A especialidade de Alergia e Imunologia Clínica nos diferentes níveis de atenção à saúde no Brasil / Allergy and Clinical Immunology specialty in the different levels of health care in Brazil

Objetivos: Avaliar a atuação de alergistas/imunologistas no serviço público e identificar prioridades, carências e demandas na assistência aos pacientes com doenças alérgicas e imunodeficiências. Métodos: Foi desenvolvido um questionário on-line autoaplicável por meio do Google Forms, composto por 17 questões de múltipla escolha sobre dados demográficos, área de atuação, local de desempenho das atividades profissionais e acesso a exames laboratoriais. Resultados: Responderam ao questionário on-line 367 associados. A média de idade foi de 45,3 anos (desvio padrão, DP = 11,7), e 255 dos participantes eram mulheres (69,5%). Atuavam também como pediatras 52,9% dos alergistas, e apenas 37,6% atendiam pacientes com imunodeficiências primárias no Sistema Único de Saúde (SUS). Os recursos para abordagem desses pacientes eram escassos e não distribuídos de maneira uniforme. Conclusões: Os especialistas em Alergia e Imunologia Clínica estão concentrados nos grandes centros, e os que atuam no serviço público não têm acesso a recursos adequados para o diagnóstico e tratamento das doenças alérgicas e imunodeficiências primárias. Ações estratégicas em várias instâncias do SUS são necessárias para melhorar a atenção aos pacientes com doenças imunoalérgicas no Brasil.

Objectives: To evaluate the performance of allergists/ immunologists in the public service and to identify priorities, needs and demands in the care of patients with allergic diseases and immunodeficiencies. Methods: A self-administered online questionnaire was developed through Google Forms, consisting of 17 multiple choice questions about demographic data, area of performance, place of professional performance and access to laboratory exams. Results: 367 patients answered the online questionnaire. The mean age was 45.3 years (standard deviation, SD = 11.7), and 255 participants were female (69.5%). A total of 52.9% of allergists also worked as pediatricians, and only 37.6% treated primary immunodeficiency patients through the Brazilian Unified Health System (SUS). Resources to manage these patients were scarce and unevenly distributed. Conclusions: Allergy and Clinical Immunology specialists are concentrated in large centers and those who work in the public service do not have access to adequate resources for diagnosis and treatment of allergic diseases and primary immunodeficiencies. Strategic actions in various levels of SUS are necessary to improve care for patients with immunologic and/or allergic diseases in Brazil.

Diretrizes da Associação Brasileira de Alergia e Imunologia e Sociedade Brasileira de Pediatria para sibilância e asma no pré-escolar / Guidelines of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics for wheezing and asthma in preschool children

A asma é uma das doenças crônicas de maior frequência na infância. Parcela significativa de crianças com asma desenvolve sintomas nos primeiros anos de vida, mas nem sempre a sua confirmação diagnóstica é fácil. Outras causas de sibilância que podem gerar confusão diagnóstica, além da complexidade para a obtenção de medidas objetivas, tais como a realização de provas de função pulmonar nessa faixa etária, são justificativas para esse fato. Especialistas na abordagem desses pacientes, da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria, após revisão extensa da literatura pertinente elaboraram esse documento, onde são comentados os possíveis agentes etiológicos, prevalência, diagnóstico diferencial, assim como tratamento e prevenção da sibilância e asma em pré-escolares.

Asthma is one of the most frequent chronic diseases in childhood. A significant portion of children with asthma develop symptoms in the first years of life, but diagnostic confirmation is not always easy. The difficulty is justified by other causes of wheezing that can generate diagnostic confusion, and by the complexity involved in obtaining objective measures ­ such as pulmonary function tests ­ in this age group. Specialists with expertise in the approach of these patients, from both the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics, after extensive review of the pertinent literature, developed this document to discuss possible etiological agents, prevalence, differential diagnosis, as well as treatment and prevention of wheezing and asthma in preschool children.

Pregnancy in HIV vertically infected adolescents and young women: a new generation of HIV-exposed infants.

BACKGROUND: Vertically infected individuals are reaching childbearing age and the new generation of HIV-exposed infants is coming to pediatric care. METHODS: Chart review of pregnancies among HIV vertically infected adolescents and young women. RESULTS: Fifteen pregnancies were reviewed. Girls had HIV diagnosis at median age 10.1 years (range 1.3-20). They started sexual life at median age 15 years (range 13-19); median age at pregnancy was 16.9 years (range 14-21.5); 36.4% had presented an AIDS-defining clinical event; have been followed for median 8.5 years (range 2.9-15.8) and had used median two antiretroviral regimens (range 0-7). Fourteen (93.3%) received antiretroviral drugs during pregnancy; median CD4 cell count during pregnancy was 394 (range 117-651) cells/µl and median viral load was 4800 copies/ml (range 50-100 000); 54% had undetectable viral load near delivery. All patients delivered by elective c-section. Median birth weight was 2650 g (range 2085-3595), median length was 47.3 cm (range 42-51) and median gestational age 38 weeks (range 37-39). All newborn received zidovudine for 6 weeks of life and none was breastfed. Fourteen (93%) infants were considered HIV-uninfected; one was lost to follow-up. CONCLUSIONS: This group of adolescents seems to have sexual behavior similar to that of HIV-uninfected. Since this is an experimented antiretroviral population, new drugs may be necessary for adequate viral suppression to avoid HIV mother-to-child transmission. Follow-up of this third generation of HIV-exposed infants needs to be addressed within HIV adolescent care.