Research progress of oral allergy syndrome / 中华预防医学杂志

Oral allergy syndrome (OAS) is an IgE-mediated hypersensitivity. Patients with pollen allergy will experience oropharyngeal allergy after eating fresh fruits or vegetables containing homologous pathogenesis-related allergen, occasionally accompanied by systemic symptoms, it is a special type of food hypersensitivity in which respiratory allergens and food allergens are similar structurally and lead to the cross-reactivity. At present, there is little research and attention to it in China. To master the definition, epidemiological characteristics, pathological mechanism, diagnosis, prevention and treatment of OAS is very important to the prevention and control of OAS. This article reviews the research progress of OAS, providing reference and prevention basis for clinicians to improve the diagnosis and differential diagnosis of OAS.

Utilidad de los péptidos 33 y 38 de Lolium perenne en la inmunoterapia de la rinitis polínica / Utility of the peptides 33 and 38 of Lolium perenne in immunotherapy of hayfever

Se aislaron y caracterizaron péptidos del polen de la gramínea Lolium perenne por métodos fisicoquímicos, se estudiaron sus propiedades bioquímicas e inmunológicas, tanto en el conejo como en humanos atópicos que sufrían de rinoconjuntivitis estacional producida por dicho polen, y se presentan los hallazgos inmunoserológicos luego de 3 años de inmunoterapia específica con los péptidos 33 y 38 obtenidos, que resultaron ser los más significativos en la composición fisicoquímica del polen.

Peptides isolated from the Lolium perenne pollen were submitted to several chemical and immunological procedures to establish their antigenicity. Immunotherapy with peptides 33 and 38 showed high potency to develop specific IgG blocking antibodies which correlated with statistical clinical improvement.

Paradoxical Increase of IgE Binding Components during Allergen-Specific Immunotherapy in Pollinosis Patients

Allergen-specific immunotherapy (SIT) reduces allergen specific IgE (sIgE) levels and achieves clinical and immunological tolerance by modulating innate and adaptive immunological responses. Increased temperature and CO2 concentrations caused by climate changes contribute to an increase of pollen count and allergenicity that influences clinical SIT outcomes. In this study, we investigated the changes of IgE binding components to tree and weed pollens in pollinosis patients who showed a paradoxical increase of serum sIgE level during pollen-SIT. We enrolled nine patients who showed an increasing pattern of serum sIgE level to alder, birch, ragweed and mugwort pollens by enzyme-linked immunosorbant assay. IgE immunoblot analysis confirmed the intensification or new generation of major IgE binding components that could be induced by climate change. The findings suggest that the regular monitoring of sIgE levels and symptom changes is required to improve the clinical outcomes of SIT in patients undergoing SIT for tree and weed pollens.

Efectividad del extracto estandarizado de hojas de petasites hybridus (tesalin®) en el tratamiento de la rinitis alérgica / Effectiveness of the standardized extract of leaves of petasites hybridus (tesalin®) in the treatment of allergic rhinitis

La rinitis alérgica es una patología frecuente, de alto impacto social, y alteración de la calidad de vida, lo que conlleva al cambio frecuente de la medicación, y al uso de más de un medicamento, sin el control adecuado de la sintomatología. Se evaluó la evolución de los síntomas clínicos en 927 pacientes con historia de rinitis alérgica perenne y estacional sintomática, sin indicación de antibioticoterapia en las dos semanas previas al tratamiento con Extracto estandarizado de hojas de Petasites Hybridus Ze339 (Tesalin®). Los síntomas de la rinitis alérgica fueron registrados en la visitas a sus médicos los días 0, 7, 14 y 28 después de iniciar el tratamiento. Los pacientes con Extracto estandarizado de hojas de Petasites Hybridus Ze339 (Tesalin®) una tableta dos o tres veces al día durante 28 días, se permitió cualquier otra medicación concomitante excepto antimicrobianos. El análisis de efectividad y tolerancia fue realizado por el médico y paciente. Para el médico, el porcentaje de pacientes que se encontraban totalmente libres de síntomas, o éstos eran muy leves,fue de 94.71%, mientras que para los pacientes fue de 95.90%, con una excelente correlación entre ambas opiniones. La tolerancia fue buena para el médico (90.70%) y para el paciente (94,47%) (p 0.95). El extracto estandarizado de hojas de Petasites Hybridus Ze339 (Tesalin®) resultó efectivo y seguro en el tratamiento de los síntomas de la rinitis alérgica no complicada

