Hospital admission for symptoms exacerbation in 2,075 infants suffering from recurrent asthma-like symptoms: (EISL-3 South America).

BACKGROUND: Contrary to what happens in children and adults, the prevalence and the factors related to hospitalisation for asthma/wheezing in infants with recurrent asthma-like symptoms are poorly known. METHODS: This study is part of the International Study of Wheezing in infants Phase 3; 2,079 infants (aged 12-18 months) with recurrent asthma-like symptoms, from 11 South American centres, were studied to determine the prevalence and the associated factors for wheezing exacerbation admission. Descriptive statistics and multivariate logistic regression were employed for analysis. RESULTS: The prevalence of admission for wheezing was 29.7% (95% CI 27.7-31.6) and was significantly associated to severe wheezing episodes (OR: 3.89; 95% CI: 2.93-5.18, p < 0.001), physician-diagnosed asthma (OR: 1.79; 95% CI: 1.33-2.41, p < 0.0001), use of inhaled corticosteroids (OR: 1.78; 95%CI: 1.38-2.29, p < 0.0001), maternal tobacco smoking during pregnancy (OR: 1.69; 95% CI: 1.19-2.39, p = 0.003) and onset of wheezing in the first trimester of life (OR: 1.30; 95% CI: 1.02-1.66, p = 0.038). Breast feeding ≥4 months (OR: 0.72; 95% CI: 0.54-0.96, p = 0.004), maternal high educational level (>12 years) (OR: 0.66; 95% CI: 0.51-0.85, p = 0.001) and total monthly household income ≥US$ 3,000 (OR: 0.34; 95% CI: 0.18-0.67, p = 0.002), were protective factors. CONCLUSIONS: Infants with recurrent asthma-like symptoms have a high rate of admissions. Tobacco smoking in pregnancy, viral respiratory illness in the first trimester of life and severe progression were risks for admissions. Improving medical management to prevent severe exacerbations, prolonging the postnatal period at home longer than 3 months, favouring breastfeeding and avoiding smoking during pregnancy may have a preventive role for admissions in infants with recurrent asthma-like symptoms.

Outcome of SARS-CoV-2 Infection in 121 Patients with Inborn Errors of Immunity: A Cross-Sectional Study.

PURPOSE: There is still scarce data on SARS-CoV-2 infection in patients with Inborn Errors of Immunity (IEI) and many unresolved questions. We aimed to describe the clinical outcome of SARS-CoV-2 infection in Brazilian IEI patients and identify factors influencing the infection. METHODS: We did a cross-sectional, multicenter study that included patients of any age affected by IEI and SARS-CoV-2 infection. The variables studied were sex, age, type of IEI, comorbidities (number and type), treatment in use for IEI, clinical manifestations and severity of SARS-CoV-2 infection. RESULTS: 121 patients were included: 55.4% female, ages from six months to 74 yo (median age = 25.1 yo). Most patients had predominantly antibody deficiency (n = 53). The infection was mostly asymptomatic (n = 21) and mild (n = 66), and one child had multisystem inflammatory syndrome (MIS-C). We could not observe sex-related susceptibility, and there was a weak correlation between age and severity of infection. The number of comorbidities was higher in severe cases, particularly bronchiectasis and cardiopathy. There were no severe cases in hereditary angioedema patients. Six patients aged 2 to 74 years died, three of them with antibody deficiency. CONCLUSION: The outcome was mild in most patients, but the Case Fatality Ratio was higher than in the general population. However, the type of IEI was not a determining factor for severity, except for complement deficiencies linked to milder COVID-19. The severity of SARS-CoV-2 infection seems to be more related to older age, a higher number of comorbidities and type of comorbidities (bronchiectasis and cardiopathy).

Os fatores associados à asma em crianças e adolescentes são universais? Estudo sistemático multicêntrico brasileiro / Are the factors associated with asthma in children and adolescents universal? A systematic multicenter Brazilian study

Objetivo: Comparar os fatores de risco associados à asma em escolares brasileiros habitantes de diferentes regiões do país. Método: Participaram estudantes (4-8 anos, n = 4.262; 10-14 anos, n = 10.603) matriculados em escolas privadas ou particulares de onze centros de nove cidades brasileiras, utilizando-se o protocolo do International Study of Asthma and Allergy in Childhood (ISAAC). Após a obtenção das taxas de prevalência de asma, foram selecionados de modo aleatório estudantes com asma ativa (resposta afirmativa para "sibilos nos últimos 12 meses") e sem asma (resposta negativa) mantendo-se como base a proporção 1:2. A seguir os responsáveis responderam questionário complementar ISAAC sobre fatores de risco. A análise de regressão logística identificou os fatores associados à expressão da asma nos escolares, em cada centro de origem. Resultados: Na faixa etária mais jovem, ter antecedente de rinite ou eczema atópico, história familiar de doenças alérgicas e ser exposto ao tabaco foram identificados pela maioria dos centros. Entre os adolescentes ocorreu o mesmo: ter rinite alérgica (8/11 centros), ter antecedentes familiares de doenças alérgicas (6/11), ser exposto passivamente ao tabaco (6/11), assim como a animais domésticos, sobretudo gato (5/11), nascer pré-termo, ter baixo consumo de vegetais e suco de frutas foram os fatores identificados. Conclusões: Os fatores associados ao desenvolvimento de asma em escolares brasileiros não foram uniformes. Fatores genéticos, como ter outra doença alérgica, ou familiares com doença alérgica, foram identificados pela maioria dos centros participantes. A exposição ao tabaco, assim como a animais domésticos, também mostrou ser de importância clínica.

