Elevated serum IL-6 levels predict treatment interruption in patients with moderate to severe psoriasis: a 6-year real-world cohort study

Abstract Background: Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. Objective: The authors evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. Methods: The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-α, tumor necrosis factor-α, and inter-leukin (IL)-2, IL-4, IL-6, IL-10, and IL-17A were measured using a cytometric bead array; clinical data were assessed. The authors calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. Results: The authors included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI 1.01-1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI 1.29-3.08; p = 0.002) were associated with treatment interruption. Study limitations: The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation. Conclusions: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting biomarker candidate for predicting psoriasis treatment response.

Outcomes and factors associated with tolerance in infants with non-IgE-mediated cow's milk allergy with gastrointestinal manifestations

Abstract Objectives To evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes. Methods Single-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test. Results Eighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 - Q3 11 months). All cases with positive follow-up OFC tests (n= 18) had been exposed to cow's milk-based formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milk-based formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test. Conclusions In infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance.

Apuntes para la historia de la alergología en Matanzas. 1961-2022

Introducción: La especialidad de alergología compite entre las más caras de la práctica médica en los países desarrollados, donde se promueve el criterio de que la alergia es una enfermedad de ricos y que los pobres no la padecen, cuando en realidad se trata de un problema de posibilidades de acceso a ese servicio. En Cuba, la alergología tiene una organización social diferente, comparada con otros países. Objetivo: Desarrollar un bosquejo histórico de la especialidad de alergología en la provincia de Matanzas. Materiales y métodos: Fueron utilizados los métodos teóricos histórico-lógico y analítico-sintético, y los empíricos entrevista y análisis documental. Resultados: Se describe el comienzo de la especialidad de alergología en Matanzas en 1961, enfatizando en la figura del Dr. Gonzalo Álvarez Rodríguez como el primer alergólogo de la provincia. Se evidencia el desarrollo y salto cualitativo del servicio, y se recogen apuntes relacionados con su origen, formación de especialistas, progreso científico, condiciones de trabajo y ampliación de la cobertura a la población en estos años. Conclusiones: Con este trabajo se inició un recuento del origen y desarrollo de la alergología en Matanzas, que enriqueció la historia de la especialidad, como parte de los servicios de salud en la provincia.

Introduction: The specialty of Allergology competes among the most expensive in medical practice in developed countries, where the criterion is promoted that allergy is a disease of the rich and that the poor do not suffer from it, when in fact it is a problem of access possibilities to that service. In Cuba, the allergy specialty has a different social organization compared with other countries. Objective: To elaborate a historical outline of allergology in the province of Matanzas. Materials and methods: Historical-logical and analytical-synthetic theoretical methods were used, as well as interview and documentary analysis empirical ones. Results: The beginning of the specialty of Allergology is described, emphasizing the role of Dr. Gonzalo Álvarez Rodríguez as the first allergist in the province. The development and qualitative leap of the service was evidenced, and notes are collected related to its origin, training of specialists, scientific progress, working conditions and expansion of coverage to the population in these years. Conclusions: With this work, an account of the origin and development of allergology in Matanzas began, which enriched the history of the specialty as part of the health services in the province.

Research progress on effects of air pollution on pollinosis and its mechanisms / 环境与职业医学

Pollinosis is one of the common allergic diseases, and its morbidity continues to increase. Studies have demonstrated that air pollution is a key environmental factor that leads to the increased prevalence of pollinosis. Air pollutants and pollen allergens exert synergistic effects in stimulating allergic responses in susceptible individuals. In this article, we analyzed the relationship between air pollution and pollinosis based on the latest studies, and elaborated potential mechanisms on how air pollution increases the incidence of pollinosis and aggravates allergic reactions. Air pollutants can increase both pollen production and the levels of allergenic proteins, and enhance allergenicity of pollen allergens through structural alterations or chemical modifications. The potential mechanisms of air pollutants exacerbating pollen allergies are as follows: Air pollutants may disrupt the barrier function of the respiratory epithelium and facilitate the penetration of pollen allergens into deeper tissues. Additionally, they may accelerate the process of the release of pollen allergy-related cytokines, promoting T helper 2 (Th2) cell differentiation and exacerbating inflammatory responses in the airways. Given the limitations of existing research, future prospective studies are needed to explore the effects of mixed pollutants and different types of pollutants on pollen, and the response mechanisms of allergy-related cells and cytokines to different pollutant categories. The findings would provide a comprehensive understanding of the impacts of air pollution on pollen allergies and scientific evidence for effective protection of the heath of pollinosis patients.