Allergic rhinitis is a common condition, high social impact, and impaired quality of life, which leads to frequent change of medication, and the use of more than one drug, without adequate control of symptoms. We evaluated the evolution of clinical symptoms in 927 patients with a history of seasonal allergic rhinitis and symptomatic, with no indication of antibiotic therapy in the two weeks before, that receiving standarized extract of leaves of Petasites Hybridus Ze339 (Tesalin®). The symptoms of allergicrhinitis were recorded in the visits to their doctors on days 0, 7, 14 and 28 after starting treatment. Patients were treated with standarized extract of leaves of Petasites Hybridus Ze339 (Tesalin®) one tablet two or three times a day for 28 days, allowed any concomitant medication except antibiotics. The effectiveness and tolerance analysis was performed by both the physician and patient. For physicians, the percentage of patients who were completely free of symptoms it was very mild, was of 94.71%, while for the patients was 95.90%, with an excellent correlation between both. Tolerance was good for the doctor (90.70%) and patients (94.47%) (P 0.95). The standarized extract of leaves of Petasites Hybridus Ze339 (Tesalin®) is effective and safe in treating the symptoms of allergic rhinitis is not complicated

Importância da avaliação oftalmológica em crianças em uso de corticoterapia inalatória / Importance of ophthalmologic exam in children using inhaled corticosteroids

Objetivo: Identificar possíveis efeitos adversos em pacientes em corticoterapia inalatória. Metodologia: Foram selecionados 15 pacientes de forma aleatória simples no período de dezembro de 2005 a abril de 2006. Participaram do estudo crianças entre 6 e 18 anos, matriculadas em um ambulatório especializado de Pneumologia Pediátrica com diagnóstico de asma e rinite alérgica associada. Todas usavam corticoterapia inalatória há, pelo menos, 10 semanas (proprionato de fluticasona – dose média de 300 mcg/dia). Os pacientes foram submetidos a exame oftalmológico completo, com anamnese, ectoscopia, exame das pupilas e motilidade ocular, refração com avaliação da acuidade visual, biomicroscopia, oftalmoscopia binocular indireta e monocular direta e tonometria de aplanação (Goldman). Especial atenção foi dada à biomicroscopia, para pesquisa de catarata cortisônica, e à tonometria e oftalmoscopia, para investigação de glaucoma cortisônico. Resultados: A idade média foi 11,46 anos, sendo 11 pacientes do sexo masculino e 4 do sexo feminino. A pressão ocular média foi de 12 mmHg. Apenas um paciente apresentou alterações compatíveis com glaucoma, confirmado pela oftalmoscopia oftalmoscopia, que mostrou escavação ótica glaucomatosa unilateral. No entanto, esse paciente tinha história prévia de uso prolongado de colírio de corticoide. Um paciente apresentava estrabismo divergente. Oito pacientes apresentavam queixa espontânea ou estimulada de prurido ocular, corroborando a associação entre asma e rinoconjuntivite alérgica. Nenhum paciente apresentou alterações sugestivas de catarata cortisônica. Conclusões: Complicações oftalmológicas são incomuns e pouco prováveis quando se utilizam doses preconizadas de corticoide inalatório. Pacientes em uso de doses elevadas ou por tempo prolongado devem ser submetidos a avaliações oftalmológicas periódicas.

