremely deep root system: the Mesquite (Prosopis) and Poplar (Populus). Finally, ragweed, a very important cause of allergy in the US, is not of prime importance in Mexico. In our study the weed most frequently causing skin sensitivity was false ragweed, Franseria, a plant growing in the dry desert climate zone in North Mexico and part of the family of the Ambrosiaceae.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> In general, we found weeds gained some significance in this Northern zone, but in many other areas weeds did not even appear among the first 12 allergens.Polysensitisation in Mexico is very common and in some centres no monosensitised patients could be detected, this is in contrast to the recent French study reporting 36% of the patients to be monosensitised.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>Aerobiological reports are still scarce in Mexico, but some data do exist for Mexico City and Monterrey.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Results from this kind of air-sampling only partly reflect what can be seen in the sense of skin sensitivity. Some pollen is highly concentrated in the air during a given season, but causes relatively few allergic reactions (e.g. Cypress). For the selection of the optimal SPT panel, aerobiology data can only be of limited help and analysing results from previously done skin tests might be of higher value.For the future two further studies might be planned, to even further disclose the aeroallergens that cause allergic symptoms in Mexican patients. In the first place, a similar study as the one presented here, but using a prospective design and the same panel of allergens, allergen provider and technique of application and documentation in all study-centres. This could lead to more reliable results. In such a study pan-allergens, such as lipid transfer protein and profilin should also be included in the test-panel. In the second place, in vitro allergy diagnostic testing is gaining in accuracy with speed. One of the techniques -using micro-array plates- allows for the detection of specific IgE to a vast range of allergenic epitopes with minor quantities of patient's sera. This technique might give way to the discovery of other aeroallergens to which the patient is sensitised and that are not routinely used in skin prick testing.It can be concluded that the most important aeroallergens in Mexico, causing SPT positivity in clinically allergic patients, are partly dissimilar from the most important allergens found in European and American surveys. A specific sensitisation pattern for Mexican allergic patients is presented, given the fact that the grasses and weeds that cause positive SPT most often in Mexico are different from the ones found in the United States of America and in Europe. In general, allergists should be well acquainted with the skin test sensitisation pattern of their population, in order to select the optimum SPT panel for their allergy clinic. Using solely aerobiological data to select the optimal skin testing panel is not recommendable. A retrospective observational study of structured SPT chart-review, such as the one here presented, is more suitable for this goal, is not too laborious to conduct and could raise useful data also in other parts of the world to guide allergists in the correct selection of their SPT allergen-panel.FundingThe study has been conducted as part of a set of studies undertaken by the Immunotherapy Committee of the Colegio Mexicano de Inmunología Clínica y Alergia (CMICA), and was done with the good-will of the participating centres in the spare time of the investigators, without any external funding.Conflict of interestNo specific conflict of interest can be detected." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres86015" "titulo" => array:5 [ 0 => "Abstract" 1 => "Background" 2 => "Methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec74196" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 4 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Patient characteristics" ] ] ] 5 => array:3 [ "identificador" => "sec0025" "titulo" => "Nationwide results" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Arthropods" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Trees, grasses, and weeds" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Moulds" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Other inhalants" ] 4 => array:2 [ "identificador" => "sec0050" "titulo" => "Results per climatic zone" ] 5 => array:2 [ "identificador" => "sec0055" "titulo" => "Polysensitisation" ] ] ] 6 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Funding" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack31838" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-08-22" "fechaAceptado" => "2010-09-28" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec74196" "palabras" => array:5 [ 0 => "Allergic rhinitis" 1 => "Allergy diagnosis" 2 => "House dust mite" 3 => "Pollen allergy" 4 => "Skin prick test" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "BackgroundA previous survey on allergens used by Mexican allergists in their skin prick test (SPT) panel showed wide variation. Humidity varies in different zones of Mexico. This might lead to differences in natural exposure and allergic sensitisation throughout the country. We aim to describe the SPT sensitivity patterns in the different climatic zones in Mexico and to show the usefulness of a structured SPT chart-review including multiple clinics in obtaining these allergen sensitisation patterns. Methods: A retrospective, structured chart-review of SPT results was undertaken in allergy clinics throughout Mexico. Ratios of SPT positivity were calculated for individual allergens, per climatic zone and nation-wide. Per allergen group the most important allergens were identified. Statistically significant differences between zones and the nation-wide data were tested with Pearson's Chi-squares test. Results4169 skin test charts were recollected. The most important allergens causing sensitisation were very similar in different zones, despite climate variation. The allergen with highest ratio of SPT positivity was Dermatophagoides pteronyssinus (51%), with trees (Ash-27%, Alder-22%, Oak19%), and Bermuda grass (26%) as second and third. In the hot zones (humid and dry) Aspergillus was statistically significant more frequently than in more temperate zones. Cockroaches thrive in big cities and humid zones and Mesquite and Poplar in dry zones. Weeds are less important. ConclusionMexico has its own SPT sensitisation pattern, which is different from America and Europe. A structured chart-review of SPT results is able to show this and might be a tool for allergists in other countries." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1687 "Ancho" => 2472 "Tamanyo" => 205912 ] ] "descripcion" => array:1 [ "en" => "Nationwide data of skin prick test positivity for the 12 most frequent allergens in Mexican allergic patients. Data were obtained by calculating the average values for SPT positivity of each allergen in each of the six different climatic zones in Mexico. N = 4169 subjects. Pearson's Chi-squares (all with 1 degree of freedom): Dpt versus Ash p<0.0001 (Risk Ratio: 1.88; 95% CI: 1.755<0.0013 (Risk Ratio: 1.24; 95% CI: 1.0847<0.0001 (Risk Ratio: 1.36; 95% CI: 1.2228<0.0001 (Risk Ratio: 1.6; 95% CI: 1.4131" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3986 "Ancho" => 3458 "Tamanyo" => 839696 ] ] "descripcion" => array:1 [ "en" => "Skin prick test positivity for 10 to 13 most frequent allergens in Mexican allergic patients living in: 2a) Zone 1, Eastern part of the country, semi-hot, humid, with rainfall all year long. N=100 subjects. 2b) Zone 2. Guadalajara, semi-hot, sub-humid, with rainfall during summer. N=200 subjects. 2c) Zone 3. The centre of the country including Mexico-city, Toluca and Pachuca, temperate temperature, sub-humid, with rainfall during summer. N=1258 subjects. 2d) Zone 4. Querétaro, temperate temperature, semi-dry. N=200 subjects. 2e) Zone 5. Monterrey, semi-hot, semi-dry to dry. N=911 subjects. 2f) Zone 6. Sonora, with temperatures ranging from temperate to very hot, dry. N=1500 subjects." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Climatic zone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Humidity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Temperature \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zone 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Eastern part \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Humid, with rainfall all year long \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Semi-hot \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zone 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Guadalajara \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sub-humid, with rainfall during summer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Semi-hot \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zone 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mexico City<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sub-humid, with rainfall during summer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Temperate</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zone 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Toluca<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zone 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pachuca<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sub-humid, with rainfall during summer and semi-dry \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zone 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Querétaro \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Semi-dry \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Temperate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zone 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monterrey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Semi-dry to dry \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Semi-hot \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zone 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sonora \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dry \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hermosillo: Temperate Cd.Obregón: Hot to very hot \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab165260.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "These data will be grouped together in the analysis, as there are no major differences in climate." ] ] ] "descripcion" => array:1 [ "en" => "Classification into climatic zones of the study-centres according to the climatic characteristics of their geographical position." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grass pollen immunotherapy: IL-10 induction and suppression of late responses precedes IgG4 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Ciencia UANL 2008;XI:69–76." ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack31838" "titulo" => "Acknowledgements" "texto" => "We would like to thank the following allergists, many of them Head of the Department of Allergy of their respective hospitals: José G. Huerta-López of the National Institute of Pediatrics, Mexico City; Blanca del Río Navarro and Virginia Blandón of the Pediatric Hospital of Mexico, Mexico City; María Isabel Rojo and Daniel Aguilar of Hospital Juarez, Mexico City; and Sandra Nora González Díaz from the University Hospital of Nuevo León, Monterrey, for allowing us to compile data from the files of their departments in the different hospitals throughout Mexico City. Moreover, we thank José Cariño for sharing his personal data of a previous study on the subject carried out in Mexico City around the end of the past century." ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000003900000006/v1_201304101057/S0301054610002855/v1_201304101057/en/main.assets" "Apartado" => array:4 [ "identificador" => "5554" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000003900000006/v1_201304101057/S0301054610002855/v1_201304101057/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054610002855?idApp=UINPBA00004N"]