Alergia a la leche de vaca: ¿se pueden evitar las pruebas de provocación oral? Un análisis probabilístico basado en datos clínicos / Cow's milk allergy: Can oral food challenges be avoided? A probabilistic analysis based on clinical data

Introducción. La prueba de provocación oral (PPO) para el diagnóstico de alergia a las proteínas de la leche de la vaca (APLV) presenta riesgos y requiere de recursos. Nuestro objetivo fue evaluar condiciones y pruebas complementarias para identificar una alta probabilidad de APLV. Población y métodos. Análisis secundario sobre estudio de pacientes atendidos en una unidad de alergia entre 2015 y 2018. Se determinaron las probabilidades prepruebas asociadas a los síntomas y sus combinaciones, y las probabilidades pospruebas luego de realizadas pruebas cutáneas y determinación de inmunoglobulina E (IgE) sérica. Resultados. Se evaluó la información de 239 pacientes. Se observaron probabilidades mayores al 95 % en pacientes con angioedema y combinación de urticaria y vómitos. Usando puntos de corte propuestos por Calvani et al., la combinación de vómitos con rinitis, sin angioedema, también superó el 95 %. Conclusión. Se ofrece una metodología para identificar pacientes en los que puede diagnosticarse APLV sin realización de PPO.

Introduction. The oral food challenge (OFC) for the diagnosis of cow's milk protein allergy (CMPA) poses risks and requires resources. Our objective was to assess conditions and complementary tests used to identify a high probability of CMPA. Population and methods. Secondary analysis of a study of patients seen at a unit of allergy between 2015 and 2018. Pre-testing probabilities associated with symptoms and their combinations and post-testing probabilities after skin prick testing and serum immunoglobulin E (IgE) levels were determined. Results. The data from 239 patients were assessed. A probability greater than 95% was observed for angioedema and a combination of urticaria and vomiting. Based on the cut-off points proposed by Calvani et al., the combination of vomiting with rhinitis, without angioedema, also exceeded 95%. Conclusion. A methodology is provided to identify patients in whom CMPA may be diagnosed without an OFC.

Análise sobre o conhecimento do pediatra brasileiro sobre a alergia à proteína do leite de vaca / Analysis of brazilian pediatricians' knowledge of cow's milk protein allergy

Analisar o conhecimento de pediatras brasileiros sobre alergia à proteína do leite de vaca (APLV) por meio de um questionário validado. Estudo quantitativo com delineamento transversal no qual foi aplicado um questionário online sobre conhecimentos de APLV. O cálculo amostral foi de 294. O formulário online foi dividido em dois blocos, sendo o primeiro composto por questões de identificação dos pediatras e o segundo composto pelo questionário validado, construído a partir do Consenso Brasileiro de Alergia Alimentar (2018). A avaliação geral do questionário mostrou um percentual de concordância de 91% e Índice de Validade de Conteúdo de 0,95. Os resultados dos questionários aplicados foram apresentados em frequências absolutas e relativas, média, mediana, desvio padrão e percentis. O nível de significância foi estabelecido em 5% (p < 0,05). O questionário validado foi respondido por 1.316 médicos brasileiros, dos quais 1.017 (77,3%) eram do sexo feminino. A média de idade observada foi de 45,50 ± 13,20 anos. Ao analisar o número total de acertos, notou-se que a média de acertos foi de 80,66 ± 10,42%. Os pediatras responderam principalmente a perguntas sobre o conceito e o tratamento da APLV. A questão com menor índice de acertos foi relacionada à investigação clínica e laboratorial. A maioria dos médicos que respondeu ao questionário demonstrou compreender o conceito e as principais recomendações terapêuticas da APLV.

