Angioedema after rt-PA infusion led to airway emergency: a case report of rescue treatment with fresh frozen plasma

Abstract The authors report the case of a 71-year-old woman presented to the Emergency Department with acute ischemic stroke. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma. Angioedema after rt-PA infusion could be a life-threatening emergency that requires quick airway management by skilled professionals. As this condition is triggered by several factors, such as unregulated histamine and bradykinin production, the traditional treatment recommended by the guidelines may not be sufficient and the use of FFP can be considered as a safe and valuable aid.

Intoxicación escombroide secundaria al consumo de atún: presentación de un caso / Scombroid poisoning secondary to tuna ingestion: a case report

Resumen: La intoxicación escombroide es ocasionada por el consumo de ciertos tipos de pescado (de la familia Scombridae), comúnmente el atún, los cuales acumulan grandes concentraciones de histamina cuando los procedimientos de refrigeración son inadecuados, ocasionando en quienes los consumen síntomas muy similares a los de una alergia alimentaria, por lo que es frecuente que no se diagnostique correctamente. Generalmente, los síntomas desaparecen en pocas horas y no suelen ser graves, excepto algunos casos descritos en la literatura especializada, de hipotensión, broncoespasmo, dificultad respiratoria, taquicardia supraventricular e, incluso, infarto agudo de miocardio. Este fue, precisamente, el caso de una mujer que ingresó al servicio de urgencias de un hospital de tercer nivel de Medellín a los pocos minutos de haber ingerido atún con una sintomatología típica de la intoxicación, pero con taquicardia supraventricular, una de sus manifestaciones graves y atípicas.

Abstract: Scombroid poisoning is caused by the consumption of certain types of fish (from the Scombridae family), especially tuna. Due to inadequate refrigeration procedures, these fish have high levels of histamine which generate symptoms similar to those of a food allergy in their consumers, so it is frequently underdiagnosed. It is self-limited in a few hours and the symptoms are usually not serious, except for specific cases reported in the literature of hypotension, bronchospasm, respiratory distress, tachyarrhythmias, and even acute myocardial infarction. We report here the case of a woman admitted to the emergency department of a third level hospital in Medellín a few minutes after eating tuna with the typical symptoms of intoxication, as well as tachyarrhythmias, a serious and atypical manifestation.

Individualized treatment for allergic rhinitis based on key nasal clinical manifestations combined with histamine and leukotriene D4 levels / Tratamento individualizado para a rinite alérgica baseado nas principais manifestações clínicas nasais e dos níveis de histamina e leucotrieno D4

Abstract Introduction The types of allergic rhinitis are roughly classified based on the causative antigens, disease types, predilection time, and symptom severity. Objective To examine the clinical typing and individualized treatment approach for allergic rhinitis and to determine the optimal treatment method for this disease using various drug combination therapies. Methods A total of 108 participants with allergic rhinitis were divided into three groups based on symptoms. Subsequently, each group was further categorized into four subgroups based on the medications received. The efficacy of the treatments was evaluated using the visual analog scale VAS scores of the total and individual nasal symptoms, decline index of the symptom score, histamine and leukotriene levels, and mRNA and protein expression levels of histamine 1 and cysteinyl leukotriene 1 receptors. Results Loratadine + mometasone furoate and loratadine + mometasone furoate + montelukast significantly improved the sneezing symptom and reduced the histamine levels compared with the other combination therapies (p < 0.05). Meanwhile, montelukast + mometasone furoate and montelukast + mometasone furoate + loratadine considerably improved the nasal obstruction symptom and decreased the leukotriene D4 levels compared with the other combination therapies (p < 0.05). Conclusion Clinical symptom evaluation combined with experimental detection of histamine and leukotriene levels can be an objective and accurate method to clinically classify the allergic rhinitis types. Furthermore, individualized treatment based on allergic rhinitis classification can result in a good treatment efficacy.

Resumo Introdução A rinite alérgica é basicamente classificada de acordo com os antígenos causadores, tipos de doença, peridiocidade e gravidade dos sintomas. Objetivo Avaliar os tipos clínicos e a abordagem terapêutica individualizada para cada tipo de rinite alérgica e determinar o método de tratamento ideal utilizando várias terapias de combinação de fármacos. Método Um total de 108 participantes com rinite alérgica foram divididos em três grupos com base nos sintomas. Posteriormente, cada grupo foi subsequentemente categorizado em quatro subgrupos com base nos medicamentos recebidos. A eficácia dos tratamentos foi avaliada utilizando os escores da escala visual analógica EVA dos sintomas nasais totais e individualmente, índice de declínio do escore de sintomas, níveis de histamina e leucotrienos e níveis de expressão de mRNA e proteína dos receptores de histamina 1 e cisteinil-leucotrieno 1. Resultados As associações entre loratadina + furoato de mometasona, assim como a de loratadina + furoato de mometasona + montelucaste melhoraram significativamente o sintoma de espirros e reduziram os níveis de histamina em comparação às outras terapias combinadas (p < 0,05). Por outro lado, a associação montelucaste + furoato de mometasona, assim como a associação montelucaste + furoato de mometasone + loratadina melhoraram consideravelmente o sintoma de obstrução nasal e diminuíram os níveis de leucotrieno D4 em comparação com as outras combinações (p < 0,05). Conclusão A avaliação clínica dos sintomas combinada com a detecção experimental dos níveis de histamina e leucotrieno pode ser um método objetivo e preciso para classificar clinicamente os tipos de rinite alérgica. Além disso, o tratamento individualizado baseado na classificação da rinite alérgica pode resultar no aumento da eficácia do tratamento.