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Original Article

D.E. Larenas-Linnemanna,

Corresponding author

marlar1@prodigy.net.mx

Corresponding author.

, G.A. Guidos Fogelbachb, A. Monteverde Alatorrec, A. Arias Cruzd, D.D. Hernández Colíne, J.A. Luna Pechf, A. Medina Hernándezg, D. Alberto García Imperialh, M.L. Cid del Pradoi, F.J. Linares Zapiénj, R.E. Huertak, J.A. Ortega Martellk

a Hospital Médica Sur, Mexico City, Mexico

b Department of Allergy, Centro Médico Nacional Siglo XXI, Mexico City, Mexico

c Department of Allergy and Clinical Immunology, Regional hospital of ISSSTE, Hermosillo Sonora, Mexico

d Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. José E. González” de la UANL, Monterrey, Nuevo León, Mexico

e Civil Hospital of Guadalajara ‘Juan I Menchaca’, Guadalajara, Jalisco, Mexico

f Private practice, Guadalajara, Jalisco, Mexico

g Autonomous University of Querétaro, Querétaro, Mexico

h Private practice, Querétaro, Querétaro, Mexico

i Head of Allergy and Clinical Immunology Clinic of Toluca, Estado de México, Mexico

j Center for Diagnosis and Treatment of Allergic Diseases and Asthma, Toluca, Estado de México, Mexico