To analyze the knowledge of Brazilian pediatricians about cow's milk protein allergy (CMPA) using a validated questionnaire. Quantitative study with a cross-sectional design in which an online questionnaire on CMPA knowledge was applied. The sample calculation indicated 1024 participants. The online form was divided into two blocks, the first comprising questions on the identification of pediatricians, and the second comprising the validated questionnaire, built from the Brazilian Consensus on Food Allergy (2018). The general evaluation of the questionnaire showed a percentage of agreement of 91% and a Content Validity Index of 0.95. The results of the applied questionnaires were presented in absolute and relative frequencies, mean, median, standard deviation, and percentiles. The level of significance was set at 5% (p <0.05). The validated questionnaire was answered by 1316 Brazilian doctors, of whom 1017 (77.3%) were females, and their mean age was 45.50 ± 13.20 years. The mean total number of correct answers was 80.66 ± 10.42%. Pediatricians mostly answered questions about the concept and treatment of CMPA. The question with the lowest rate of correct answers was related to clinical and laboratory investigation. Most physicians who answered the questionnaire demonstrated they understood the concept and the main CMPA therapeutic recommendations.

Neomycin: sources of contact and sensitization evaluation in 1162 patients treated at a tertiary service

Abstract Background: Neomycin is used in several over-the-counter pharmaceutical formulations in Brazil. In Europe and Canada, where it is not freely available, its sensitization frequency is lower than in the United States, where this does not occur. Objective: To present the frequency of sensitization to neomycin observed in a tertiary hospital and the pharmaceutical formulations sold in Brazil containing neomycin. Method: Retrospective analysis of positive results to neomycin, obtained through patch tests performed in a tertiary hospital, from 2009 to 2018 and investigation of topical drugs and vaccines containing neomycin in Brazilian databases available on the internet. Results: Among 1,162 patients, 71 (6%) had positive reactions to neomycin, 65% female and 35% male individuals, 46% were over 50 years old, and 24% had a personal history of atopy. The dermatitis lasted from four months to 20 years. Lesions were located in 69% of the patients on the upper limbs, in 55% they were on the lower limbs, and in 42% they were disseminated in more than 4 sites. Polysensitization was detected in 55% of cases. Of these, 28% were linked to sensitization to rubber allergens and 27% to potassium bichromate. A total of 158 topical presentations of neomycin were found: 79 ointments, 58 creams, 10 ophthalmic solutions, seven otological solutions, one oral solution, two nasal solutions, and one antiseptic powder, in addition to 11 types of vaccines. Study limitations: Retrospective study. Conclusion: Sensitization to neomycin occurred in 6% of the studied population, affecting more females aged over 50 years, with skin lesions located mainly on the upper and lower limbs, in the context of chronic contact dermatitis. Neomycin was found in 135 formulations, most of them available over the counter, as well as in 11 miscellaneous vaccines.

The Value of Multiple Medication Trials Prior to Balloon Sinuplasty in the Management of Chronic Sinonasal Disease

Abstract Introduction In patients with chronic rhinosinusitis, conservative interventions with extended medical trials are often attempted prior to procedural treatment. Balloon sinuplasty (BSP) is an established procedure for symptomatic relief from chronic rhinosinusitis. However, data suggesting the suboptimal efficacy of prolonged medication management trials, prior to BSP, is lacking. Objectives The purpose of this study was to evaluate the efficacy of prolonged medication management trials, prior to BSP, for patients with chronic rhinosinusitis. Methods A retrospective review was performed for all adults with chronic rhinosinusitis who received extended medical management prior to their BSP at two outpatient clinics, from November 1, 2013, to June 31, 2018. The patients' Sino-Nasal Outcome Test (SNOT) scores were compared between baseline, post-medication trials, and post-BSP. Results The SNOT scores of a total of 64 patients were collected. Overall, patients showed a significant worsening of symptoms during the medication management trials from baseline (p = 0.002126) but significant improvement of symptoms after undergoing BSP (p < 0.0001). Conclusions The patient symptom burden worsened and prolonged during medication management trials. The BSP procedure alone showed significant improvement in the quality of life for chronic rhinosinusitis patients, when considering their SNOT scores. The worsening of patients' symptoms during medication management may invalidate the necessity of prolonged medication management trials.