Síndrome de Kounis como manifestación de anafilaxia / Kounis Syndrome as a manifestation of anaphylaxis

Introducción: el síndrome de Kounis corresponde a la isquemia miocárdica aguda relacionada con la liberación de mediadores inflamatorios que llevan a vasoespasmo coronario y/o complicación de una placa ateromatosa durante una reacción alérgica. La incidencia de eventos coronarios en procesos alérgicos en Estados Unidos es de 8 casos por 100000 habitantes por año. Métodos: describimos el caso de una mujer que desarrolla síndrome de Kounis, posterior a múltiples picaduras de abeja, recibiendo manejo en una unidad de cuidado intensivo de una institución de salud de Colombia. La paciente presentó un síndrome coronario agudo tipo infarto agudo de miocardio con elevación del segmento ST, con arteriografía coronaria en la cual se evidenció ausencia de lesiones vasculares o vasoespasmo, con presencia de un trombo flotante en la arteria descendente anterior, sin evidencia de enfermedad ateroesclerótica. Resultados: el síndrome de Kounis es frecuente en los pacientes con anafilaxia, sin embargo, se informa poco en la literatura, debido a la falta de sospecha diagnostica y al poco reconocimiento clínico. Los síntomas de este síndrome pueden ser típicos como el dolor torácico opresivo de gran intensidad irradiado a miembro superior izquierdo o a cuello, o atípicos como disnea, nauseas o palpitaciones, los cuales pueden confundirse con las manifestaciones del proceso anafiláctico. Conclusiones: en la actualidad no existen guías para el tratamiento del síndrome y depende de la forma de presentación, comorbilidades y disponibilidad de un grupo médico interdisciplinar, que incluya monitoria y vigilancia en una unidad de cuidado intensivo.(AU)

Introduction: Kounis syndrome refers to the myocardial ischemia which results from the release of inflammatory-provoking mediators during an allergic reaction thereby causing coronary vasospasm and/or complication brought on by atheromatous plaque. The incidence of coronary disease induced by allergies in the United States is 8 cases per 100000 inhabitants per year. Methods: we cite the case of a woman who developed Kounis syndrome after receiving multiple bee stings. She was treated in the intensive care unit of a Colombian health institution. The patient presented with acute myocardial infarction with ST-segment elevation, and with no presence of vascular lesions or vasospasm during the coronary arteriography. It was further noted that there was a floating thrombus in the anterior descending artery without evidence of atherosclerotic disease. Results: Kounis syndrome is frequent in patients with anaphylaxis, however, only a few cases are reported in studies due to the lack of diagnostic suspicion and little clinical recognition. Symptoms suggesting this syndrome may be typical, such as oppressive chest pain which radiates to the upper left limb or neck, or atypical such as dyspnea, nausea, or palpitations which may be confused with the manifestations of the anaphylactic process. Conclusions: currently there are no directives for the treatment of the syndrome. It depends upon the manner of presentation, comorbidities, and the availability of an interdisciplinary medical group. It requires monitoring and surveillance in an intensive care unit.(AU)

Tradução e adaptação transcultural para o idioma português (Brasil) do instrumento "Angioedema Activity Score" / Translation and cross-cultural adaptation to the Portuguese language (Brazil) of the instrument "Angioedema Activity Score"

Introdução: Tradução e adaptação transcultural do instrumento Escore de Atividade do Angioedema (Angioedema Activity Score - AAS) para o idioma português do Brasil. Métodos: O documento original em alemão foi traduzido para o português (cultura brasileira) e posteriormente retrovertido para a língua alemã. As traduções foram analisadas pelos pesquisadores brasileiros e alemães para definição da versão final em português. A versão final foi respondida por 10 pacientes com angioedema recorrente, com o intuito de identificar possíveis dificuldades na compreensão e nos termos utilizados. Resultados: Todos os pacientes compreenderam as perguntas, embora apenas a metade tenha preenchido adequadamente o questionário. Conclusões: O documento do Escore de Atividade do Angioedema adaptado para a cultura brasileira se mostrou um instrumento fidedigno à versão alemã original.

Introduction: To translate and validate the Angioedema Activity Score to Brazilian Portuguese aiming further use of this tool in patients with recurrent angioedema. Methods: The original questionnaire in German was translated into Portuguese (Brazilian culture) and subsequently back translated into the German language. The translations were analyzed by Brazilian and German researchers to define the final version in Portuguese. The final version was administered to 10 patients with recurrent angioedema in order to identify possible issues in understanding the terms used. Results: All patients had a good comprehension of the questions, but only half of them completed the questionnaire properly. Conclusions: The Angioedema Activity Score adapted to the Brazilian culture proved to be a reliable instrument to the original German version.

Suppression of wheal and flare in histamine test by the main H1 antihistamines commercialized in Brazil

Abstract: Background: Several dermatoses are mediated by histamine, such as urticaria, angioedema, and papular urticaria. There are no Brazilian studies comparing the potency of antihistamines. Objectives: To evaluate the tolerability and efficacy of the main commercial brand and generic H1 antihistamines, regarding the suppression of the wheal and flare to the histamine test. Methods: A quasi-experimental, open study with 10 healthy adults submitted to the histamine test on the ventral aspect of the forearms. After 20 minutes, wheal and flares were measured. The tests were performed after two hours of intake of dexchlorpheniramine, hydroxyzine, levocetirizine, fexofenadine, cetirizine, loratadine, ebastine, desloratadine, epinastine and rupatadine, as well as generics of loratadine, cetirizine and fexofenadine. Results: All antihistamines presented a reduction in the wheal compared to the control (p <0.02), as well as in the flare, except for rupatadine (p = 0.70). In the internal comparison, cetirizine, fexofenadine, epinastine, levocetirizine, dexchlorpheniramine and hydroxyzine were the most potent, with no difference between them (p > 0.1). As for halo, cetirizine, epinastine, hydroxyzine and fexofenadine were the most potent, with no difference between them (p > 0.1). The most common adverse effect was drowsiness, which was more prevalent among first-generation drugs (p < 0.01). Generic loratadine, fexofenadine and cetirizine halos were higher than their controls (p <0.03).. Study limitations: A single-center study evaluating only aspects related to histamine. Conclusions: Brazilian commercial antihistamines presented different profiles of inhibition of wheal and flares in the histamine test, as well as adverse effects. Generic loratadine, fexofenadine and cetirizine presented larger flares than brand drugs.

