RESUMO
BACKGROUND: Food allergy and eosinophilic esophagitis are a substantial and evolving public health issue. Clinicians should know the relationship between these diseases and how one may predispose to the other. This can help minimize misdiagnosis. OBJECTIVE: The objective of this study was to assess esophageal eosinophilia and eosinophilic esophagitis frequency in patients with persistent cow's milk allergy and anaphylaxis manifestations. METHODS: Patients with persistent cow's milk allergy with anaphylaxis manifestations were enrolled from 2012 through 2016 at the São Paulo University Hospital, Brazil. All of them were submitted to endoscopy despite the presence or absence of gastrointestinal symptoms. Demographics data, atopic comorbidities, medication use, endoscopic findings, and esophageal eosinophilia frequency were evaluated. RESULTS: Eighty-nine patients were selected. The median age was 8 years. It was observed that 34 of 89 patients (38.2%; 95% confidence interval [CI]: 28.14%-49.16%) presented with esophageal eosinophilia. Five patients (7.1%) presented proton pump inhibitor-responsive esophageal eosinophilia, and 10 patients (14.2%) presented eosinophilic esophagitis. We found that 29.4% were asymptomatic patients, 23.5% had nonspecific symptoms, 23.5% had persistent typical symptoms, and 23.5% had intermittent typical symptoms. There was an association with inflammatory endoscopy findings in 21 patients (61.7%). CONCLUSIONS: This description demands scientific attention because it is the highest frequency of esophageal eosinophilia yet described in a group of patients with cow's milk allergy presenting with anaphylaxis. Eosinophilic esophagitis is a condition that can coexist "silently" with an IgE-mediated food allergy and is most often underestimated and underdiagnosed.
Assuntos
Anafilaxia , Esofagite Eosinofílica/diagnóstico , Hipersensibilidade a Leite , Adolescente , Adulto , Biópsia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Objetivo: Determinar o impacto da Dermatite Atópica (DA) no estado nutricional e metabolismo ósseo em crianças.Métodos: Quarenta e nove crianças com DA moderada ou grave (4-12 anos) e 48 crianças saudáveis foram avaliadas por z-escore altura/idade, z-escore peso/idade, z-escore IMC, duração e gravidade da doença, uso de Glicocorticoides (GC) tópico e parâmetros ósseos. Conteúdo mineral ósseo (CMO), densidade mineral óssea (DMO) e z-escores foram medidos por absormetria de dupla emissão de raios-X (DXA). Níveis séricos de cálcio, fósforo, fosfatase alcalina, cortisol e telopeptídeo carboxiterminal do colágeno tipo 1 (CTX), e níveis plasmáticos de 25 hidroxivitamina D (25OHD) e hormônio da paratireoide (PTH), foram determinados.Resultados: Crianças com DA apresentaram menor altura para idade quando comparadas às crianças controle (p = 0,007). Menor CMO em coluna lombar [16,5 (6,4) vs. 19,8 (8,3)g, p = 0,027] e fêmur total [12,2 (4,0) vs. 14,2 (5,0)g, p = 0,029] foi encontrado em crianças com DA. Níveis de CTX foram menores em pacientes com DA [1,36 (0,59) vs. 1,67 (0,79)ng/mL, p = 0,026] e tendência a níveis mais baixos de fosfatase alcalina foi observada em crianças com DA [228 (75,3) vs. 255 (70,7) ng/mL, p = 0,074]. Crianças com DA apresentaram níveis mais baixos de cortisol que crianças saudáveis [9,06 (4.8) 10,57 vs. (4,9), p = 0,061], sem diferença significante.Conclusões: Redução em altura para idade, remodelamento ósseo e conteúdo mineral ósseo em crianças com DA moderada ou grave poderia estar associada a fatores incluindo determinantes genéticos, baixa exposição solar, inflamação crônica e uso crônico do GC tópico.
Objective: To determine the impact of atopic dermatitis (AD) on nutritional status and bonemetabolism parameters in children. Methods: Forty-nine children with moderate to severe AD (4-12 years old) and 48 healthy children were assessed using height/age z-scores, weight/agez-scores, body mass index z-scores, disease activity and severity, topical use of glucocorticoids (GC), and bone parameters. Bone mineral content (BMC), bone mineral density (BMD), andz-scores were measured using dual-energy X-ray absorptiometry (DXA). Serum levels ofcalcium, phosphorus, alkaline phosphatase, cortisol, and carboxy terminal telopeptide of type1 collagen (CTX), and plasma levels of 25 hidroxy vitamin D (25OHD) and parathyroid hormone,were determined. Results: AD children presented lower height/age z-score, as compared tocontrols (p = 0.007). Lower BMC at lumbar spine [16.5(6.4) vs. 19.8(8.3)g, p = 0.027] and totalfemur [12.2(4.0) vs. 14.2 (5.0) g, p = 0.029] was found in AD children. CTX levels were lower in ADpatients, as compared to healthy children [1.36(0.59) vs. 1.67(0.79)ng/mL, p = 0.026] and a trendto lower levels of alkaline phosphatase was observed in AD children [228(75.3) vs. 255 (70.7) ng/mL, p = 0.074]. Children with AD presented lower levels of serum cortisol in comparison to thehealthy group [9.06(4.8) vs. 10.57(4.9), p = 0.061], without statistical significance. Conclusions: Reduced height for age, BMD, and bone turnover in children with moderate to severe AD couldbe associated with genetic determinants, insufficient sun exposure, chronic inflammation, andchronic use of topical GC.