Aproximando a Atenção Especializada da Atenção Primária à Saúde: em busca do cuidado integral ao paciente com asma no Brasil / Aligning Specialized Care with Primary Health Care: in search of comprehensive care for asthma patients in Brazil

A ocorrência de doenças alérgicas e asma ainda cresce em muitos países. Dados mostram que aproximadamente um quarto dos habitantes de países industrializados apresenta algum tipo de alergia, e nos países em desenvolvimento estas doenças podem alcançar proporções ainda maiores da população. No Brasil, embora não exista até o momento uma agenda política nacional de atenção à saúde dos pacientes com alergias e asma, iniciativas individuais em diferentes regiões têm beneficiado milhares de pacientes ao longo das últimas décadas. Estes programas têm como principais objetivos qualificar o cuidado em saúde, melhorar a qualidade de vida (especialmente dos pacientes com asma e rinite alérgica) e reduzir os indicadores de morbimortalidade relacionados às doenças. Com essa finalidade, os programas vêm se ocupando de diversas ações de educação em saúde, capacitação profissional, busca ativa para garantir diagnóstico e tratamento oportuno, e proporcionar acesso a medicamentos de forma gratuita e continuada. Entretanto, a falta de um caráter institucional que garanta o acesso universal a ações cientificamente fundamentadas, impede a equidade e a continuidade do cuidado, além de dificultar a atenção integral em asma e em outras doenças alérgicas.

Allergic diseases and asthma are on the rise in many countries. Data show that approximately 25% of the inhabitants of industrialized countries have some type of allergy, reaching even greater proportions in developing countries. Although a national health care agenda for patients with allergies and asthma has not yet been developed in Brazil, individual initiatives in different regions have benefited thousands of patients in recent decades. The main objectives of these programs are to improve health care, quality of life (especially for patients with asthma and allergic rhinitis), and reduce disease-related morbidity and mortality indicators. To this end, these programs have been engaged in health education actions, professional training, performing active searches to ensure timely diagnosis and treatment, and providing free and continuous access to medication. However, the due to the non-institutional character of these programs, universal access, evidence-based actions, and continuity of care are not guaranteed, and it is difficult to provide comprehensive care for asthma and other allergic diseases.

Segurança da vacinação contra a COVID-19 em doentes referenciados dos cuidados de saúde primários por alergia ao veneno de himenópteros / COVID-19 vaccination safety in patients with hymenoptera venom allergy referred by primary health care

Introdução: As reações de hipersensibilidade após vacinação contra a COVID-19 têm vindo a ser descritas, embora a anafilaxia seja rara. A hipersensibilidade ao veneno de himenópteros constitui a terceira causa mais frequente de anafilaxia em Portugal, embora não pareça aumentar o risco de anafilaxia à vacinação contra a COVID-19. Objetivos: Avaliar a segurança da vacinação contra a COVID-19 em doentes com história de alergia ao veneno de himenópteros referenciados dos Cuidados de Saúde Primários (CSP). Métodos: Estudo observacional retrospectivo com inclusão dos doentes com alergia ao veneno de himenópteros referenciados pelos CSP ao serviço de Imunoalergologia, para estratificação do risco de reações de hipersensibilidade à vacina contra o SARS-CoV-2, entre janeiro e dezembro de 2021. Resultados: No total, incluíram-se 18 doentes, 72% do sexo feminino, média de idades de 61±18 [21-89] anos. Na caracterização do tipo da reação ao veneno de himenópteros, as reações locais exuberantes corresponderam a 33% de todas as reações referidas. Quanto a sintomas sistêmicos de anafilaxia, foram referidos sintomas mucocutâneos (33%), respiratórios (28%), cardiovasculares (33%) e gastrointestinais (11%). A abelha foi o inseto mais frequentemente implicado (61%). Relativamente aos valores de triptase basal, 3 doentes apresentaram níveis acima do cut-off estabelecido de 11,4 ng/mL, tendo indicação formal para iniciar esquema de vacinação em meio hospitalar. Durante o processo vacinal registrou-se um total de 46 administrações em 18 doentes, todas sem intercorrências. Apenas 5 doentes foram vacinados em meio hospitalar, tendo sido os restantes encaminhados para os CSP. Os doentes com mastocitose confirmada ou suspeita foram submetidos à pré-medicação com anti-histamínico anti-H1 e anti- H2, bem como montelucaste, na véspera e no dia da vacinação. Conclusões: A vacinação contra a COVID-19 é segura em doentes com reação de hipersensibilidade ao veneno de himenópteros. O protocolo utilizado mostrou ser eficaz na segregação de doentes entre CSP e cuidados secundários/terciários.