Objective: To compare factors associated with the development of asthma in Brazilian schoolchildren residing in different geographical regions. Method: Children and adolescents (4-8 years, n = 4,262; 10-14 years, n = 10,603) enrolled in public or private schools at 11 centers from 9 Brazilian cities were screened using the protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). After obtaining asthma prevalence rates, schoolchildren with active asthma (positive response for wheezing in the past 12 months) and without asthma (negative response) were randomly selected at a ratio of 1:2. Then, their parents or guardians were asked to answer the supplementary ISAAC questionnaire on risk factors. Multivariate logistic regression analysis identified factors associated with the expression of asthma among schoolchildren at each center. Results: Among children, having a history of rhinitis or atopic eczema, having a family history of allergic diseases, and being exposed to tobacco were identified as risk factors at most centers. Among adolescents, similar results were found: having allergic rhinitis (8/11 centers), having a family history of allergic diseases (6/11), being passively exposed to tobacco (6/11), being exposed to domestic animals, especially cat (5/11), having been born preterm, and having a low intake of vegetables and fruit juice were the main factors identified. Conclusion: Risk factors for the development of asthma in Brazilian schoolchildren were not unanimous. Genetic factors, such as having another allergic disease, or having family members with allergic disease, were identified by most of the participating centers. Exposure to tobacco, as well as to domestic animals, also showed to be clinically important.

[Phadiatop in the diagnosis of respiratory allergy in children: Allergy Project--PROAL]. / Phadiatop no diagnóstico de alergia respiratória em crianças: Projeto Alergia (PROAL).

OBJECTIVES: To evaluate the positivity of Phadiatop in children from several Brazilian pediatric allergology centers and to compare its results with the presence of serum specific IgE to inhalant and food allergens. PATIENTS AND METHOD: Phadiatop and serum specific IgE levels (RAST) to inhalant and food allergens (UniCAP - Pharmacia) were measured in 457 children from several pediatric allergy centers and in a non-allergic control group (n = 62), distributed across five age groups. RESULTS: Phadiatop was positive in 305 atopic children (67.6%) and in 25.8% of controls (p < 0.001). Among atopic children the distribution of positive test varied according to age: 7.9% (24/305) among under 2 year-olds, 15.4% (47/305) in 2 to 3 year-olds, 22.0% (67/305) in 3 to 4 year-olds, 19.3% (59/305) in 4 to 5 year-olds and 35.4% (108/305) in 5 to 12 year-olds. No concordance between food allergens and Phadiatop was observed. Analysis of the relationship between positive inhaled allergen RASTs and positive Phadiatop showed best indices with house dust mites (D. pteronyssinus, D. farinae and Blomia tropicalis). CONCLUSIONS: Phadiatop is a useful tool for diagnosing domestic mite allergy.

Phadiatop® no diagnóstico de alergia respiratória em crianças: Projeto Alergia (PROAL) / Phadiatop® in the diagnosis of respiratory allergy in children: Allergy Project - PROAL

OBJETIVO: Avaliar a positividade do Phadiatop® em crianças acompanhadas em serviços brasileiros de alergologia e compará-la aos resultados de IgE sérica específica a alérgenos inalantes e alimentares. CASUíSTICA E MÉTODO: Em 457 crianças acompanhadas em serviços de alergia pediátrica e um grupo de crianças controle não-alérgicas (n = 62), distribuídas em cinco faixas etárias, foram determinados em amostra de soro: Phadiatop® e IgE específica (RAST) a alérgenos inalantes e alimentares (UniCAP - Pharmacia®). RESULTADOS: O Phadiatop® foi positivo em 305 crianças atópicas (67,6 por cento) e em 25,8 por cento das controles (p < 0,001). Entre as crianças atópicas, a distribuição de positividade variou de acordo com a faixa etária: 7,9 por cento (24/305) entre as abaixo de 2 anos, 15,4 por cento (47/305) nas de 2 a 3 anos, 22,0 por cento (67/305) nas de 3 a 4 anos, 19,3 por cento (59/305) nas de 4 a 5 anos e 35,4 por cento (108/305) nas de 5 a 12 anos. Não houve concordância entre os alérgenos alimentares e a presença de Phadiatop® positivo. O estudo da relação entre os RAST positivos para alérgenos inalados e o Phadiatop® positivo mostrou melhores índices com os ácaros domiciliares (D. pteronyssinus, D. farinae e Blomia tropicalis). CONCLUSÕES: O Phadiatop®é método útil no diagnóstico de alergia aos ácaros domiciliares.