k Autonomous University of the State of Hidalgo, Pachuca, Hidalgo, Mexico

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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Skin prick test positivity for 10 to 13 most frequent allergens in Mexican allergic patients living in&#58;</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2a&#41;</span> Zone 1&#44; Eastern part of the country&#44; semi-hot&#44; humid&#44; with rainfall all year long&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100 subjects&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2b&#41;</span> Zone 2&#46; Guadalajara&#44; semi-hot&#44; sub-humid&#44; with rainfall during summer&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>200 subjects&#46;</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2c&#41;</span> Zone 3&#46; The centre of the country including Mexico-city&#44; Toluca and Pachuca&#44; temperate temperature&#44; sub-humid&#44; with rainfall during summer&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1258 subjects&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2d&#41;</span> Zone 4&#46; Quer&#233;taro&#44; temperate temperature&#44; semi-dry&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>200 subjects&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2e&#41;</span> Zone 5&#46; Monterrey&#44; semi-hot&#44; semi-dry to dry&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>911 subjects&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2f&#41;</span> Zone 6&#46; Sonora&#44; with temperatures ranging from temperate to very hot&#44; dry&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1500 subjects&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The only treatment of allergic rhinitis that interferes with the immunological alterations and the natural course of the disease is immunotherapy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> As such&#44; it may have long lasting and preventive effects<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and lately an indication for its early use in the therapy of allergic rhinitis and asthma has been supported by experts&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Immunotherapy is allergen-specific&#59; as a consequence an adequate diagnosis of the patient&#39;s allergies<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> is mandatory for immunotherapy to be effective&#46; The composition of the panel with which diagnostic skin prick testing is performed should include all relevant allergens in the region&#44; taking into account cross-reactivity patterns between aeroallergens&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> However&#44; in many regions in the world a full pollen mapping is not yet a reality&#44; making it difficult for the allergists in those countries to adequately select with which allergens to test&#46; The current study shows that a simple retrospective chart-review of previous skin prick test &#40;SPT&#41; results in allergists&#8217; offices can give a clue to the skin test sensitivity of a population in defined climatologic zones&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In Mexico&#44; only very recently attempts have been made to map the pollen count in the air of the major cities&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> As a result&#44; a nationwide survey on which allergens are being used by Mexican allergists in SPT showed wide variation among centres&#46; Moreover&#44; some allergens recommended to be used in diagnostic testing in the United States and in Europe were not included&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Climate and race differences between Mexico and other areas might lead to a dissimilar sensitisation pattern and oblige Mexican allergists to adjust their diagnostic allergen panel&#44; but this is hard to accomplish&#44; given the scarce aerobiological data&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Also&#44; at a national level sensitisation patterns could show divergence between regions&#44; because of climatic diversity&#46; Tropical humidity predominates in the Eastern and Southern part&#44; as opposed to hot&#44; dry desert areas in the North of the country&#46; As such&#44; Mexico is divided into different climatic zones by the National Institute for Statistics and Geography &#40;Instituto Nacional de Estad&#237;stica y Geograf&#237;a&#44; INEGI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> This division will be used in our present survey&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of our study is dual&#46; In the first place we would like to describe the SPT sensitivity pattern of Mexico as a whole to contrast it with the patterns described in America and Europe&#46; In second place we would like to investigate if differences exist in allergy sensitisation patterns in the various climatic zones within Mexico&#44; as classified by INEGI &#40;see below under methods&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is an observational&#44; cross-sectional retrospective study of SPT sensitivity in various regions in Mexico carried out from January 2007 to December 2008&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Allergists practicing in different regions in Mexico were asked to download into a standardised Excel spreadsheet the results of their last hundred positive SPTs&#44; done during routine workup of clinically allergic patients in their practice&#44; using the panel of allergen extracts&#44; lancets and technique they normally use&#46; Subjects of any age and sex were included&#44; as long as they had a history of allergic rhinitis&#44; conjunctivitis or asthma or allergic skin disease&#46; Patients signed informed consent before the SPT&#44; according to daily routine in each clinic&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The study-centres were classified according to the climatological characteristics of their geographical position&#46; In the world map of climates&#44; most of the territory of Mexico is situated in the temperate temperature zone&#44; so the division used in this study is primarily based on humidity and secondary on average temperature&#44; see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The results for Mexico City and its two neighbouring cities&#44; Toluca and Pachuca&#44; will be grouped&#44; as their climates are quite alike&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For each centre the demographic data of the patients and SPT results were downloaded into a standardised Excel spreadsheet&#46; Skin test results were tabulated as &#8216;positive&#8217;&#44; &#8216;negative&#8217; or &#8216;not done&#8217; according to the physician&#39;s report on the clinic&#39;s SPT form and per clinic the ratio of SPT positivity was calculated for each allergen&#46; Next&#44; study-centres&#8217; results were electronically grouped per climatic zone &#40;see climatic zone distribution&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Finally&#44; the frequency of SPT positivity was calculated per zone&#46; Subsequently&#44; an average value was given for the whole country&#46; In some zones more data could be gathered than in other zones&#44; with just one or two study-centres&#46; For the nationwide data&#44; all zones were given the same weight of importance&#44; to avoid over-representation of certain zones with a lot of centres&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The routine SPT panel of allergens was used in each clinic&#44; resulting in some allergens being tested in some clinics and not in others&#44; as there is