Introduction: Despite numerous reports of hypersensitivity reactions to COVID-19 vaccination, anaphylaxis is rare. Although hypersensitivity reactions to hymenoptera venom are the third most common cause of anaphylaxis in Portugal, they don't appear to enhance the risk of anaphylactic reaction to COVID-19 vaccination. Objectives: To assess the safety of COVID-19 vaccination in patients with a history of hymenoptera venom allergy. Methods: This retrospective observational study included patients with hymenoptera venom allergy referred by primary health care to the Immunoallergology Outpatient Clinic of a tertiary hospital between January and December 2021 to stratify the risk of hypersensitivity reactions to the SARSCoV- 2 vaccine. Results: A total of 18 patients were included: 72% women; mean age 61 (SD, 18 [range 21-89]) years. One-third of all reported reactions to hymenoptera venom were large and local. Topical systemic symptoms of anaphylaxis were mucocutaneous (33%), respiratory (28%), cardiovascular (33%) and gastrointestinal (11%). The honeybee was the most frequently involved hymenoptera species (61%). The basal tryptase levels of 3 patients were above the established cut-off (11.4 ng/mL) and they were formally indicated for vaccination in a hospital setting. Concerning the vaccination process, 46 doses were administered to the 18 patients and no reactions were recorded. Only 5 patients were vaccinated in a hospital environment; the rest were referred to primary health care centers. Patients with confirmed or suspected mastocytosis were premedicated with anti-H1 and anti-H2 antihistamines, as well as montelukast, the day before and on the day of vaccination. Conclusions: COVID-19 vaccination is safe for patients with hypersensitivity to hymenoptera venom. The risk assessment protocol effectively designated patients to primary or secondary/tertiary health care.

Intraoperative Cardiac Arrest due to Allergic Acute Coronary Syndrome (Kounis syndrome) Triggered by Cephalosporin

An acute coronary syndrome due to mast?cell activation in the presence of an allergen is known as Kounis Syndrome (KS). This relatively new entity of KS is being increasingly recognized among allergists, cardiologists, and emergency physicians; however, it is not well?known among anesthesiologists. We report here, a case of type 2 KS due to antibiotic administration causing sudden perioperative cardiac arrest.

Alergia ocular: tipos, edad de aparición, prevalencia y morbilidad / Ocular allergy: types, age of onset, prevalence and morbidity

Introducción: La alergia es el desorden más común del sistema inmunitario. En las últimas décadas, la prevalencia de las enfermedades alérgicas ha aumentado de forma considerable en todos los países. Objetivo: Describir el contexto actual de la alergia ocular para la realización de un diagnóstico precoz, una identificación temprana de los subtipos, un adecuado manejo terapéutico y un control de la severidad. Métodos: Se realizó una búsqueda sistemática de la literatura científica de mayor impacto con el uso de las palabras clave. Se limitó la búsqueda por tipo de diseño (revisiones, series de casos, estudios descriptivos, analíticos y experimentales, metaanálisis). No se tuvo en cuenta el idioma de la publicación. Las bases de datos utilizadas fueron: PubMed, Ebsco Host, Lilacs y Science Direct. Se identificaron y se evaluaron 114 artículos, de los cuales se seleccionaron 24 por su pertinencia para el estudio. Conclusiones: La alergia ocular es uno de los trastornos oculares más comunes encontrados en las consultas pediátricas y oftalmológicas. Si bien en la mayoría de los casos se trata de formas leves, estas pueden interferir en la calidad de vida del paciente. Es importante que estos pacientes con manifestaciones oftalmológicas de alergia se remitan al alergólogo para detectar otra patología, que, asociada al padecimiento alérgico, origine los síntomas que suelen ser graves, con una duración y frecuencia importantes(AU)