Objective: To identify possible adverse effects in patients using inhaled corticosteroid therapy. Methodology: Fifteen patients (between 6 and 18 years old) were randomly selected from a Pediatric Pulmonology Ambulatory from December 2005 to April 2006. All of them were using inhaled corticosteroid therapy for asthma associated with allergic rhinitis, for at least 10 weeks tonome(fluticasone – mean dose 300 mcg/day). Patients were submitted to complete ophthalmological exam, including anmnese, ectoscopy, pupils exam, ocular mobility, visual acuity, biomicroscopy, binocular indirect and monocular direct ophthalmoscopy and tonometry (Goldman). Special attention was given to biomicroscopy, searching for cataract, and to tonometry and ophthalmoscopy, searching for glaucoma due to corticosteroid. Results: mean age of the patients was 11.46 years, with 11 males and 4 females. Mean ocular pressure was 12 mmHg. Only one patient showed evidence of glaucoma, but he had used corticosteroid collyrium for a long period. One patient showed divergent strabismus. Eight patients complained about ocular itch, supporting the association between asthma and allergic rhinoconjunctivitis. No patient presented cataract. Conclusions: Ophthalmological complications are uncommon when using recommended doses of inhaled corticosteroid for asthma treatment. Patients using high doses or for long periods should be submitted to periodic ophthalmological evaluation.

Rinite alérgica: indicadores de qualidade de vida / Allergic rhinitis: indicators of quality of life

O objetivo desta revisão foi apresentar evidências da relação entre rinite alérgica e redução da qualidade de vida. As fontes de dados foram artigos originais, revisões e consensos indexados nos bancos de dados Medline e LILACS entre 1997 e 2008. As palavras de busca foram "rinite alérgica", "qualidade de vida" e "distúrbios do sono". Os pacientes com rinite alérgica frequentemente têm redução na qualidade de vida causada pelos sintomas clássicos da doença (espirros, prurido, coriza e obstrução). Além disso, a fisiopatologia da rinite alérgica, com frequência, interrompe o sono, ocasionando fadiga, irritabilidade, déficits de memória, sonolência diurna e depressão. A carga total da doença recai não apenas no funcionamento social e físico prejudicados, mas também no impacto financeiro, que se torna maior quando se consideram as evidências de que a rinite alérgica é um possível fator casual de comorbidades, tais como a asma e a sinusite. A obstrução nasal, o mais proeminente dos sintomas, está associada a eventos respiratórios relacionados aos distúrbios do sono, uma condição que tem profundo efeito sobre a saúde mental, o aprendizado, o comportamento e a atenção. Finalmente, a rinite alérgica - doença crônica que afeta crianças, adolescentes e adultos - frequentemente é subdiagnosticada ou inadequadamente tratada. O impacto deletério dos distúrbios do sono associados à rinite alérgica sobre a habilidade para realizar as atividades de vida diária dos pacientes é um importante componente da morbidade da doença. Com um diagnóstico acurado, existem vários tratamentos disponíveis que podem reduzir a carga associada à rinite alérgica.

The objective of this review was to present evidence of the relationship between allergic rhinitis and impairment of quality of life. The data sources were original articles, reviews and consensus statements entered into the Medline and LILACS databases between 1997 and 2008. The following search terms were used: "allergic rhinitis"; "quality of life"; and "sleep disorders". Quality of life is often impaired in patients with allergic rhinitis, due to the classic symptoms of the disease (sneezing, pruritus, rhinorrhea and nasal obstruction). In addition, the pathophysiology of allergic rhinitis often disrupts sleep, leading to fatigue, irritability, memory deficits, daytime sleepiness and depression. The total burden of this disease goes beyond impairment of physical and social functioning. It has also a financial impact, which becomes greater when we consider the evidence that allergic rhinitis is a possible causal factor of comorbidities, such as asthma and sinusitis. Nasal obstruction, the most prominent symptom, is associated with sleep disorders, which can have a profound effect on mental health, learning, behavior and attention. Finally, allergic rhinitis-a chronic condition that affects adults, adolescents and children-is often underdiagnosed or inadequately treated. The deleterious impact that allergic rhinitis-related sleep disorders have on patient capacity to perform activities of daily living is an important component of the morbidity of the disease. With an accurate diagnosis, there are various available treatments that can reduce the burden of allergic rhinitis.

