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High rates of uncontrolled asthma and other allergies and their underlying factors should be considered when classifying these problems during clinical and epidemiological surveys because they could be important confounding factors. In summary, the climate, cultural and socioeconomic conditions in the Tropics facilitate an environment for the development of allergic diseases.
Although socioeconomic conditions and particularly hygiene are modifiable risk factors, temperature and humidity levels are more constant and very appropriate for mite growth. The consequence of mite allergen exposure throughout the year is, probably the most important particularity of the Tropics with regards to allergy. Since the inception of allergy is largely dependent on the ecology and environmental effects, it is expected to find a broad diversity of predisposing and aggravating factors around the world.
Studies in temperate areas often report that allergic diseases are more frequent in children with parental antecedents of atopy. Patients first develop cutaneous symptoms early in life, in the context of IgE sensitization to food allergens and aeroallergens, and then have respiratory symptoms in late childhood. They are also more frequent in children with early wheezing in the context of atopic sensitization. There is a male predominance that equilibrates gradually during childhood and cessation of symptoms is common but less likely if two allergic phenotypes co-exist e.
The problem of defining the natural history of allergy is not exclusive of the Tropics; in fact, the information available in temperate and industrialized countries is not enough to make accurate conclusions. Understanding the natural history will help to control the increasing trend of allergy prevalence, especially in tropical places, where asthma is also becoming a public health problem.
As stated by The Global Asthma Report Given the remarkable differences between tropical and temperate areas, certain environmental triggers and risk factors have particular relevance in the inception and progression of allergic diseases in the Tropics, as well as in defining the strategies for diagnosis and treatment [ 22 ].
Different phenotype paths The tropical climate is among the particular factors that may influence the natural history of allergy. In this region of the world there are periods of the year with and without rain dry season [ 23 ] but not seasonal variations as described in temperate areas [ 24 ]. The high humidity is reflected in a high number of house dust mites, cockroaches, and molds and therefore a higher allergen load in homes and bedding materials. The rainy season is related to acute exacerbations of asthma by rapid changes to cold temperatures, the effects of thunderstorms on aerobiology or by promoting outbreaks of respiratory viral infections [ 25 , 26 ].
Moreover, in regions with high temperatures, high humidity and rainfall through the year, the exposure to home dampness and molds in indoor bedrooms increases the risk for current symptoms of rhinoconjunctivitis [ 27 ].
Poor ventilation in indoor bedrooms is common, especially in deprived areas [ 28 ]. In some regions and because of the high temperature, windows and doors are open most of the time, and some studies revealed that in those settings natural ventilation is a protective factor for asthma [ 29 ]. The climate also predisposes to insect bites that induce papular urticaria. As occurred in developed countries a few decades ago, urbanization seems to be critical in modifying allergic susceptibility, as suggested by the fact that prevalence of allergic diseases in urban and sub-urban areas of the Tropics are comparable to those found in affluent countries, but are very low or non-observed in rural communities [ 30 — 33 ].
Urbanization has a deep impact on the type of housing and bedding, access to green areas, diet, quality of water and air and exposure to pollutants. It should be pointed out that in many tropical areas urbanization often occurs in the context of poverty, and this combination promotes the exposure to noxious agents, fungal spores, and obsolete or low quality products that are regulated or even forbidden in the developed world, but modify allergy risk and promote reactions to nickel, cosmetics, detergents, rubber and pesticides in tropical settings [ 34 , 35 ].
Wealth is also an important risk factor because even within short geographical distances the prevalence of IgE sensitization to aeroallergens is significantly higher in urban communities of high income compared to those economically deprived [ 36 ]. A remarkable finding is the high prevalence of recurrent wheezing in several tropical countries, compared to Europe and USA.
Diverse viruses have been detected in children suffering acute respiratory illnesses in the Tropics [ 37 ]. In temperate areas, viral infections are also a frequent cause of wheezing but in tropical countries the admissions to hospitals are more frequent and the episodes more severe http: In some tropical regions the viral-induced exacerbations of asthma are independent on the time of the year [ 42 ]. The oropharyngeal microbiome appeared to contain many more Streptococci in infants of rural Ecuador compared to Western Europe and the USA, and comparisons between healthy and wheezing children revealed significant differences in several bacterial phylotypes [ 43 ].
The few longitudinal studies analyzing the trajectories of allergic symptoms in the Tropics revealed particular aspects in the expression of allergic phenotypes. One remarkable finding is that the timeline in which IgE sensitization and symptoms evolve in the Tropics differs to the atopic march that has been described in some industrialized countries [ 44 ].