El papel de los mastocitos en la evaluación de la respuesta inflamatoria posoperatoria, al implantar mallas protésicas para la reparación de defectos de la pared abdominal en biomodelos rata Wistar / The role of mast cells in the assessment of postoperative inflammatory response to implanting prosthetic mesh for the repair of abdominal wall defects in Wistar rats

Resumen Objetivo: El objetivo de este estudio fue evaluar el papel de los mastocitos en la respuesta inflamatoria posoperatoria tras el implante de mallas protésicas para la reparación de defectos de la pared abdominal en biomodelos rata Wistar. Materiales y Métodos: Se fabricó una malla de fibroma entretejiendo sus hilos. Se utilizaron 25 ratas Wistar macho adultas, a las cuales se les creó un defecto quirúrgico de 30 × 20 mm en la pared abdominal anterior. Este defecto anatómico fue posteriormente reparado con uno de los dos tipos de mallas previamente esterilizadas, las cuales fueron la malla de fibroína, y la malla comercial ultrapo monocryl prolene composite (Johnson & Johnson-Ethicon). A los 28 días después del procedimiento quirúrgico se sacrificaron los biomodelos y se extrajeron las muestras que posteriormente fueron tratadas con técnicas histoquímicas para su análisis histológico. Resultados: El estudio reportó adherencia a omento en los dos tipos de malla utilizadas, sin embargo, la malla comercial mostró adherencias de amplio espesor a colon, intestino delgado e hígado, incluyendo también al omento menor. Se encontró que la malla comercial presentaba mayor cantidad de mastocitos en las regiones estudiadas (dermis, perimisio, y la serosa visceral). Discusión: Estudios refieren que los mastocitos y sus productos como la histamina, la serotonina, entre otras juegan un papel clave en el control de la inflamación local, la cicatrización de heridas, adherencias y las reacciones a cuerpos extraños in vivo. Conclusión: Con base en la literatura consultada se puede concluir que el presente estudio es vanguardista en lo que respecta al posible papel que juegan los mastocitos en el proceso de reparación de defectos anatómicos de la pared abdominal.

Objective: The objective of this study was to evalúate the role of mast cells in the postoperative inflammatory response after implantation of prosthetic mesh to repair abdominal wall defects in Wistar rat. Materials and Methods: An abdominal wall defect (30 × 20 mm) was created in the anterior abdominal wall of 25 adult male Wistar rats. The anatomical defect was then repaired with one of the two type's meshes. Fibroin and monocryl ultrapo prolene meshes. Fibroin meshes were manufactured by weaving its threads, the polypropylene mesh was bought to Johnson & Johnson-Ethicon. After 28 days of implantation Wistar rats were sacrificed and the mesh with abdominal tissue was extracted. Subsequently the samples were treated with histochemical techniques for histological analysis. Results: The study reported adherence to omentum in both types of meshes used, however, the polypropylene mesh showed widely adhesions to colon, slight to intestine and liver, also in a very lower amount, adhesions to omentum. It was found that mast cells were presented in all the studied regions for the polypropylene mesh (dermis, perimysium, and visceral serosa). Discussion: Studies indicate that mast cells and their products such as histamine, seroto- nin, and others play a key role in controlling local inflammation, wound healing, adhesions, and reactions to foreign bodies in vivo. Conclusion: We can conclude that this study is a good step to show the possible role of mast cells in the abdominal wall repair process.

Isolation and identification of allergens and biogenic amines of Prosopis juliflora genotypes

Background: Prosopis, or mesquite (Prosopis juliflora (Sw.) DC.), was introduced in Saudi Arabia several decades ago and is heavily used in street, roadside, and park plantations. It shows great adaptation to the prevailing climatic conditions such as high temperature, severe drought, and salinity and spreads naturally in many parts of the Kingdom. This research was conducted to isolate allergen proteins and biogenic amines from the pollen grains of P. juliflora genotypes in Saudi Arabia from two regions, namely Al-Qassim and Eastern regions. Results: The results showed that 18 different allergen proteins were detected in P. juliflora genotypes, with molecular weight ranging from 14 to 97 kDa. Moreover, P. juliflora genotypes from the two studied regions contained eight biogenic amines, namely histamine, tyramine, tryptamine, ß-phenylethylamine, butricine, codapherine, spermidine, and spermine. All genotypes from the Al-Qassim region were found to contain all eight amines, while in the Eastern region, histamine was absent in three genotypes, spermine was absent in six genotypes, and spermidine was absent in three genotypes. Genotypes B23, E20, and E21 had the lowest biogenic amine quantity. Conclusions: All identified proteins from mesquite trees from both regions (Eastern and Al-Qassim) cause allergies in patients who are sensitive to pollen grains. Bioamines, except histamine and tyramine, were recorded at varying concentrations in different genotypes.