Aurora and crepuscle in infantile allergic rhinitis

Objectives: This study is designed to verify the circadianity of allergic rhinitis in children inhabiting a tropical city and to compare its rhythm in different annual seasons.Introduction: Allergic rhinitis presents a circadian and a circannual variation in the intensity of the symptoms. However, most of the studies are carried out with adults living in temperate/cold cities. Few data are available about children, especially those living in tropical climates.Methods: Observational study based on questionnaires. The caretakers of a total of 218 children inhabiting a tropical city that were diagnosed with active allergic rhinitis the moment they looked for prompt-attendance services were interviewed.Results: Coughing was the major symptom that alerted the caretakers. Blocked and runny noses were also very common. The symptoms were mostly intermittent and stronger during the aurora and the crepuscle. Most of the children woke up in the pre-dawn period.Discussion: The intermittence of the symptoms and the characteristic of woking the children up in predawn suggests that an ideal medication would be efficient in intermittent dosages, to be used only when necessary.Conclusions: The circadian rhythm of infantile allergic rhinitis has some features in common with the circadian rhythm of the asthma. It is similar to adult rhinitis, but presents some peculiarities.

Prevalência de asma e rinite alérgica em escolares no município de Santo Ângelo/RS / Prevalence of asthma and allergic rhinitis among students from Santo Ângelo/RS

Introdução: A asma é uma doença inflamatória crônica, caracterizada por hiper-responsividade das vias aéreas inferiores que se manifesta por episódios recorrentes de sibilância, dispnéia, aperto no peito e tosse. Objetivo: Determinar a prevalência de asma e rinite alérgica em adolescentes do município de Santo Ângelo/RS. Metodologia: Foi realizado um estudo observacional, prospectivo e transversal; a amostra foi constituída por estudantes de 13 a 14 anos. Foram investigadas as variáveis: sexo, idade e interferência dos sintomas das doenças nas atividades diárias através da aplicação de um questionário epidemiológico padronizado do ISAAC (International Study of Asthma and Allergies in Childhood). Resultados: O número de questionários aplicados foi de 1.031, sendo considerados válidos 979 (94,9 por cento). A prevalência de asma nos adolescentes foi de 10,5 por cento, baseada na questão “já teve ou tem asma”. A prevalência de rinite alérgica foi de 34,6 por cento, baseada na questão “já teve ou tem rinite alérgica”. Quanto à polinose “alergia ao pólen na primavera” a prevalência foi de 30,4 por cento. Considerando-se o sub-diagnóstico das doenças, a prevalência de prováveis asmáticos foi de 12 por cento e a de adolescentes com provável rinite de 12 por cento. Conclusão: A prevalência de asma no presente estudo mostrou-se entre os valores médios mundiais e nacionais, já as prevalências de rinite alérgica e polinose mostraram-se elevadas de acordo com as médias de outros estudos. Estes dados apontam que em Santo Ângelo/RS essas doenças constituem um problema de saúde pública entre os adolescentes.

Introduction: Asthma is an inflammatory chronic disease, characterized as a hyperresponsivity of the lower airways that manifests itself through recurrent episodes of sibilance, dyspnea, chest pressure, and coughing. Aim: To determine the prevalence of asthma and allergic rhinitis in adolescents living in the municipality of Santo Ângelo/RS. Methods: An observational transversal, prospective study was performed, the sample comprising 13- and 14-year-old students. The variables sex, age, and interference of the symptoms of the disease in the daily activities were investigated through the administration of the standardized epidemiological questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC). Results: Of the 1,031 questionnaires responded, 979 (94.9 percent) were considered as valid. The prevalence of asthma among the adolescents was 10.5 percent, based on the question: “Have you ever had asthma?”. The prevalence of allergic rhinitis was 34.6 percent, based on the question “Have you ever had allergic rhinitis?. As for pollen allergy during the spring, the prevalence was 30.4 percent. Considering the underdiagnosis of the diseases, the prevalence of probable asthmatics was 12 percent and of adolescents with probable rhinitis was 12 percent. Conclusion: The prevalence of asthma in the present study was consistent with the reported mean world and national values, but the prevalences of allergic rhinitis and pollen allergies were high as compared to the means reported elsewhere. The data indicate that in Santo Ângelo, RS these conditions are a public health problem among adolescents.