variation in the allergens included in the individual SPT panels of Mexican allergists&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> For that reason results are given as ratios dividing the total number of positive tests by the total number of tests done with each particular allergen&#46; For figures and calculations only allergens which were tested in more than one study-centre will be taken into account&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The data will first be presented nationwide and then per allergen group&#46; Per climatic zone the twelve allergens that give positive SPT with major frequency will be depicted&#46; We will describe detectable trends in SPT sensitivity comparing humid with drier zones of the Mexican Republic&#46; Finally&#44; Pearson&#39;s Chi-squares test will be used to calculate if statistically significant differences can be found for SPT sensitivity of some allergens between certain zones and the nationwide data as expressed by the risk ratios and their 95&#37; confidence intervals&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">A total of 4169 positive skin prick tests were included&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patient characteristics</span><p id="par0055" class="elsevierStylePara elsevierViewall">Patients&#8217; ages ranged between 2 and 65 years&#44; with some exceptions&#46; 34&#37; of the patients were diagnosed with allergic rhinitis&#59; 17&#37;with asthma&#59; 44&#37;with rhinitis and asthma&#59; and 5&#37; with allergic skin disease&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Nationwide results</span><p id="par0060" class="elsevierStylePara elsevierViewall">The single allergen which is by far the most important in causing allergic sensitisation in all regions in Mexico is house dust mite&#44; more commonly statistically significant than all other allergens &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; For the whole of Mexico the five most important allergens are house dust mite&#59; tree pollen&#59; Bermuda grass&#59; cockroach&#59; and cat &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Although there are marked climate differences throughout Mexico&#44; especially in humidity&#44; this pattern is quite consistent in all zones&#46; Some local differences can&#44; however&#44; be detected&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Arthropods</span><p id="par0065" class="elsevierStylePara elsevierViewall">Looking at individual groups of allergens&#44; for dust mites the extract that gives skin test positivity most frequently is <span class="elsevierStyleItalic">Dermatophagoides pteronyssinus</span> in all regions&#46; Between 46-70&#37; of all patients present a positive SPT to this allergen&#44; with the exception of one centre in Queretaro&#44; where only 21&#37; of the patients had a positive result&#44; reducing the average for that zone to 29&#37;&#46; Storage mites have shown positive SPT in 23-35&#37; of the patients in one study-centre&#44; but they have not been tested in other centres and therefore were not shown in the global presentation&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Trees&#44; grasses&#44; and weeds</span><p id="par0070" class="elsevierStylePara elsevierViewall">For trees&#44; Ash &#40;<span class="elsevierStyleItalic">Fraxinus</span>&#41; and Oak &#40;<span class="elsevierStyleItalic">Quercus</span>&#41; are the two extracts that provoke a positive skin test with major frequency in the humid&#44; sub-humid and semi-dry areas and in one centre Alder &#40;<span class="elsevierStyleItalic">Alnus</span>&#41; was found with very high frequency &#40;52&#37;&#41;&#46; However&#44; in the dry areas Ash and Oak are much less important and the most allergenic trees are Mesquite &#40;<span class="elsevierStyleItalic">Prosopis</span>&#41; and Poplar &#40;<span class="elsevierStyleItalic">Populus</span>&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The primary grass that sensitises Mexican allergic patients is Bermuda grass &#40;<span class="elsevierStyleItalic">Cynodon dactylon</span>&#41;&#44; followed by Kentucky Bluegrass &#40;<span class="elsevierStyleItalic">Poa pratense</span>&#41;&#46; Orchard grass &#40;<span class="elsevierStyleItalic">Dactylis glomerata</span>&#41; provoked a positive SPT in 34&#37; of the patients in one centre&#44; but this grass was not tested in other centres&#44; so -as stated above- it was omitted from the global presentation&#46; Grasses are more important in the drier areas of Mexico&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">False ragweed &#40;<span class="elsevierStyleItalic">Franseria</span>&#41; is the weed with the highest prevalence of SPT positivity&#44; followed by ragweed &#40;<span class="elsevierStyleItalic">Ambrosia</span>&#41;&#46; The distribution pattern of this pollen is interesting&#58; it is only of importance in the drier northern regions&#46; Only false ragweed&#44; but not ragweed&#44; is among the 12 most important allergens nationwide&#44; ranked 12&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Moulds</span><p id="par0085" class="elsevierStylePara elsevierViewall">Moulds are a frequently found allergic sensitiser for patients in hot climates&#44; both humid and dry &#40;respectively&#44; Veracruz-Eastern region and Yaqui valley-Northern region&#41;&#46; Of all moulds <span class="elsevierStyleItalic">Aspergillus</span> has the highest percentage of positive skin tests&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Other inhalants</span><p id="par0090" class="elsevierStylePara elsevierViewall">One of the most important allergens causing SPT sensitivity in Mexico are cockroaches&#44; both the American &#40;<span class="elsevierStyleItalic">Periplaneta Americana</span>&#41; and the German &#40;<span class="elsevierStyleItalic">Blatella germanica</span>&#41;&#46; This allergen has a clear distribution in big cities and humid areas&#44; where the ratio of sensitised patients is higher than for cat&#46; It is of minor importance in smaller cities with a semi-humid to dry climate &#40;Toluca&#44; Pachuca&#44; Quer&#233;taro&#41; where SPT positivity to cat becomes more frequent&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results per climatic zone</span><p id="par0095" class="elsevierStylePara elsevierViewall">If the regions of the Mexican Republic are divided according to humidity&#44; taking temperature only as a secondary factor &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; the following trends can be observed when analysing results from Zone 1 to Zone 6&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Data from the Eastern region of the National Health Security Institute &#40;Instituto Mexicano del Seguro Social&#41;&#44; involving mostly the humid state of Veracruz&#44; show house dust mite is the most important allergen&#44; followed by various trees and cockroaches&#46; In this hot and humid climate Zone 1&#44; moulds frequently cause allergy&#46; Only around 10&#37; of the patients are sensitised to weeds and grasses &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">In the sub-humid zones &#40;Guadalajara&#44; Mexico City&#44; Pachuca&#44; Toluca&#41; apart from house dust mites&#44; trees and cockroaches&#44; grasses become important with Bermuda grass in the first place &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b-c&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Moving on to the semi-dry climate of Queretaro &#40;Zone 4&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>d&#41; weeds start appearing among the 10 most important