Validation of an HPLC-UV method for the identification and quantification of bioactive amines in chicken meat / Validação de metodologia por HPLC/UV para identificação e quantificação de aminas bioativas em carne de frango de corte

A high-performance liquid chromatography with ultraviolet detection (HPLC-UV) method was validated for the study of bioactive amines in chicken meat. A gradient elution system with an ultraviolet detector was used after extraction with trichloroacetic acid and pre-column derivatization with dansyl chloride. Putrescine, cadaverine, histamine, tyramine, spermidine, and spermine standards were used for the evaluation of the following performance parameters: selectivity, linearity, precision, recovery, limits of detection, limits of quantification and ruggedness. The results indicated excellent selectivity, separation of all amines, a coefficient of determination greater than 0.99 and recovery from 92.25 to 102.25% at the concentration of 47.2mg.kg-1, with a limit of detection at 0.3mg.kg-1 and a limit of quantification at 0.9mg.kg-1 for all amines, with the exception of histamine, which exhibited the limit of quantification, of 1mg.kg-1. In conclusion, the performance parameters demonstrated adequacy of the method for the detection and quantification of bioactive amines in chicken meat.(AU)

Um método de cromatografia líquida de alta eficiência (CLAE) para pesquisa de aminas bioativas em carne de frango foi validado. Foi utilizado um sistema de gradiente de eluição com detector ultravioleta, após extração com ácido tricloroacético e derivação pré-coluna com cloreto de dansila. Os padrões de putrescina, cadaverina, histamina, tiramina, espermidina e espermina foram utilizados para avaliação dos seguintes parâmetros de desempenho: seletividade, linearidade, precisão, recuperação, limites de detecção, limites de quantificação e robustez. Os resultados mostraram excelente seletividade e separação de todas as aminas, coeficiente de determinação superior a 0,99, recuperação entre 92,25 e 105,25% na concentração 47,2mg.kg-1, limites de detecção de 0,3mg.kg-1 e limite de quantificação de 0,9mg.kg-1 para todas as aminas, com exceção da histamina, que apresentou o limite de quantificação mais alto, de 1mg.kg-1. Foi concluído que os parâmetros de desempenho demonstraram adequação do método para detecção e quantificação de aminas bioativas em carne de frango.(AU)

Bacteria isolated from Korean black raspberry vinegar with low biogenic amine production in wine

Abstract A high concentration of histamine, one of the biogenic amines (BAs) usually found in fermented foods, can cause undesirable physiological side effects in sensitive humans. The objective of this study is to isolate indigenous Acetobacter strains from naturally fermented Bokbunja vinegar in Korea with reduced histamine production during starter fermentation. Further, we examined its physiological and biochemical properties, including BA synthesis. The obtained strain MBA-77, identified as Acetobacter aceti by 16S rDNA homology and biochemical analysis and named A. aceti MBA-77. A. aceti MBA-77 showed optimal acidity % production at pH 5; the optimal temperature was 25 °C. When we prepared and examined the BAs synthesis spectrum during the fermentation process, Bokbunja wine fermented with Saccharomyces cerevisiae showed that the histamine concentration increased from 2.72 of Bokbunja extract to 5.29 mg/L and cadaverine and dopamine was decreased to 2.6 and 10.12 mg/L, respectively. Bokbunja vinegar prepared by A. aceti MBA-77 as the starter, the histamine concentration of the vinegar preparation step was decreased up to 3.66 mg/L from 5.29 mg/L in the wine preparation step. To our knowledge, this is the first report to demonstrate acetic acid bacteria isolated from Bokbunja seed vinegar with low spectrum BA and would be useful for wellbeing vinegar preparation.

Effect of high-voltage electrical stimulation on the albumin and histamine serum concentrations, edema, and pain in acute joint inflammation of rats

BACKGROUND: The mechanism by which high-voltage electrical stimulation (HVPC) acts on edema reduction is unknown. OBJECTIVE: To assess the effect of HVPC with negative polarity (-) applied to the ankle of rats with acute joint inflammation. METHOD: Sixty-four rats were divided into four groups (n=16): inflamed+HVPC(-), 0.03 mL application of ι-carrageenan (3%) to the tibiotarsal joint plus HVPC(-); inflamed+HVPC placebo, carrageenan application and HVPC placebo; normal+HVPC(-), HVPC application(-); and normal control, no intervention. The HVPC(-) 100 Hz at a submotor level was applied daily for 45 min on three consecutive days. The variables were pain, hind-foot volume, and serum histamine and albumin assessed before and during the 48 hours following inflammation. The variables were compared using the t test, one-way ANOVA, nested ANOVA for repeated measures, and the post hoc Bonferroni test. Analysis of covariance was applied to adjust the effects of HVPC(-) by measurements of pain, inflammation, albumin, and histamine at 24 h, and the final weight was compared to the other groups. The significance level was set at p<0.05. RESULTS: There were no differences between the inflamed+HVPC(-) and inflamed+HVPC placebo groups in terms of pain or edema (p>0.05). Albumin was reduced in the groups that received the intervention, but there was no differences between them. There was only a 24 hour increase in histamine with the normal+HVPC(-) (p=0.0001) and inflamed+HVPC placebo groups (p=0.01) compared to the normal control group. CONCLUSIONS: The results of the present study suggest that HVPC(-) with the parameters employed did not reduce pain or edema and did not change serum albumin or histamine levels,, which indicates the inability of this resource to have a positive effect when treating treat acute joint inflammation. .

