RESUMEN
BACKGROUND: Rhinosinusitis is highly prevalent in patients with common variable immunodeficiency (CVID), and probably allergic rhinitis (AR) may be masked by a history of repeated respiratory infections. The diagnosis of AR is based on the patient's symptoms and detection of specific immunoglobulin E (IgE) to aeroallergens. This study was designed to identify rhinitis of probable allergic cause in patients with CVID. METHODS: This study included 72 adult CVID patients. The patients were divided into three groups according to their history: suggestive of AR, nonallergic rhinitis, and without rhinitis. They were tested for total and specific IgE (in vivo and in vitro). RESULTS: The patients' mean age was 38.2 years. A history of chronic rhinitis was observed in 59 (81.9%) of the cases, 31 of which (43%) had a history suggestive of AR. Patients with a history of rhinitis (whether allergic or nonallergic) presented an earlier onset of symptoms and diagnosis of CVID. Total IgE was undetectable in 86.1% of patients. AR was confirmed by detection of specific IgE to aeroallergens in only 5.6% of the patients. CONCLUSION: In CVID patients, chronic rhinitis may be allergic, because many have personal and family histories suggestive of atopy. However, in this study, allergy was confirmed by specific IgE detection in only 5.6% of cases. CVID patients with a history suggestive of AR commonly present negative results on traditional testing, so additional experiments may be necessary. One suggestion for the investigation of AR in CVID patients would be nasal provocation with the most prevalent allergens.
Asunto(s)
Alérgenos/inmunología , Inmunodeficiencia Variable Común/inmunología , Rinitis Alérgica Estacional/inmunología , Adulto , Edad de Inicio , Inmunodeficiencia Variable Común/complicaciones , Inmunodeficiencia Variable Común/epidemiología , Epítopos/inmunología , Femenino , Estudios de Seguimiento , Humanos , Inmunoglobulina E/sangre , Masculino , Persona de Mediana Edad , Rinitis Alérgica Estacional/complicaciones , Rinitis Alérgica Estacional/epidemiología , Pruebas Cutáneas , Adulto JovenRESUMEN
OBJETIVO: Avaliar a resposta clínica a imunização com antígenos proteicos e polissacarídicos após administração de vacinas de antígenos específicos (Pneumococo e Influenza H2N3 e H1N1) em pacientes com imunodeficiência comum variável (ICV) acompanhados no ambulatório de Imunodeficiências Primáriasdo Serviço de Imunologia Clínica e Alergia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). MÉTODOS: Os pacientes foram diagnosticados segundo critérios da OMS, PAGID e ESID. Os pacientes foram vacinados contra Influenza H2N3, Influenza H1N1 e Pneumococo. A avaliação clínica foi realizada a partir de um escore clínico no qual os parâmetros considerados foram: pneumonias, sinusites, otite média aguda, infecções de vias aéreas superiores virais (IVAS), amigdalite, diarreia, bronquiectasias, hospitalizações, uso de antibiótico terapêutico, uso de antibiótico profilático, sepse e meningite. Avaliação do escore clínico foi realizada durante o ano que precedeu a vacinação e um ano após a administração das vacinas. RESULTADOS: Participaram do estudo 45 pacientes (51% mulheres), com idade entre 20 a 78 anos (média 36,3 anos). Observamos mediana de 7 anos de retardo no diagnóstico dos pacientes com ICV. IVAS, pneumonias e sinusites foram as manifestações infecciosas mais frequentes em mulheres (80%, 78% e 55% respectivamente). IVAS, sinusites e pneumonias foram os achados mais frequentes em homens (78%, 65% e 35% respectivamente). Houve redução significativa do escore clínico em relação ao número de sinusites e IVAS após a administração das vacinas (p < 0,001).CONCLUSÕES: Observamos redução do número de infecções, especialmente sinusites e IVAS no ano posterior à vacinação. Esta observação reforça o benefício da vacinação e sugere modificação na orientação quanto às indicações de vacinas nos pacientes com ICV.