allergens&#44; and in still drier climates -apart from the importance of weeds- there is a change in the families of trees that cause a wheal with the SPT&#44; moving away from the Fagaceae &#40;<span class="elsevierStyleItalic">Quercus</span>&#41;&#44; Betulaceae &#40;<span class="elsevierStyleItalic">Alnus</span>&#41; and Oleaceae &#40;<span class="elsevierStyleItalic">Fraxinus</span>&#44; <span class="elsevierStyleItalic">Ligustrum</span>&#41; toward trees which are more resistant to drought&#58; Mesquite and Poplar &#40;Zones 5 and 6&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Figs&#46; 2e and f</a>&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">SPT positivity for <span class="elsevierStyleItalic">Aspergillus</span> is more frequent in the Eastern zone than in the rest of Mexico &#40;with the exception of the North&#41; with statistical significance &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#44; Risk Ratio&#58; 2&#46;25&#59; 95&#37; CI&#58; 1&#46;351<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>R&#46;R&#46;&#60;3&#46;757&#41;&#46; In the Northern dry and hot zone both <span class="elsevierStyleItalic">Aspergillus</span> &#40;p &#60; 0&#46;0001&#59; Risk Ratio&#58; 3&#46;36&#59; 95&#37; CI&#58; 2&#46;8039</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Polysensitisation</span><p id="par0120" class="elsevierStylePara elsevierViewall">Most of our study-subjects presented polysensitisation&#44; with monosensitised patients varying between zero &#40;Civil Hospital of Guadalajara &#8216;Juan I Menchaca&#8217;&#44; Guadalajara&#41; and 10&#46;4&#37; &#40;Hospital Juarez&#44; Mexico City&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">With the current survey we showed that a simple well-structured chart-review of SPT positivity in multiple clinics can result in useful data on sensitisation in allergic patients&#44; which are in line with the climatic conditions reported by national institutes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">For the allergic patients in Mexico the most frequent allergen causing SPT sensitivity is <span class="elsevierStyleItalic">Dermatophagoides pteronyssinus</span>&#44; followed by trees&#44; and cockroaches&#46; Some patterns can be detected in SPT sensitivity according to the different climatic zones in Mexico&#44; varying from tropical humid&#44; through sub-humid temperate to hot dry desert climates&#46; Statistically significant differences can be found between the frequencies with which certain allergens cause SPT sensitivity in some zones in comparison with others&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The present investigation is a retrospective study in which each clinic was allowed to use their own SPT routine&#44; without standardising between centres&#46; As such&#44; allergen panels&#44; quality of the allergens used for SPT and skin prick test technique varied between centres&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> These are probably confounding factors&#46; To reduce bias&#44; the allergens that were tested in one only study-centre were not taken into account for the presentation of the global data&#46; In some cases&#44; however&#44; their SPT positivity was over 20&#37;&#46; Those cases have been mentioned in the results section&#44; as they might present important exploring areas for the future&#58; for example the storage mites and Orchard grass&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Two zones had a very high number of patients&#44; which might skew the nationwide results if they had been given a weight according to the number of patients included&#46; To avoid this confounding factor it was decided to give the same weight to all zones for the calculation of the nationwide data and only average the percentages&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Even though our study has the methodological shortcomings of being a retrospective&#44; observational study&#44; some interesting points can be learnt from the present work&#46; Despite the fact that there are large climate differences throughout the Republic of Mexico&#44; in all tested areas <span class="elsevierStyleItalic">Dermatophagoides pteronyssinus</span> is the most important allergen&#46; Three previous studies in Mexico City pointed at this same allergen<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> &#40;Espinosa Leal&#44; personal communication&#59; Cari&#241;o&#44; personal communication&#41;&#46; This is in accordance with the findings of both a pan-European<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and an American<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> study on the prevalence of SPT sensitivity&#44; and of a very recent study in France&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> all reporting that the main allergen causing sensitisation is house dust mite&#46; However&#44; the second most important allergen found in Mexico is Ash tree pollen&#44; as opposed to grass pollen in the pan-European&#44; American and French reports&#46; In Italy&#44; grass pollen was far more important than perennial allergens&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The third allergen in the NHANES III survey in the US was ragweed&#44; immediately followed by cockroach&#59; in the pan-European survey&#59;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and the French<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> study it was cat&#46; In Mexico&#44; cockroach and cat sensitisations were also frequent&#44; coming in fifth and sixth places&#44; preceded by Bermuda grass and Alder&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Looking at individual groups of allergens we find that the specific skin test sensitivity to grass differs in Mexico from the US and Europe&#46; In Mexico&#44; Bermuda grass sensitisation is by far the most frequent&#44; while in the US the prime grass allergen is <span class="elsevierStyleItalic">Lolium perenne</span> and in Europe it is <span class="elsevierStyleItalic">Phleum pratense</span>&#44; two species with high cross-reactivity&#44; which they do not share with Bermuda grass&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6</span></a> The most important trees causing skin sensitisation in allergic patients in Mexico were Ash &#40;<span class="elsevierStyleItalic">Fraxinus</span>&#41;&#44; Alder &#40;<span class="elsevierStyleItalic">Alnus</span>&#41; and members of the <span class="elsevierStyleItalic">Cupressaceae</span> family&#44; all trees growing in moist to wet soil&#46; They are somewhat related to Oak and Birch&#44; the most frequent skin sensitisers in the US and Europe&#44; respectively&#44; but have definitely their own allergens and should as such be skin prick tested separately&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In the semi-dry to dry climate zone in the North of Mexico these trees can hardly be found&#46; The few trees still thriving under these conditions are trees resistant to droughts&#44; adapted to arid soil due to an extremely deep root system&#58; the Mesquite &#40;Prosopis&#41; and Poplar &#40;Populus&#41;&#46; Finally&#44; ragweed&#44; a very important cause of allergy in the US&#44; is not of prime importance in Mexico&#46; In our study the weed most frequently causing skin sensitivity was false ragweed&#44; <span class="elsevierStyleItalic">Franseria</span>&#44; a plant growing in the dry desert climate zone in North Mexico and part of the family of the Ambrosiaceae&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In general&#44; we found weeds gained some significance