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¿Puede el movimiento del ala de
una mariposa en Africa afectar
la temporada de huracanes en Puerto Rico?
¿O el patrón de reproducción de hongos?
¿O las exacerbaciones de enfermedades
respiratorias?
Ambiente y alergias
El efecto mariposa
2 de abril de 2004
Convención Médicos de Familia
Fernando J López-Malpica, MD
Patrocinado por
Schering-Plough del Caribe
Objectives
• Understand that a diseased state is the
result of our genetic predisposition in a
very complex interplay with the
environment
• Understand the role of inflammation in
the allergic condition and the
importance of the preventive approach
in management
Objectives
• Stimulate critical thinking, curiosity and
interest in this area by means of
clinically relevant information
• Transmit relevant, useful knowledge
that can be used in your everyday
practice
DNA double
helix
Nature and Nurture
Concept
Nature and Nurture
• Two major factors are critical to the
development of allergy:
– the individual's genetic background
– the environment.
• Allergy is a multifactorial disease, and
complex interventions are likely to be
required to decrease prevalence of this
increasingly common disease.
Atopy and Genetics
Nature and Nurture
• Up to 40% of people in western
populations show an exaggerated
tendency to mount IgE responses
• On the basis of family linkage studies,
loci on chromosomes 11q and 5q have
been implicated as containing genes
that may be important
Nature and Nurture Concept
• The story of our life begin
when our grandparents are
conceived!
Nature and Nurture (cont.)
• The gene for allergy has not yet been
fully identified.
• Thus, environmental factors appear to
be the critical factors that can be
controlled at this moment.
Rhinitis
• Is a clinical entity that can be caused by
different conditions,
– Allergies
– Vasomotor
– Non specific irritants
– Infections
– NSAID Sensitivity
– Hormonal changes
– Medications
Contaminantes mayores
• Ozono a nivel terrero, no en altos niveles de
atmósfera
• PM-10 y 2.5
• Monóxido de carbono
• Dióxido de sulfuro
• Dióxido de nitrógeno
• Se miden en más de 1,000 ciudades y se
publican niveles más altos en el dia
• Se publican en radio, TV, internet y prensa
“Air Quality Index (AQI)”
Air Quality Index
(AQI) Values
Levels of Health
Concern
Colors
When the AQI
is in this range:
...air quality
conditions are:
...as symbolized
by this color:
0 to 50
Good
Green
51 to 100
Moderate
Yellow
101 to 150
Unhealthy for
Sensitive Groups
Orange
151 to 200
Unhealthy
Red
201 to 300
Very Unhealthy
Purple
301 to 500
Hazardous
Maroon
Material particulado 10
“Particulate Matter 10”(PM-10)
• Mezcla de partículas sólidas y gotas de líquido
en el aire, combustión y procesos industriales
• < de 50 microgram/m3 anual o 150
microgram/m3 al año
• Efectos sobre el sistema respiratorio, daño al
tejido pulmonar, cáncer y muerte prematura
• Partículas finas (PM-2.5)- <2.5 micras, 15-65/m3
Ozono
• Aumenta respuesta tipo IgE a los
alergenos
• Produce cambios en ADN de las vias
respiratorias
Partículas de diesel
• Puede inducir inflamación alérgica
• Aumenta respuesta inmediata y tardía a
los alergenos
• Contribuye a la sensitización de
neoantigenos
Endotoxinas
• Lipopolisacaridos(LPS) derivados de
bacterias gram negativas
• Inflamación alérgica aumenta respuesta a
LPS
• En edificios enfermos, cerca de
desperdicios de animales y polvo agricola
Nature and Nurture
2 de marzo de 2004
MODIS
(Moderate Resolution Imaging
Spectroradiometer)
Nave Terra de la NASA
Polvo del Sahara
• Relación clima-polvo
– Puede producir precipitación de lluvia o nieve
• Enfria atmósfera
– Refleja radiación solar
• Sirve de vector de hongos
– Estudio de corales
– Especies transportadas del Sahara
Volcán Soufriere,
Montserrat
1995
Circulación del viento
Pollen
Colorful flowers
Insects and birds
Pollen
Unattractive flowers
Wind
Indoor Pets
Avoidance
Dust Mites
• Wash bedding often with hot water
• Use a zippered plastic cover for
mattress and box spring
• Maintain low humidity and low
temperature
• Use a filter type vacuum (HEPA)
• Remove bedroom carpet
• Use an acaricide
Molds
Air Sampling Machine
Use of Dehumidufier
Establishing a partnership to
manage allergic diseases
• Beyond patient
education!
– Explain importance of
developing partnership with
patients
– Identify and address patient
concerns and fears
– Describe the nature of the
disease
– Work together as a team
towards goals of therapy
Monte Veniaminof, Alaska
Feb, 2004
Pinatubo, Filipinas 1991