Assuntos
Humanos , Criança , Adolescente , Densidade Óssea , Dermatite Atópica , Fosfatase Alcalina/análise , Glucocorticoides , Estado Nutricional , Interpretação Estatística de Dados , Técnicas e Procedimentos Diagnósticos , Métodos , Padrões de Referência , PacientesRESUMO
The subspecialty of pediatric allergy and immunology in Brazil is in its early years and progressing steadily. This review highlights the research developed in the past years aiming to show the characteristics of allergic and immunologic diseases in this vast country. Epidemiologic studies demonstrated the high prevalence of asthma in infants, children, and adolescents. Mortality rates and average annual variation of asthma hospitalization have reduced in all pediatric age groups. Indoor aeroallergen exposure is excessively high and contributes to the high rates of allergy sensitization. Prevalence of food allergy has increased to epidemic levels. Foods (35%), insect stings (30%), and drugs (23%) are the main etiological agents of anaphylaxis in children and adolescents. Molecular diagnosis of primary immunodeficiencies (PID) showed a high incidence of fungal infections including paracoccidioidomycosis in X-linked hyper-IgM syndrome, and the occurrence of BCG adverse reactions or other mycobacterial infections in patients with chronic granulomatous disease. Education in pediatric allergy and immunology is deficient for medical students, but residency programs are effective in training internists and pediatricians for the practice of allergy. The field of PID requires further training. Last, this review is a tribute to Prof. Dr. Charles Naspitz, one of the pioneers of our specialty in Brazil.
Assuntos
Alergia e Imunologia/tendências , Asma/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Infecções/epidemiologia , Adolescente , Poluição do Ar em Ambientes Fechados/efeitos adversos , Alérgenos/efeitos adversos , Alérgenos/imunologia , Alergia e Imunologia/educação , Asma/complicações , Brasil , Criança , Educação de Pós-Graduação em Medicina/tendências , Hipersensibilidade Alimentar/complicações , Doença Granulomatosa Crônica/epidemiologia , Humanos , Síndrome de Imunodeficiência com Hiper-IgM Tipo 1/epidemiologia , Incidência , Lactente , PrevalênciaRESUMO
Objetivo: O objetivo desse estudo foi avaliar alterações na resposta clínica e imunológica ao camarão após a imunoterapia com Dermatophagoides pteronyssinus. Métodos: Selecionou-se 35 indivíduos alérgicos a Dermatophagoides pteronyssinus (Der p), os quais foram submetidos a testes cutâneos de leitura imediata. A detecção de IgE específica in vitro foi feita para o ácaro, camarão, e para tropomiosina de camarão. Em todos, avaliou-se reatividade clínica ao camarão através de provocação oral. Dez pacientes foram alocados para o grupo controle, e 25 foram submetidos à imunoterapia alérgeno específica para o ácaro. Os testes cutâneos e a dosagem de IgE sérica específica foram repetidas após a indução da imunoterapia, e após 1 ano do início. A reatividade clínica ao camarão foi reavaliada no final do estudo pela provocação oral. Resultados: No grupo dos pacientes que foram submetidos à imunoterapia, observamos diminuição na reatividade nos testes cutâneos e dosagem de IgE específica para Der p e camarão. Dos 10 pacientes com testes cutâneos positivos para camarão, 4 foram negativos na dosagem após um ano de imunoterapia (p= 0,04). Quanto à dosagem sérica de IgE para camarão, dos 9 positivos no início, 6 ficaram negativos (p= 0,014). Nenhum paciente submetido a imunoterapia desenvolveu nova sensibilização para camarão. Não houve alteração na reatividade clínica ao camarão após imunoterapia. Conclusão: A imunoterapia para Dermatophagoides pteronyssinus foi acompanhada de diminuição da reatividade imunológica para camarão e clinicamente não houve alteração da sensibilidade a camarão.
Objective: The objective of this study was to determine changes in clinical and immunological response to shrimp after immunotherapy with Dermatophagoides pteronyssinus. Methods: We studied 35 allergic subjects to Dermatophagoides pteronyssinus (Der p) submitted to skin tests. The detection of serum specific IgE was performed to mite, shrimp, and tropomyosin from shrimp. In all patients, the clinical reactivity to shrimp was assessed through oral challenge. Ten patients were allocated to the control group, and 25 were submitted to immunotherapy for mite. Skin tests and determination of serum specific IgE were repeated after the induction of limmnunotherapy (3-4 months) and 1 year after of beginning of the treatment. The clinical reactivity to shrimp was assessed again at the end of the study by oral challenge. Results: In the group of patients who were undergoing immunotherapy, we observed decreased reactivity in the skin tests and specific IgE levels to Der p and shrimp. Among the 10 patients with positive skin tests to shrimp, 4 were negative when assessed after one year of immunotherapy (p = 0.04). About serum specific IgE to shrimp, from the 9 positive reactors in the beginning of treatment, 6 became negative (p= 0.014). There was no change in clinical reactivity to shrimp after immunotherapy. Conclusion: The immunotherapy for Dermatophagoides shrimp. pteronyinus was accompanied by decreased immune reactivity to shrimp and c1inically there was no change in sensitivity to shrimp.