in this Northern zone&#44; but in many other areas weeds did not even appear among the first 12 allergens&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Polysensitisation in Mexico is very common and in some centres no monosensitised patients could be detected&#44; this is in contrast to the recent French study reporting 36&#37; of the patients to be monosensitised&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Aerobiological reports are still scarce in Mexico&#44; but some data do exist for Mexico City and Monterrey&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Results from this kind of air-sampling only partly reflect what can be seen in the sense of skin sensitivity&#46; Some pollen is highly concentrated in the air during a given season&#44; but causes relatively few allergic reactions &#40;e&#46;g&#46; Cypress&#41;&#46; For the selection of the optimal SPT panel&#44; aerobiology data can only be of limited help and analysing results from previously done skin tests might be of higher value&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">For the future two further studies might be planned&#44; to even further disclose the aeroallergens that cause allergic symptoms in Mexican patients&#46; In the first place&#44; a similar study as the one presented here&#44; but using a prospective design and the same panel of allergens&#44; allergen provider and technique of application and documentation in all study-centres&#46; This could lead to more reliable results&#46; In such a study pan-allergens&#44; such as lipid transfer protein and profilin should also be included in the test-panel&#46; In the second place&#44; in vitro allergy diagnostic testing is gaining in accuracy with speed&#46; One of the techniques -using micro-array plates- allows for the detection of specific IgE to a vast range of allergenic epitopes with minor quantities of patient&#39;s sera&#46; This technique might give way to the discovery of other aeroallergens to which the patient is sensitised and that are not routinely used in skin prick testing&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">It can be concluded that the most important aeroallergens in Mexico&#44; causing SPT positivity in clinically allergic patients&#44; are partly dissimilar from the most important allergens found in European and American surveys&#46; A specific sensitisation pattern for Mexican allergic patients is presented&#44; given the fact that the grasses and weeds that cause positive SPT most often in Mexico are different from the ones found in the United States of America and in Europe&#46; In general&#44; allergists should be well acquainted with the skin test sensitisation pattern of their population&#44; in order to select the optimum SPT panel for their allergy clinic&#46; Using solely aerobiological data to select the optimal skin testing panel is not recommendable&#46; A retrospective observational study of structured SPT chart-review&#44; such as the one here presented&#44; is more suitable for this goal&#44; is not too laborious to conduct and could raise useful data also in other parts of the world to guide allergists in the correct selection of their SPT allergen-panel&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">The study has been conducted as part of a set of studies undertaken by the Immunotherapy Committee of the <span class="elsevierStyleItalic">Colegio Mexicano de Inmunolog&#237;a Cl&#237;nica y Alergia</span> &#40;CMICA&#41;&#44; and was done with the good-will of the participating centres in the spare time of the investigators&#44; without any external funding&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">No specific conflict of interest can be detected&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and methods"
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              "titulo" => "Patient characteristics"
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        5 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Nationwide results"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Arthropods"
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            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Trees&#44; grasses&#44; and weeds"
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            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Moulds"
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            3 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Other inhalants"
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            4 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Results per climatic zone"
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            5 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Polysensitisation"
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        ]
        6 => array:2 [
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          "titulo" => "Discussion"
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        7 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Funding"
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        8 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conflict of interest"
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        9 => array:2 [
          "identificador" => "xack31838"
          "titulo" => "Acknowledgements"
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        10 => array:1 [
          "titulo" => "References"
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      ]
    ]
    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2010-08-22"
    "fechaAceptado" => "2010-09-28"
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        0 => array:4 [
          "clase" => "keyword"
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          "identificador" => "xpalclavsec74196"
          "palabras" => array:5 [
            0 => "Allergic rhinitis"
            1 => "Allergy diagnosis"
            2 => "House dust mite"
            3 => "Pollen allergy"
            4 => "Skin prick test"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A previous survey on allergens used by Mexican allergists in their skin prick test &#40;SPT&#41; panel showed wide variation&#46; Humidity varies in different zones of Mexico&#46; This might lead to differences in natural exposure and allergic sensitisation throughout the country&#46; We aim to describe the SPT sensitivity patterns in the different climatic zones in Mexico and to show the usefulness of a structured SPT chart-review including multiple clinics in obtaining these allergen sensitisation patterns&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#58; A retrospective&#44; structured chart-review of SPT results was undertaken in allergy clinics throughout Mexico&#46; Ratios of SPT positivity were calculated for individual allergens&#44; per climatic zone and nation-wide&#46; Per allergen group the most important allergens were identified&#46; Statistically significant differences between zones and the nation-wide data were tested with Pearson&#39;s Chi-squares test&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">4169 skin test charts were recollected&#46; The most important allergens causing sensitisation were very similar in different zones&#44; despite climate variation&#46; The allergen with highest ratio of SPT positivity was <span class="elsevierStyleItalic">Dermatophagoides pteronyssinus</span> &#40;51&#37;&#41;&#44; with trees &#40;Ash-27&#37;&#44; Alder-22&#37;&#44; Oak19&#37;&#41;&#44; and Bermuda grass &#40;26&#37;&#41; as second and third&#46; In