[Atopic dermatitis: a modern view of pediatricians and pediatric allergologist].

The article presents the views of pediatric allergologist on the problem of atopic dermatitis/ atopic eczema in children. Atopic dermatitis (AD) is considered from a modern viewpoint of allergic 'march', which is characteristic (typical) for children with atopy. These data indicate to systemic nature of atopic 'march', the first step of which is atopic eczema. Further evolution of atopic dermatitis leads to a transformation of it in other atopic diseases--allergic rhinitis and bronchial asthma; this fact indicates that immunopathological disorders are united in these diseases and it conditions the possibility of prevention. It has taken into consideration the systemic nature of atopic diseases, combined therapy is great important and has to include not only basic local therapy, in particular topical corticosteroids (mometasone furoate--Elokom) during the exacerbation, and the systematic elimination of trigger factors, diet, the removal of the digestive system dysfunctions and the imbalance of vitamins. A long-time systemic basic therapy by H1-antihistamines of second generation, such as desloratadine (Aerius) takes a special place in the treatment of atopic dermatitis.

Probiotics for atopic diseases.

One suggestion for why some people develop atopic diseases, such as allergic rhinitis, asthma and atopic eczema, is that there are alterations in their intestinal microflora not seen in those without such conditions. This idea underlies the proposal that probiotics (orally administered micro-organisms) containing, for example, Lactobacillus and Bifidobacterium species, might help to prevent and treat atopic disorders by altering intestinal microflora. We have recently reviewed the use of probiotics for gastrointestinal disorders. Here, we look at whether they have a place in the prevention and treatment of atopic diseases.

Effects of dietary yoghurt on immunological and clinical parameters of rhinopathic patients.

OBJECTIVES: To examine the immunological and clinical influence of 4 months' feeding with either yoghurt or partially skimmed milk or nothing, on 20 volunteers. SUBJECTS: Thirteen subjects had a demonstrated allergic rhinopathy and seven were healthy subjects and participated as controls. RESEARCH DESIGN: Either a group of seven or a group of six rhinopathic patients were fed either 450 g yoghurt or 450 g partially skimmed milk, respectively, for 4 months between March and October 1999. All subjects maintained their usual diet throughout the study. Peripheral blood mononuclear cells (PBMC) were isolated before and after the experimental period and cultured for periods of 40 and 64 h. Proliferation index assay and release of IFNgamma and IL-4 without and with PHA stimulation were assessed. Allergic rhinopathy was evaluated before and after the 4 months period by performing the nasal functionality tests (Active Anterior Rhinomanometry, Acoustic Rhinometry), the prick test, the nasal specific provocation test (NPT), the dosage of specific IgE blood levels, the evaluation of the symptomatological score and the nasal mucociliary transport test. RESULTS: No significant change of the proliferation index was noted among the three groups. Cultured PBMC of the group fed with yoghurt released more IFNgamma and less IL-4. Cytokine plasma levels were at and remained at basal levels. Prick test, specific serum IgEs and NPT remained immodified. Muco-ciliary transport time (MCTt) and symptomatological score showed a definitive improvement after yoghurt feeding. CONCLUSION: Yoghurt feeding appears to improve or prevent allergic recurrences in rhinopatic patients.

Furoato de mometasona spray nasal no tratamento da rinite alérgica em adultos: um estudo colaborativo / Mometasone furoate nasal spray in the treatment of adults with allergic rhinitis: a collaborative study

Os corticosteróides intranasais säo considerados uma classe terapêutica importante no tratamento da rinite alérgica (RA), persistente ou intermitente. Entrre eles se destaca o furoato de mometasona (FM) na formulaçäo spray nasal aquoso que tem sido administrado a adultos e a crianças a partir de três anos de idade. O objetivo é avaliar a eficácia e a tolerabilidade do FM spray aquoso em dose única diária de 200 mcg (2 atomizaçöes de 50 mcg/narina) por 14 dias, em adultos com RA. Este estudo, aberto e prospectivo, avaliou 899 pacientes (18 a 55 anos, média 31,3) com diagnóstico médico de RA. Além de informaçöes sobre a RA(intensidade, duraçäo, medicaçöes utilizadas anteriormente,doenças associadas), foram pontuados os sintomas e sinais de RA (obstruçäo nasal, prurido nasal,espirros, rinorréia), conforme a intensidade (0 a 3) e obteve-se o escore global. As pontuaçöes foram determinadas no início e ao final de 14 dias de tratamento. Solicitou-se a avaliaçäo da eficácia e tolerabilidade do FM pelo médico e pelo paciente, além do registro das reaçöes adversas. Houve predomínio de RA persistente e de intensidade moderada/grave. O esquema de tratamento foi respeitado por 96,1 porcento dos pacientes. Houve reduçäo estatísticamente significativa dos sintomas e sinais, assim como do escore global ao final do estudo. Reaçöes adversas foram relatadas por 10,6 porcento dos pacientes, sendo de intensidade leve ou moderada na maioria deles. A eficácia e a tolerabilidade foram superiores a 90 porcento segundo a opiniäo dos médicos e dos pacientes. O FM spray nasal aquoso (200 mcg/dia) foi eficaz no controle de sinais e sintomas de RA, foi bem tolerado e proporcionou elevados índices de adesäo ao esquema de tratamento.(au)

[Non-allergic rhinitis or intrinsic rhinitis? Unusual features of nickel allergy]. / Rhinite non allergique ou rhinite intrinseque? Aspects inhabituels de l'allergie au nickel.

The clinical expression of nickel is known for its great diversity, from classical contact eczema to rhinitis, including work-related allergy, and by secondary hyperthermia to a metallic heart valve. Very often, hypersensitivity which may be of type I or type IV is secondary to contact of the hapten with sensitive cells, however some authors have reported the possibility of reactivation of lesions, especially dermatological (urticaria-eczema) by tests of oral ingestion. However, review of the literature does not mention the possibility of O.R.L. problems of the rhinitis type, from rhinosinusitis following ingestion of nickel and the two clinical cases that we report that involve one child of 11 years and one patient of 59 years, both of whom presented a serious rhinitis with a tendency to surperinfection, developing to perennial, where a patch-test to nickel was strongly positive, and who have seen an improvement in their clinical problems with a strict diet without this hapten. This confirms that the need is eventually physiopathological and suggests the necessity to search systematically for a possibility of hypersensitivity to haptens by the patch test technique in rhinitis that is labelled "non-allergic", by a negative reaginic history to pneumoallergens and trophallergens.