Introduction: Allergy is the most common disorder of the immune system. In recent decades, the prevalence of allergic diseases has increased considerably in all countries. Objective: To describe the current context of ocular allergy in order to make an early diagnosis, an early identification of subtypes, establish an adequate therapeutic management and control of severity. Methods: A systematic search of the scientific literature with the highest impact was performed using keywords. The search was limited by type of design (reviews, case series, descriptive, analytical and experimental studies, meta-analysis). The language of the publication was not taken into account. The databases used were: PubMed, Ebsco Host, Lilacs and Science Direct. A total of 114 articles were identified and evaluated, of which 24 were selected for their relevance to the study. Conclusions: Ocular allergy is one of the most common ocular disorders encountered in pediatric and ophthalmology consultations. Although in most cases these are mild forms, they can interfere with the patient's quality of life. It is important that these patients with ophthalmologic manifestations of allergy are referred to the Allergist to detect other pathology, which associated with the allergic condition originate the symptoms that are usually severe, with a significant duration and frequency(AU)

Enfrentamiento de la anafilaxia en el servicio de urgencia / Approach of Anaphylaxis in the emergency room

La anafilaxia es una reacción en su mayoría de hipersensibilidad tipo I, que estimula la activación generalizada de mastocitos, y provoca un cuadro clínico multisistémico que puede ser fatal. Se estima que tiene una incidencia de 0,03-0,1% y una prevalencia de vida de 0,5-2% en la población general. Generalmente, la reacción inmunológica ocurre posterior a la ingesta de alimentos, uso de medicamentos o picaduras de insectos, pero también se han descrito mecanismos no inmunológicos (no IgE) que actúan directamente sobre los mastocitos, llamadas en la literatura "reacciones anafilactoideas". La anafilaxia fue descrita por Paul Portier y Charles Robert Richet en 1902 en perros, los cuales desarrollaban esta reacción posterior a la inyección repetida de veneno de anémonas (medusas). Sin embargo, esta entidad no tuvo criterios diagnósticos ni pilares de manejo estructurado hasta el año 2006. En ese año en se publicó el segundo simposio de manejo de la anafilaxia, en donde se definieron criterios diagnósticos clínicos claros y el rol fundamental de la adrenalina en su manejo; la única droga que cambia el pronóstico del paciente.

Anaphylaxis is mainly a type I hypersensitivity reaction. It triggers a widespread activation of mast cells, causing a multisystemic clinical scenario that can be fatal. It is estimated to have an incidence of 0.03-0.1% and a lifetime prevalence of 0.5-2%. Most immunological reactions occur after food ingestion, medication, or insect stings, but non-immunological (non-IgE) mechanisms that act directly on mast cells, called Anaphylactoid Reactions, have been also described. Anaphylaxis was described by Paul Portier and Charles Robert Richet in 1902 in dogs, that developed this disease after repeated injections of anemones (jellyfish) venom. However, this entity didn't have established diagnostic criteria or an standarized management until 2006. In this year, the second anaphylaxis management sym-posium took place and clear clinical diagnostic criteria were defined. The fundamental role of adrenaline in its management was also established. The former is the only drug that has demonstrated to improve prognosis of the patient

Safety profile of CoviShield (ChAdOx1nCoV-19) vaccine among healthcare workers in a tertiary care hospital