the hot zones &#40;humid and dry&#41; Aspergillus was statistically significant more frequently than in more temperate zones&#46; Cockroaches thrive in big cities and humid zones and Mesquite and Poplar in dry zones&#46; Weeds are less important&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mexico has its own SPT sensitisation pattern&#44; which is different from America and Europe&#46; A structured chart-review of SPT results is able to show this and might be a tool for allergists in other countries&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nationwide data of skin prick test positivity for the 12 most frequent allergens in Mexican allergic patients&#46; Data were obtained by calculating the average values for SPT positivity of each allergen in each of the six different climatic zones in Mexico&#46; N &#61; 4169 subjects&#46; Pearson&#39;s Chi-squares &#40;all with 1 degree of freedom&#41;&#58; Dpt versus Ash p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001 &#40;Risk Ratio&#58; 1&#46;88&#59; 95&#37; CI&#58; 1&#46;755<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0013 &#40;Risk Ratio&#58; 1&#46;24&#59; 95&#37; CI&#58; 1&#46;0847<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001 &#40;Risk Ratio&#58; 1&#46;36&#59; 95&#37; CI&#58; 1&#46;2228<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001 &#40;Risk Ratio&#58; 1&#46;6&#59; 95&#37; CI&#58; 1&#46;4131</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Skin prick test positivity for 10 to 13 most frequent allergens in Mexican allergic patients living in&#58;</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2a&#41;</span> Zone 1&#44; Eastern part of the country&#44; semi-hot&#44; humid&#44; with rainfall all year long&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100 subjects&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2b&#41;</span> Zone 2&#46; Guadalajara&#44; semi-hot&#44; sub-humid&#44; with rainfall during summer&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>200 subjects&#46;</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2c&#41;</span> Zone 3&#46; The centre of the country including Mexico-city&#44; Toluca and Pachuca&#44; temperate temperature&#44; sub-humid&#44; with rainfall during summer&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1258 subjects&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2d&#41;</span> Zone 4&#46; Quer&#233;taro&#44; temperate temperature&#44; semi-dry&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>200 subjects&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2e&#41;</span> Zone 5&#46; Monterrey&#44; semi-hot&#44; semi-dry to dry&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>911 subjects&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">2f&#41;</span> Zone 6&#46; Sonora&#44; with temperatures ranging from temperate to very hot&#44; dry&#46; N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1500 subjects&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Climatic zone&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Region&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Temperature&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">Zone 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Eastern part&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Humid&#44; with rainfall all year long&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Semi-hot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Zone 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Guadalajara&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Sub-humid&#44; with rainfall during summer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Semi-hot&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Zone 3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mexico City<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Sub-humid&#44; with rainfall during summer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Temperate</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zone 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Toluca<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zone 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pachuca<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sub-humid&#44; with rainfall during summer and semi-dry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zone 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quer&#233;taro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Semi-dry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Temperate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zone 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Monterrey&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Semi-dry to dry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Semi-hot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zone 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sonora&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hermosillo</span>&#58; Temperate <span class="elsevierStyleItalic">Cd&#46;Obreg&#243;n&#58;</span> Hot to very hot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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              "nota" => "<p class="elsevierStyleNotepara">These data will be grouped together in the analysis&#44; as there are no major differences in climate&#46;</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Classification into climatic zones of the study-centres according to the climatic characteristics of their geographical position&#46;</p>"
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      "titulo" => "References"
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                  "host" => array:1 [
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                  "contribucion" => array:1 [
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              "referencia" => array:1 [
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              ]
            ]
            10 => array:3 [
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                  "contribucion" => array:1 [
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                        0 => array:2 [
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                            0 => "D&#46; Larenas Linnemann"
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                      "autores" => array:1 [
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                            0 => "S&#46;J&#46; Arbes Jr&#46;"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaci.2005.05.017"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0185" class="elsevierStylePara elsevierViewall">We would like to thank the following allergists&#44; many of them Head of the Department of Allergy of their respective hospitals&#58; Jos&#233; G&#46; Huerta-L&#243;pez of the National Institute of Pediatrics&#44; Mexico City&#59; Blanca del R&#237;o Navarro and Virginia Bland&#243;n of the Pediatric Hospital of Mexico&#44; Mexico City&#59; Mar&#237;a Isabel Rojo and Daniel Aguilar of Hospital Juarez&#44; Mexico City&#59; and Sandra Nora Gonz&#225;lez D&#237;az from the University Hospital of Nuevo Le&#243;n&#44; Monterrey&#44; for allowing us to compile data from the files of their departments in the different hospitals throughout Mexico City&#46; Moreover&#44; we thank Jos&#233; Cari&#241;o for sharing his personal data of a previous study on the subject carried out in Mexico City around the end of the past century&#46;</p>"
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Article information