Objective: To evaluate clinical response to immunization with polysaccharide and protein antigens following administration of specific antigen vaccines (Pneumococcus and Influenza H2N3 and H1N1) in patients with common variable immunodeficiency (CVID) treated at the Primary Immunodeficiency Outpatient Clinic of the Division of Clinical Immunology and Allergy at the Clinical Hospital of the School of Medicine of University of São Paulo (HC-FMUSP). Methods: Patients were diagnosed according to WHO, PAGID, and ESID criteria. Patients were vaccinated against Influenza H2N3, Influenza H1N1, and Pneumococcus. Clinical evaluation was performed using clinical scores for the following parameters: pneumonia, sinusitis, acute otitis media, viral upper respiratory tract infections (URI), tonsillitis, diarrhea, bronchiectasis, hospitalizations, antibiotic therapy, antibiotic prophylaxis, sepsis, and meningitis. Evaluation focused on one year prior to immunization and one year after the administration of vaccines. Results: A total of 45 patients (51% women), aged 20 to 78 years (mean 36.3 years), were evaluated. A median delay of 7 years was observed in the diagnosis of patients with CVID. URI, pneumonia, and sinusitis were the most frequent infectious conditions found in women (80%, 78%, and 55%, respectively); URI, sinusitis, and pneumonia were the most frequent findings in men (78%, 65%, and 35%, respectively). There was a significant reduction in the clinical scores assigned to the number of sinusitis and URI episodes following administration of the vaccines (p < 0.001). Conclusions: A reduction was observed in the number of infections, particularly sinusitis and URI, in the year following immunization. This finding reinforces the benefit of vaccination and suggests modifications to current recommendations for vaccines in patients with CVID.
Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Persona de Mediana Edad , Antígenos Bacterianos , Infecciones Bacterianas , Inmunodeficiencia Variable Común , Fenotipo , Polisacáridos Bacterianos , Vacunas , Técnicas y Procedimientos Diagnósticos , Métodos , PacientesAsunto(s)
Adyuvantes Inmunológicos/uso terapéutico , Asma/tratamiento farmacológico , Vacuna BCG/uso terapéutico , Dermatophagoides pteronyssinus/inmunología , Desensibilización Inmunológica , Hipersensibilidad Inmediata/tratamiento farmacológico , Animales , Asma/diagnóstico , Niño , Quimioterapia Combinada , Femenino , Humanos , Hipersensibilidad Inmediata/diagnóstico , MasculinoRESUMEN
Níveis de imunoglobulina A secretora na saliva de crianças eutróficas
Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Inmunoglobulina A Secretora/análisis , Inmunoglobulinas/análisis , Saliva/inmunología , Factores de EdadRESUMEN
A falta de estímulos infecciosos é apontada como uma das causas do aumento de doenças alérgicas. Existem evidências de que a atopia teria como base a disfunção imune. Por ocasião da apresentação do antígeno citocinas são decisivas no tipo de resposta imune resultante. Num estudo randomizado duplo cego avaliamos a associação da vacina BCG com imunoterapia específica para o ácaro Dermatophagoides pteronyssinus em 21 pacientes asmáticos. Observamos após imunoterapia: melhora dos sintomas clínicos e da função pulmonar, redução da reatividade cutânea, da linfoproliferação com Dpt, aumento dos níveis da IgG especifica e da IL-10, nos dois grupos, com e sem BCG. Não houve diferença dentre eles. / Decreased exposure to infectious agents has been pointed as one of the factors involved in the increasing of allergic diseases. Immune dysfunction underlines atopy. Cytokines profile during antigen presentation is decisive to define immune response. Association of BCG vaccine with specific immunotherapy for Dermatophagoides pteronyssinus were assessed in double blind randomized study in 21 asthmatic patients. Improvement in clinical symptoms and in pulmonary function, reduction in cutaneous reactivity and in lymphoproliferation with Dpt extract and increase in specific IgG and IL-10 levels, were observed in both groups, with or without BCG. No difference were observed between groups...