Histamina e rastreamento de pescado: revisão de literatura / Histamine and traceability of fish: literature review

A preocupação com a qualidade do pescado sempre foi um tema recorrente, visto que é um alimento de alto valor nutricional para toda população, porém com grande susceptibilidade à deterioração e formação de substâncias prejudiciais ao homem, caso não sejam obedecidas as condições de conservação. Um exemplo de substância formada é a histamina, uma diamina biogênica primária e heterocíclica, não volátil, termoestável, originada pela descarboxilação da L-histidina, quando as condições de manuseio e estocagem são inadequadas, favorecendo a multiplicação da microbiota natural do pescado. A histamina possui potencial alergênico, podendo causar um quadro de intoxicação no ser humano e, em casos graves, levar à morte. Para tal problema, um sistema de rastreabilidade poderia ser a solução. Seu objetivo é garantir ao consumidor um produto seguro e saudável por meio do controle de todas as fases da produção, industrialização, distribuição e comercialização, possibilitando uma perfeita correlação entre o produto final e a matéria-prima que lhe deu origem. Em diversos países existem atualmente sistemas de rastreabilidade controlando a cadeia de pescado. No Brasil, vários entraves podem ser apontados para a não obrigatoriedade da rastreabilidade em pescado. A divisão de regulamentação do setor entre diferentes órgãos, tais como Ministério da Pesca e Aquicultura (MPA), Ministério da Agricultura, Pecuária e Abastecimento (MAPA) e a Agência Nacional de Vigilância Sanitária (ANVISA), a falta de articulação entre esses órgãos fiscalizadores, a baixa capacitação de mão de obra e a desvalorização dos produtos da pesca, o que trazem a descapitalização da base da cadeia produtiva. De tal maneira, pode-se afirmar que há uma série de desafios para que ocorra a implantação de um sistema de rastreabilidade em território nacional. De acordo com o exposto, este estudo objetivou, através de uma revisão bibliográfica sistemática da literatura, informar a situação atual da escombrotoxicose e da rastreabilidade da histamina em pescado.(AU)

Concern about the quality of the fish has always been a recurring theme since it is a food of high nutritional value for the whole population, but with greater ease of formation and decay of harmful substances to man, if not well maintained. An example of a substance formed is histamine, a biogenic diamine primary and heterocyclic, non-volatile, thermoestable, originated by the decarboxylation of L-histidine when the conditions of handling and storage are inadequate, favoring the multiplication of natural microbiota. It has allergen potential and can cause intoxication in humans and, in severe cases, lead to death. For this problem, a traceability system could be the solution. The aim is to ensure the consumer a safe and wholesome product by controlling all stages of production, processing, distribution and marketing, enabling a perfect correlation between the final product and the raw material. In several countries, there are currently traceability systems controlling the chain of fish. In Brazil, several factors can be identified as barriers to the adoption of traceability: different regulatory agencies such as the Ministry of Fisheries and Aquaculture (MPA), Ministry of Agriculture, Livestock and Supply (MAPA), and the National Health Surveillance Agency (ANVISA), the lack of coordination between these sectors, the lack of training of skilled labor and the devaluation of fishery products, which brings decapitalization of the base of the production chain. According to this, there are a number of challenges to deploy a traceability system in the country. This study aimed, through a systematic literature review of the literature, to report the current status of escombrotoxicose and traceability of histamine in fish.(AU)

Medicinas tradicionales andinas y su despenalización: entrevista con Walter Álvarez Quispe / Decriminalizing traditional Andean medicine: an interview with Walter Álvarez Quispe

Walter Álvarez Quispe, terapeuta kallawaya y biomédico especializado en cirugía general y ginecología, presenta la lucha de los terapeutas tradicionales y alternativos por la depenalización de estos sistemas médicos andinos realizada entre 1960 y 1990. Bolivia se torna el primer país en América Latina y el Caribe en despenalizar la medicina tradicional antes de los planteamientos de la Conferencia Internacional sobre Atención Primaria de Salud (Alma-Ata, 1978). Los datos aportados por el entrevistado aseguran que los logros alcanzados, principalmente por los kallawayas, responden a un proyecto propio y autónomo. Estas conquistas no se deben a las políticas oficiales de interculturalidad en salud, aunque busquen atribuirse para sí los logros alcanzados.

Walter Álvarez Quispe, a Kallawaya healer and biomedical practitioner specializing in general surgery and gynecology, presents the struggle of traditional and alternative healers to get their Andean medical systems depenalized between 1960 and 1990. Bolivia was the first country in Latin America and the Caribbean to decriminalize traditional medicine before the proposals of the International Conference on Primary Health Care (Alma-Ata, 1978). The data provided by the interviewee show that the successes achieved, mainly by the Kallawayas, stem from their own independent initiative. These victories are not the result of official policies of interculturality in healthcare, although the successes achieved tend to be ascribed to them.

Incidencia de histamina y de bacterias indicadoras de calidad higiénica, en filetes, ruedas y trozos de pescado de especies pelágicas comercializadas en un mercado de pescado de la isla de Margarita (Venezuela) / Incidence histamine and hygienic quality indicators´s bacteria in fillets, slice and pieces pelagic fish´s marketing in one fish´s market of Margarita´s Island (Venezuela)