ISSN: 03010546
Original language: English

DOI:10.1016/j.aller.2010.09.006

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	7	1	8
2024 October	24	17	41
2024 September	23	11	34
2024 August	19	15	34
2024 July	38	12	50
2024 June	54	11	65
2024 May	68	8	76
2024 April	61	12	73
2024 March	41	10	51
2024 February	36	6	42
2024 January	74	7	81
2023 December	65	39	104
2023 November	47	7	54
2023 October	55	19	74
2023 September	39	6	45
2023 August	28	9	37
2023 July	86	17	103
2023 June	76	13	89
2023 May	93	11	104
2023 April	86	5	91
2023 March	67	1	68
2023 February	59	4	63
2023 January	37	20	57
2022 December	18	6	24
2022 November	29	9	38
2022 October	23	18	41
2022 September	17	10	27
2022 August	19	7	26
2022 July	14	16	30
2022 June	23	12	35
2022 May	16	19	35
2022 April	15	21	36
2022 March	22	14	36
2022 February	20	8	28
2022 January	22	10	32
2021 December	17	8	25
2021 November	18	6	24
2021 October	16	21	37
2021 September	16	9	25
2021 August	8	7	15
2021 July	6	12	18
2021 June	13	9	22
2021 May	12	9	21
2021 April	26	23	49
2021 March	12	16	28
2021 February	14	7	21
2021 January	12	7	19
2020 December	1	0	1
2020 November	0	4	4
2020 August	0	1	1
2020 July	0	1	1
2020 May	0	2	2
2020 March	0	1	1
2020 February	0	4	4
2020 January	0	1	1
2019 December	0	1	1
2019 October	0	2	2
2019 September	0	2	2
2019 July	0	9	9
2019 June	0	2	2
2019 May	0	12	12
2018 March	2	0	2
2018 February	12	1	13
2018 January	30	2	32
2017 December	6	1	7
2017 November	14	3	17
2017 October	25	4	29
2017 September	18	2	20
2017 August	16	3	19
2017 July	19	4	23
2017 June	23	4	27
2017 May	34	10	44
2017 April	29	12	41
2017 March	33	15	48
2017 February	37	1	38
2017 January	22	3	25
2016 December	43	4	47
2016 November	28	7	35
2016 October	47	7	54
2016 September	80	3	83
2016 August	24	1	25
2016 July	17	1	18
2016 June	34	13	47
2016 May	17	12	29
2016 April	18	12	30
2016 March	17	7	24
2016 February	15	10	25
2016 January	28	14	42
2015 December	18	8	26
2015 November	17	7	24
2015 October	20	5	25
2015 September	22	8	30
2015 August	42	3	45
2015 July	32	4	36
2015 June	16	0	16
2015 May	12	2	14
2015 April	9	8	17
2015 March	14	6	20
2015 February	8	7	15
2015 January	27	2	29
2014 December	16	9	25
2014 November	9	6	15
2014 October	15	5	20
2014 September	19	5	24
2014 August	21	4	25
2014 July	13	6	19
2014 June	15	5	20
2014 May	11	3	14
2014 April	9	4	13
2014 March	76	8	84
2014 February	64	8	72
2014 January	73	6	79
2013 December	59	10	69
2013 November	65	6	71
2013 October	67	12	79
2013 September	62	8	70
2013 August	71	15	86
2013 July	59	11	70
2013 June	36	3	39
2013 May	34	7	41
2013 April	29	7	36
2013 March	20	6	26
2013 February	7	5	12
2013 January	3	0	3
2012 December	3	1	4
2012 November	0	3	3
2012 October	2	2	4
2011 November	462	0	462

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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