RESUMO
BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.
Assuntos
Asma/diagnóstico , Asma/prevenção & controle , Criança , Pré-Escolar , Feminino , Humanos , Masculino , MéxicoRESUMO
BACKGROUND: The most important allergen manufacturers are based in Europe and in the US. In some countries local products are also sold. No comparison between European, US and local products has been made until now. AIM OF THE STUDY: To determine total protein content and total specific IgE binding capacity or major allergen content of diagnostic extracts from European, US and Mexican origins relative to the CBER/FDA reference extracts for Dermatophagoides pteronyssinus (Dpt), Bermuda grass and cat (10,000(B) AU/mL). METHODS: Diagnostic extracts were purchased from various manufacturers, blinded and shipped to the analysing laboratory, where the following assays were conducted: total protein concentration (Bradford), specific IgE competition ELISA (Dpt and Bermuda grass) and determination of Fel d 1 U/mL. When available, CBER/FDA recommended tests and reagents were used. RESULTS: Total protein content of US reference extracts was higher than all other extracts. Relative potency of European and US-bought Dpt extracts 3,300-4,400 AU/mL, Bermuda grass 800-2,500 BAU/mL and cat 2.1-4.4 Fel d IU/mL (Ref. 19 U/mL), with one exception. Locally produced Mexican products were almost all below 1,000 (B)AU/mL. CONCLUSIONS: Three diagnostic extracts from European manufacturers and from Mexican providers which obtain extracts in US have a <50% relative potency compared to 10,000 (B)AU/mL US extracts. Locally produced Mexican extracts have much lower total protein content and specific IgE binding capacity. These in vitro results must be complemented with other in vitro and in vivo skin prick tests to obtain a more complete picture of comparison of potency. Nevertheless results are quite consistent for the allergens tested here.