Se estudió la incidencia de histamina y de bacterias indicadoras de manejo higiénico en filetes, ruedas y trozos de diez especies de pescado en estado fresco, (Euthynnus alletteratus; Caranx latus; Ophisthonema oglinum; Alectis crinitus; Sardinella aurita; Thunnus alalunga; Sarda sarda; Scomberomorus cavalla; Coryphaena hippurus y Xyphias gladius), comercializadas en un mercado de pescado de Isla de Margarita (Venezuela). Según normas COVENIN se enumeraron (UFC g-1) aerobios a 25 y 32 °C, coliformes fecales y Escherichia coli (NMP g-1); histamina (mg/100 g) y pH. También recuentos (UFC g-1) de enterobacterias (ICMSF) y bacterias descarboxiladoras de histidina (Niven y otros). Todos los recuentos de aerobios a 25 °C excedieron el valor m (Log10 = 5,70 UFC g-1) fijado por ICMSF (1986). La prueba r de Pearson indicó que los recuentos a 25 y 32 °C estuvieron altamente relacionados (n = 90; r = 0,89; p < 0,01). E. coli superó en el 76% de las muestras el valor m (Log10 = 1,04 NMP g-1). Las mayores cifras de histamina se detectaron en T. alalunga (promedio 43,5 mg/100 g en uno de tres muestreos); seguido por S. aurita (promedios de 23,7 y 28,0 mg/100 g respectivamente, en dos muestreos). Sólo en muestras de T. alalunga se detectaron olores penetrantes y músculos con elasticidad disminuida. Estos datos y la observación de factores adversos, tales como contacto directo con superficies y utensilios sucios, restos de vísceras, desangrado deficiente, presencia de insectos, utilización de agua no potable y la exposición a temperaturas no apropiadas, reflejan que la manipulación del pescado no fue adecuada. Se recomienda que inspectores sanitarios implementen acciones tendentes a corregir estas deficiencias.

The incidence of histamine and of bacteria that indicate hygienic handling of fillets, slices and pieces of ten pelagic fresh fish (Euthynnus alletteratus; Caranx latus; Ophisthonema oglinum; Alectis crinitus; Sardinella aurita; Thunnus alalunga; Sarda sarda; Scomberomorus cavalla; Coryphaena hippurus and Xyphias gladius), sold in a fish market at Margarita Island (Venezuela) was assessed. According to COVENIN´s norms, total aerobic plate count (FCU g-1) at 25 and 32 °C; fecal coliforms and Escherichia coli (MPN g-1); histamine (mg/100 g) and pH were measured. Also, members of the Enterobacteriaceae family (FCU g-1) and histamine producing bacteria were counted, according to ICMSF and Niven et al respectively. All total aerobic plate count at 25 °C surpassed the m number (Log10 = 5.70 CFU g-1) established by ICMSF (1986). The Pearson test (r) showed that bacteria total counts at 25 and 32 °C were highly related (n = 90; r = 0.89; p < 0.01). E. coli exceeded in 76% of samples the number (Log10 = 1.04 MPN g-1). Histamine biggest numbers were detected in T. alalunga (average 43.5 mg/100 g in one of three samplings), followed by S. aurita (averages of 23.7 and 28.0 mg/100 g respectively, in two samplings). Only in T. alalunga samples were penetrating odors detected and muscles with reduced elasticity. This data and the adverse factors observed, such as: fish in direct contact with dirty areas and utensils, leftover viscera, faulty bleeding, presence of insects, use of non potable water and the exposition of fish at inappropriate temperatures, revealed the handling of fish was not suitable. It is recommended that sanitary officers carry out actions necessary to correct these deficiencies.

Perspectivas atuais sobre inflamação e remodelamento das vias aéreas na asma e na rinite alérgica / Current perspectives on airway inflammation and remodelling in asthma and allergic rhinitis

O desenvolvimento da rinite alérgica (RA) e da asma requer uma interação entre ambiente, sistema imunológico e susceptibilidade genética. Enquanto a rinite induzida por pólen é a mais característica doença alérgica mediada pela imunoglobulina E, na RA perene os desencadeantes da alergia são mais contínuos e levam à inflamação constante. Várias células e mediadores coordenam e mantêm essa inflamação. Embora a histamina ainda seja um dos principais mediadores da reação alérgica, muitos outros mediadores produzidos por diferentes tipos celulares estão envolvidos. Assim, a intrincada interação entre esses mediadores, citocinas, quimiocinas, neuropeptídeos, moléculas de adesão e várias células na forma de uma rede complexa leva ao desenvolvimento de sintomas específicos e à hiper-reatividade não específica presente na RA. A asma é caracterizada por graus variáveis de inflamação crônica e alterações estruturais nas vias aéreas que incluem denudação epitelial, metaplasia das células caliciformes, espessamento subepitelial, aumento da massa do músculo liso nas vias aéreas, aumento das glândulas brônquicas, angiogênese, e alterações nos componentes da matriz extracelular envolvendo as pequenas e grandes vias aéreas. Acredita-se que a inflamação crônica inicie e perpetue ciclos de dano e reparo tecidual na asma, embora o remodelamento também possa ocorrer em paralelo com a inflamação. Ao mesmo tempo em que RA e asma apresentam várias semelhanças em termos de perfil e resposta das células inflamatórias e dos mediadores, o remodelamento como observado na asma não é característico da RA. Na asma, as relações entre inflamação e remodelamento das vias aéreas e função pulmonar estão sendo melhor compreendidas. Uma variedade de células inflamatórias e células estruturais atuam na coordenação da inflamação e das mudanças estruturais na asma. O aumento da responsividade das vias aéreas é um marcador substituto de inflamação e pode refletir o desenvolvimento de mudanças estruturais nas vias aéreas. Tal aumento persistente da responsividade brônquica aponta para a ocorrência de remodelamento parcialmente resistente à terapia.