In the atopic march the symptoms often appear in a particular sequence starting with atopic dermatitis AD as the first manifestation of allergy in an infant, followed by food allergy, seasonal or perennial allergic rhinitis and finally asthma at late childhood [ 45 ]. The Ecuavida birth cohort in Esmeraldas Ecuador reported that 2. From those studies we can conclude that in some areas of the Tropics the dynamics of allergic manifestations is skewed to debut with respiratory symptoms.
However, it is worth mentioning that birth cohorts in Malaysia [ 49 ] and Taiwan [ 50 ] have found that timelines for allergic symptoms in early childhood proceed according to the atopic march of temperate areas, suggesting that depending on the genetic background and the socioeconomic setting, the natural history can largely differ even within tropical regions.
Since very few longitudinal studies have prospectively followed the evolution of allergic phenotypes in the same individuals, most conclusions on the natural history have been derived from cross-sectional studies. More studies considering careful phenotype assessment, bias in sample selection and heterogeneous exposure to infectious agents are highly needed.
The following points could summarize the particularities in the natural history of allergic conditions in the Tropics. All of them will be further analyzed in each section of this review. Early respiratory symptoms are more frequent than AD in children. The reason is still unclear but perennial mite exposure, early helminthic infections and genetic factors may play a role.
In general, there is a low prevalence of physician-diagnosed AD, varying from infrequent or non-observed in some places to common in others. Remarkable differences in AD prevalence can be observed even in the same country. Allergic skin reactions do occur in the Tropics and in general are the same as in temperate countries, but in some regions they show remarkable differences regarding to clinical presentation and risk factors [ 52 ].
Parasite migration or treatment with antiparasitic drugs can induce urticaria. Papular urticaria by insect bites is more common than in the rest of the world. Early exposures to geohelminths infections modify the expression of allergic diseases, including their frequency and severity [ 53 , 54 ].
The symptoms of rhinoconjunctivitis reported in urban centers of developing countries are more severe than those reported in developed countries [ 55 ]. IgE sensitization to aeroallergens occurs early in life and at higher frequencies compared to temperate areas [ 13 , 56 , 45 ].
The main sensitizers in allergic patients living in tropical urban environments are HDM [ 57 ] and cockroach [ 58 — 60 ]. IgE response in airway allergy is dominated by a single class of allergen source, dust mites. There are no significant differences in the allergen levels during the year [ 61 ]. The frequency of IgE sensitization and the strength of IgE levels to cross-reactive pan-allergens like tropomyosin are higher compared to temperate areas [ 62 ].
Sensitization to pollens is less frequent and less intense than to mite allergens. In regions with transition to subtropical areas the role of pollens is important, although the pattern of sensitization is different to that observed in Europe [ 63 , 64 ]. IgE sensitization to food allergens is frequently detected without symptoms and aeroallergen sensitization is not usually preceded by food sensitization.
The sources of food allergens are different; for instance hypersensitivity to shellfish, fish and fruits is more common than reactions to nuts, peanut and wheat [ 65 — 67 ]. Early respiratory symptoms and allergen sensitization in the Tropics It is well recognized that wheezing is frequent in the Tropics and several factors have been implicated including viral infections, elevated endotoxin levels and pollutants [ 46 , 68 , 69 ].
However, there are few studies on the atopic component of early wheezing in the Tropics, which has made the analysis of this important point based on reports from temperate countries. In addition, in a nested case-control study in children from Esmeraldas Ecuador it was found that IgE sensitization to Ascaris has also been associated with wheezing in children sensitized to mites or food allergens [ 71 , 72 ].
The influence of allergen sensitization on wheezing has been detected, although at a low rate, even in parasited communities and using skin testing for atopy diagnosis [ 73 ]. All of these finding suggest the great importance of early sensitization to mite and Ascaris allergens, although a proportion of wheezing is driven by non-IgE pathways, more likely viral infections.
However, as will be discussed later see Allergen sensitization and asthma symptoms sensitization rates increase with age and in older children reach impressive levels. In addition, maternal antecedent of allergic disease is an independent risk factor for wheezing and asthma in the offspring [ 74 ].
It has been also found that maternal effects are significant for boys but not for girls [ 75 ]. In summary, there are few studies addressed to establish the natural history of allergic disorders in the Tropics. Although not well investigated, childhood viral infections seem to be as prevalent as in temperate zones, being an important cause of wheezing, the commonest respiratory symptom in infancy.
In addition, there are reports suggesting that it is associated with IgE sensitization to mite and helminth allergens. The progress and severity of asthma is influenced by helminth infections.
It is more frequent in urban areas where helminths are less prevalent and with lower parasitic load. The prevalence and particularities of allergic diseases in the Tropics Because of the increasing trends of allergy in industrialized countries, one frequently discussed issue regarding allergy in the Tropics is its prevalence. Although in the past it was difficult to understand, now it is generally accepted that allergic disorders are very common in underdeveloped countries of the Tropics. Linda Rochin lrochin ucsc.