The effect of immunotherapy on nonspecific bronchial hyperresponsiveness in bronchial asthma and allergic rhinitis

Allergen injection therapy may improve nonallergic bronchial hyperresponsiveness, but results at the moment are less than convincing. The present study was conducted to evaluate the effect of immunotherapy on the degree of nonspecific bronchial hyperresponsiveness in patients with allergic bronchial asthma (BA) and/or allergic rhinitis (AR). Methacholine challenge bronchial provocation test, allergic skin test, serum IgE and peripheral blood eosinophil counts were performed before and after 12 months or more of immunotherapy. The improved group, as determined by a shift of at least two doubling concentrations of methacholine, was 75% of AR (n=16), 41.7% of BA (n=24) and 53.8% of BA+ AR (n=13). The geometric mean of the methacholine provocational concentration (PC20) changed from 3.40 to 14.36 mg/ml (P <0.05) in AR, from 0.73 to 1.04 mg/ml in BA (not significant), and from 1.43 to 5.07 mg/ml (P <0.05) in BA+ AR. In conclusion, nonspecific bronchial hyperresponsiveness was improved by immunotherapy in three quarters of the allergic rhinitis cases and in about a half of the allergic bronchial asthma patients, which suggests that immunotherapy might be helpful at preventing the development of bronchial hyperresponsiveness in allergic rhinitis patients, and that it does not improve bronchial hyperresponsiveness in about a half of allergic bronchial asthma patients.

A homeopatia e uma resposta placebo? / Is the homeopathy a placebo response?

Num experimento duplo-cego randomizado, foi testada a hipotese de que as potencias homeopaticas sao placebo. O modelo escolhido para estudo comparou, os efeitos de uma preparacao de mistura de polens de capim com placebo, em 144 pacientes com Febre do Feno ativa. A resposta era mais significativa quando os resultados eram corrigidos para a dose de polen, e quando ela estava associada a uma diminuicao de 50% da necessidade de anti-histaminicos. Nos pacientes que receberam o tratamento homeopatico foi notada, inicialmente, uma agravacao mais frequente dos sintomas, seguida de melhora. Nao houve evidencia que sustentasse a ideia de que a acao do placebo explica, completamente, as respostas clinicas para as drogas homeopaticas

The Electron Microscopic Study of Enzymes in Eosinophils

The author has made the electron microscopic study of enzymes in eosinophils in order to clearify the influence of hyposensitization in allergic rhinitis to the activity of enzymes in eosinophilic granules and the following results were obtained. 1. In all 3 control, hyposensitization and allergic groups, eosinophilic granules with matrix and crystalloid core in circulating blood and tissue was observed. 2. In all 3 groups, activity of acid phosphatase was not found in neutrophil, basophil, macrophage and glands as a form of coagulated activating colony of acid phosphatase. 3. In control and hyposensitizing groups, number of eosinophils were smaller than that was counted in allergic group. Activity of peroxidase in granule was weak and granular out flowing and rupture of cell membrane were not observed. 4. In allergic group, eosinophil count was high, activity of peroxidase in granule was strong and granular out flowing and rupture of cell membrane were severe. At the same time, many vacuoles, which were suspected to be the result of phagocyte the protein as foreign substance, wag observed. Judging from the fact that eosinophil has a specific relation to allergic diseases and the activity of peroxidase that exist as an enzyme in eosinophilic granule is strong, it is believed that the major function of eosinophil is phagocytosis of antigen, or antigen-antibody complex. On the other hand, the fact that activity of peroxidase was weak in hyposensitizing group lead us to believe that the activity of peroxidase may be used as an indicator for detecting hyposensitizing status in the treatment of allergic disease.