The development of AR and asthma requires an interaction between the environment, imune system and genetic susceptibility. While pollen-induced rhinitis is the most characteristic IgE mediated allergic disease, in perennial allergic rhinitis the allergic triggers are more continuous, and lead to on going inflammation. Several cells and mediators orchestrate and maintain this inflammation. Although histamine is still one of the major mediators of the allergic reaction, many other mediators produced by different cell types are involved. Thus, the intricate interaction amongst these mediators, cytokines, chemokines, neuropeptides, adhesion molecules and various cells in the form of a complex network leads to the development of specific symptoms and the non specific hyperreactivity of allergic rhinitis. Asthma is characterized by variable degrees of chronic inflammation and structural alterations in the airways which include epithelial denudation, goblet cell metaplasia, subepithelial thickening, increased airway smooth muscle mass, bronchial gland enlargement, angiogenesis, and alterations in extracellular matrix components, involving large and small airways. Chronic inflammation is thought to initiate and perpetuate cycles of tissue injury and repair in asthma, although remodeling may also occur in parallel with inflammation. While AR and asthma share several similarities in the inflammatory cell and mediator profiles and responses, remodeling as seen in asthma is not characteristic of AR. In asthma, the relationships of airway inflammation, remodeling and lung function are becoming better understood. A variety of inflammatory cells and structural cells play a role in orchestrating the inflammation and structural changes in asthma. Increased airway responsiveness is a surrogate marker of inflammation and may reflect the development of structural changes in the airways. Such persistent increased bronchial responsiveness indicates remodeling which is partly resistant to therapy.

Antihistamínicos Parte II - ¿Cuáles son las opciones y en qué basarse para elegir la mejor? / Antihistamines Part II - What are the options and how to choose the best?

Los antihistamínicos han sido usados durante los últimos 50 años y se han convertido en los medicamentos de mayor prescripción en el mundo. En este artículo se revisa el desarrollo de nuestro conocimiento referente a la histamina en el transcurso del siglo, como mediador biológico almacenado y liberado mayormente por los basófilos y mastocitos; mediador biológico situado en diferentes tejidos corporales, y otras células, con un papel fisiológico fundamental en el control de la secreción de ácido gástrico y un papel fisiopatológico en una gama de trastornos alérgicos. La síntesis y estudios farmacológicos de agonistas y antagonistas selectivos han establecido la existencia de cuatro tipos de receptores de histamina y antagonistas de ellos, que han encontrado muy importantes aplicaciones terapéuticas. Debido al aumento de la prevalencia de las enfermedades alérgicas según el Libro Blanco de Alergia (WAO), se deben crear normas que promuevan el uso de los antihistamínicos de manera adecuada y racional. De esta manera, la correcta elección debe ser realizada de acuerdo a su eficacia, tolerabilidad, seguridad, grupo etario, situaciones y precauciones particulares en pacientes con algún riesgo incrementado. El crear normas que promuevan una práctica terapéutica óptima o uso racional de dichos medicamentos. Elegirlos de acuerdo a su eficacia, tolerabilidad, seguridad, grupo etario, situaciones y precauciones especiales en pacientes portadores de ciertas enfermedades de riesgo a utilizarlos.(AU)

Antihistamines have been used for the past 50 years and have become the most prescribed drugs in the world. This article reviews the development of our knowledge concerning the histamine in the course of the century, as a biological mediator mostly stored and released by basophils and mast cells biological mediator located in different body tissues, and other cells, having a fundamental physiological role in the control of gastric acid secretion and pathophysiological role in a variety of allergic disorders. The synthesis and pharmacological studies of selective agonists and antagonists has established the existence of four types of histamine receptor antagonists and histamine receptor found important therapeutic applications. Power demonstrations relate most allergic diseases whose symptoms are chronic and persistent emphasis by (WAO) White Paper on Alergia1 a steady increase in allergic diseases with a prevalence of 30-40% of the world population affected at least one allergic condition, considering the most common allergic rhinitis and chronic diseases common in our modern society. Creating standards that promote optimal therapeutic practice or rational use of such drugs. Choose them according to their efficacy, tolerability, safety, age group, situations and special precautions in patients with certain diseases risk to use. (AU)

Antihistamínicos Parte 1 - Historia y características de los receptores histaminérgicos / Antihistamines. Part 1 - History and characteristics of histaminergic receptors

Los antihistamínicos han sido usados durante los últimos 50 años y se han convertido en los medicamentos de mayor prescripción en el mundo. En este artículo se revisa el desarrollo de nuestro conocimiento referente a la histamina en el transcurso del siglo, como mediador biológico almacenado y liberado mayormente por los basófilos y mastocitos; mediador biológico situado en diferentes tejidos corporales, y otras células, con un papel fisiológico fundamental en el control de la secreción de ácido gástrico y un papel fisiopatológico en una gama de trastornos alérgicos. La síntesis y estudios farmacológicos de agonistas y antagonistas selectivos han establecido la existencia de cuatro tipos de receptores de histamina y antagonistas de ellos, que han encontrado muy importantes aplicaciones terapéuticas. Debido al aumento de la prevalencia de las enfermedades alérgicas según el Libro Blanco de Alergia (WAO), se deben crear normas que promuevan el uso de los antihistamínicos de manera adecuada y racional. De esta manera, la correcta elección debe ser realizada de acuerdo a su eficacia, tolerabilidad, seguridad, grupo etario, situaciones y precauciones particulares en pacientes con algún riesgo incrementado. El crear normas que promuevan una práctica terapéutica óptima o uso racional de dichos medicamentos. Elegirlos de acuerdo a su eficacia, tolerabilidad, seguridad, grupo etario, situaciones y precauciones especiales en pacientes portadores de ciertas enfermedades de riesgo a utilizarlos.(AU)