Alfred Aguirre was cited before 1, onlookers at the campus Titan Student Union Pavilion along with the fathers of three other Southern California Superior Court judges. They and the other Latino veterans at the event served aboard aircraft carriers off the coast of Japan and flew cargo planes over Europe.
The veterans received a commemorative medal and a copy of Aguirre's recently completed book "Undaunted Courage: And one of those aspects of our heritage is the patriotism of our veterans. War and Operation Desert Storm veterans. Aguirre said that the event is important because it spotlights what few Americans realize; Latinos have served in the military since the American Revolution.
Judge Hernandez attended the event on behalf of his father, who could not attend because of illness. And they rarely owned houses.
That's a statement to the spirit of those who served in World War n, who returned with a conviction that they were first-class citizens and they and their families deserved such treatment" Life in the service was much different from the fife Alfred Aguirre bad experienced at home.
We were all brothers. We all fought together. The next year, segregation in Orange County was abolished with a landmark ruling from U. District Judge Paul J. McCormick in Mendez v. Westminster that segregated schools are not equal. He said his son constantly reminds him of the impact his service had on him and all Latinos. Jones and served from December 7, , to March 3, ; due to illness, was not a candidate for the full term; resumed the practice of law; died in Albuquerque, N.
Linda Chapa LaVia, a former U. Army officer, believes military men and women who fight for national security should get job and financial security in return. Chapa LaVia, who rose to first lieutenant in the National Guard. The Aurora Democrat sponsored legislation that bars public-sector employers from discriminating against National Guard members and military reservists. In part because of her efforts, Illinois is now the first state to include those groups in its Human Rights Act, which forbids discrimination in employment, promotions and loans.
Other legislation she sponsored ensures public-sector employees will continue to acc rue pension and other benefits while away for military reasons, including training. Chapa LaVia likes be heard, in more ways than one.
Jack Franks, D-Woodstock, who sits next to Ms. Chapa LaVia in Springfield. To get voters' attention two years ago, she turned up the volume on her door-to-door campaign, visiting about 31, Aurora homes. She was the first Hispanic elected to the Illinois General Assembly outside of Cook County and the first Democrat from her district in 20 years. Another trait that makes her an atypical freshman: Most Springfield newbies socialize with members of their own party, because it feels safer, says Mr.
But more often than not, both Democrats and Republicans join Ms. Chapa LaVia's dinner groups. It doesn't hurt that her husband has Republican ties; he served two years ago on the citizens' advisory committee for Republican state Sen. Chris Lauzen of Aurora. Her legislative choices can cut across party lines, too. She voted against a bill allowing illegal immigrants to have state driver's licenses, making her the only Hispanic member, and one of only two Democrats, to do so.
In addition to her current political success she's running unopposed this year , Ms. Last year, she donated a defibrillator to the House and Senate after Rep. Bill Black collapsed on the floor during a session. The cause turned out to be a herniated disc, she says, "but it scared the bejesus out of me.
Publication is in Grolier Academic Reference Announces a Major New Encyclopedia on Latinos and Latinas in the United States Encyclopedia Latina is a groundbreaking, interdisciplinary reference work that deals with Latino history and culture in the United States from the age of discovery to the present.
Comprehensive and analytical, this unique encyclopedia presents all aspects of Latino life in the United States as well as the influence and contributions of Hispanic culture. The substantive, signed articles cover topics, issues, organizations, events, themes, movements, U. Surgeon General's Family History Initiative http: If one generation of a family has high blood pressure, it is not unusual for the next generation to have similarly high blood pressure.
Tracing the illnesses suffered by your parents, grandparents, and other blood relatives can help your doctor predict the disorders to which you may be at risk and take action to keep you and your family healthy.
To help focus attention on the importance of family health history, U. Surgeon General Richard H. Surgeon General's Family History Initiative, to encourage all American families to learn more about their family health history. National Family History Day: Thanksgiving is the traditional start of the holiday season for most Americans. Whenever families gather, the Surgeon General encourages them to talk about, and to write down, the health problems that seem to run in their family.
Learning about their family's health history may help ensure a longer future together. My Family Health Portrait: Americans know that family history is important to health. A recent survey found that 96 percent of Americans believe that knowing their family history is important. Yet, the same survey found that only one-third of Americans have ever tried to gather and write down their family's health history.
Because family health history is such a powerful screening tool, the Surgeon General has created a new computerized tool to help make it fun and easy for anyone to create a sophisticated portrait of their family's health. The tool will help you organize your family tree and help you identify common diseases that may run in your family. When you are finished, the tool will create and print out a graphical representation of your family's generations and the health disorders that may have moved from one generation to the next.
That is a powerful tool for predicting any illnesses for which you should be checked.
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