Antihistamines have been used for the last 50 years and have become the most prescribed medications in the world. In this article we review the development of our knowledge regarding histamine in the course of the century, as a biological mediator stored and released mostly by basophils and mast cells; biological mediator located in different body tissues, and other cells, with a fundamental physiological role in the control of gastric acid secretion and a physiopathological role in a range of disorders allergic The synthesis and pharmacological studies of selective agonists and antagonists have established the existence of four types of histamine receptors and antagonists of them, who have found very important therapeutic applications. Due to the increased prevalence of allergic diseases according to the White Paper on Allergy (WAO), standards should be created that promote the use of antihistamines in an adequate and rational way. In this way, the correct choice must be made in accordance to its efficacy, tolerability, safety, age group, situations and special precautions in patients with an increased risk. The creation of norms that promote an optimal therapeutic practice or rational use of said medications. Choose them according to their effectiveness, tolerability, safety, age group, situations and special precautions in patients with certain risk diseases to use them.

Urticária: diagnóstico e tratamento / Urticaria: diagnosis and treatment

A urticária apresenta-se com diversas formas clínicas e causas distintas. Constitui uma das dermatoses mais frequentes: 15% a 20% da população têm pelo menos um episódio agudo da doença em sua vida. A urticária é classificada do ponto de vista de duração da evolução temporal em aguda (inferior a seis semanas) ou crônica (superior a seis semanas). O tratamento da urticária pode compreender medidas não farmacológicas e intervenções medicamentosas, as quais são agrupadas em tratamentos de primeira (anti-histamínicos), segunda (corticosteróides e antileucotrienos) e terceira linha (medicamentos imunomoduladores). Essa entidade clínica acarreta importante perda na qualidade de vida e deve ser prontamente tratada pelo profissional de saúde.

The urticaria presents itself with diverse clinical forms and distinct causes. It is one of the most common dermatosis: 15% to 20% of the population has at least one acute episode of illness in their life. Urticaria is classified based on its temporal evolution as acute (less than 6 weeks) or chronic (more than 6 weeks). Management strategies may involve nonpharmacological measures and drug interventions, which are grouped into first-(antihistamines), second (corticosteroids and antileukotrienes) and third-line therapies (immunomodulators). This clinical entity has a major loss in quality of life and should be promptly treated by a health professional.

Avaliações objetiva e subjetiva da obstrução nasal em crianças e adolescentes com rinite alérgica / Objective and subjective assessments of nasal obstruction in children and adolescents with allergic rhinitis

OBJETIVO: Relacionar a avaliação objetiva da obstrução nasal por rinometria acústica (volume dos cinco primeiros centímetros da cavidade nasal) e rinomanometria anterior ativa (resistência nasal total) com a avaliação subjetiva (escore de obstrução). MÉTODO: Participaram do estudo 30 pacientes (7 a 18 anos) com rinite alérgica persistente e 30 controles. O escore foi referido para cavidade nasal total e narinas em separado. As três variáveis foram mensuradas nos momentos basal e após indução de obstrução nasal. RESULTADOS: Houve correlações significantes e negativas entre resistência e volume nasal em todos os grupos e situações de avaliação, exceto para narina mais obstruída, grupo controle, pós-obstrução. Para a cavidade nasal total, não houve correlação significante entre as variáveis objetivas e subjetiva, exceto entre escore e volume na cavidade nasal total no grupo controle pós-obstrução. Na narina mais obstruída, houve correlação significante e negativa para escore e resistência e significante e positiva para escore e volume nasal no grupo total, momento basal. Não houve diferença nítida nos coeficientes de correlação entre pacientes e controles, e estes não se alteraram após a indução de obstrução nasal. CONCLUSÕES: Avaliação objetiva da obstrução nasal não apresentou correlação significativa com a avaliação subjetiva na cavidade nasal total, mas sim na avaliação unilateral. Houve correlação entre avaliações objetivas. Rinite alérgica ou obstrução nasal aguda não interferiram na correlação entre as avaliações objetiva e subjetiva da obstrução nasal. Sugere-se utilidade no acréscimo de métodos objetivos para avaliação da obstrução nasal em pesquisas e, na sua impossibilidade, avaliação das narinas em separado.

OBJECTIVE: To correlate objective assessment of nasal obstruction, as measured by acoustic rhinometry (volume of the first 5 cm of the nasal cavity) and active anterior rhinomanometry (total nasal airway resistance), with its subjective evaluation (obstruction scores). METHOD: Thirty patients, aged 7 to 18 years, with persistent allergic rhinitis and thirty controls were enrolled. The obstruction score was reported for the whole nasal cavity and for each nostril separately. The three variables were measured at baseline and after induction of nasal obstruction. RESULTS: There were significant and negative correlations between resistance and nasal volume in all groups and scenarios, except for the most obstructed nostril, in the control group, post-obstruction. For the whole nasal cavity, there was no significant correlation between objective and subjective variables except between score and total nasal cavity volume in the control group, post-obstruction. Regarding the most obstructed nostril, we found a significant negative correlation between score and resistance and a significant positive correlation between score and volume for the total group at baseline. There were no clear differences in the correlation coefficients found in patients and controls. The correlation coefficients did not change after induction of nasal obstruction. CONCLUSIONS: Objective assessment of nasal obstruction did not correlate significantly with subjective evaluation for the nasal cavity as a whole, but there was a correlation for unilateral assessments. There was correlation between the objective evaluations. Allergic rhinitis and acute induction of nasal obstruction did not affect the correlation between objective and subjective assessments of nasal obstruction. Addition of an objective method for evaluation of nasal obstruction could be useful in the research setting; if no such method can be used, each nostril should be evaluated separately.