Background: Coronavirus 2019 was declared as a pandemic by the World Health Organization in March 2020. Bereft of specific treatment for the disease, vaccinations and COVID appropriate behavior have come to be the main approaches to combat the pandemic. A number of vaccines have been approved after clearing clinical trials. Hence, it is essential to evaluate the safety profile of each vaccine for ensuring optimum health of the general population. This study was conducted to evaluate the adverse events following CoviShield vaccination in a tertiary care center. Aims and Objectives: The aim of the study was to describe the pattern of adverse effects, treatment given, and comorbidities seen in healthcare workers (HCW) who reported to the adverse drug reaction (ADR) monitoring center in the department of pharmacology Government T.D. Medical College, Alappuzha, following CoviShield vaccination from January 2021 to October 2021. Materials and Methods: A retrospective and descriptive study was carried out at Department of Pharmacology, GTDMCA involving all HCW who reported side effects following CoviShield vaccination in the ADR monitoring centre (AMC) in the Department of Pharmacology, GTDMCA from January 2021 to Oct 2021. Results: Out of 620 HCWs who reported adverse event following vaccination, majority (45%) were from the age group 21–30 years. About 83% of HCWs who reported adverse effect were women. Majority of the respondents (96%) experienced the adverse effects within 24 h. About 88% of respondents experienced these adverse effects after the initial dose alone. Commonly encountered adverse effects were fever (57%), headache (43%), myalgia (38%) etc. Hypertension (7%) was the most common comorbidity seen. Majority of the beneficiaries (70%) took paracetamol for the treatment of the adverse effect. Conclusion: Majority of the vaccinated HCWs experienced minor and self-limiting adverse event following immunization (AEFI) with Chimpanzee Adenovirus Oxford novel CoronaVirus-19. No serious AEFI were reported to the AMC. Despite the record speed at which the vaccine has been developed, it has shown to have a good safety profile considering the millions of doses that have been administered.

Inmunogenicidad y capacidad protectora de variantes de la nueva vacuna antialérgica PROLINEM DS / mmunogeni city and protective efficacy of variants of a novel PROLINEM DS anti - allergic vaccine

Introducción: La vacuna antialérgica de segunda generación PROLINEM-DS está compuesta por alérgenos del ácaro Dermatophagoides siboney y la combinación de adyuvantes: proteoliposoma de N. meningitidis B y gel de hidróxido de aluminio. La adsorción del alérgeno es relevante para la seguridad y eficacia clínica de las vacunas adsorbidas en gel de hidróxido de aluminio en estudios previos se demostró la influencia negativa de los iones fosfato en la adsorción del alérgeno. Objetivo: Evaluar la inmunogenicidad y capacidad protectora de cuatro variantes de formulación obtenidas dentro del espacio de diseño de la vacuna PROLINEM DS. Métodos: Se emplearon 4 variantes de formulación con diferentes contenidos de tampón fosfato salino y gel de hidróxido de aluminio. Se administraron a ratones BALB/c 3 dosis subcutáneas una por semana. Luego, los ratones fueron sometidos a reto alergénico por aerosol. Resultados: Todas las variantes indujeron anticuerpos IgG1 e IgG2a alérgeno específico. Este efecto se correlacionó con el balance de citoquinas proinflamatorias Th1/Th2 en los pulmones y en los ganglios. La variante con reducción de tampón fosfato salino y gel de hidróxido de aluminio fue la de mayor índice IgG/IgE después de la vacunación. Esta relación muestra, en una variable, el equilibrio entre los componentes potencialmente bloqueadores y efectores. La tolerancia local en el lugar de la inyección mostró una reducción de los granulomas en los ratones vacunados con menos gel de hidróxido de aluminio. Conclusiones: La reducción del contenido de gel de hidróxido de aluminio y fosfatos se consideran mejoras farmacéuticas sin inconvenientes en cuanto a la inmunogenicidad de esta vacuna con un perfil de seguridad satisfactorio para futuros ensayos clínicos en humanos.

Introduction: The second generation anti allergic vaccine named PROLINEM DS is based on allergens from D. siboney house dust mite and a combination adjuvant containing PL and Alum. Allergen adsorption is relevant both safety and clinical efficacy in alum-adsorbed vaccines. Negative influence of phosphate ions on allergen adsorption was demonstrated in previous researches. Objective: To evaluate immunogenicity and protective efficacy of four variants obtained within design space of PROLINEM DS vaccine. Methods: Four variants were differentiated from each other by both phosphate and alum contents. Balb/c mice were administered with 3 doses by subcutaneous route. Further, mice were subjected to allergen aerosol challenge. Results: Specific IgG1 and IgG2a antibodies were induced by four vaccine variants. It was correlated with pro inflammatory cytokines balance Th1/Th2 both in lungs and lymphatic nodes. Formulation with lower PBS and Alum levels showed the highest IgG/IgE ratio at the end of vaccination schedule. This ratio shows in one variable the balance between potentially blocking and effector components. Mice injected with lower level of Alum showed a reduction of granuloma size in the site of vaccine administration. Conclusion: Decrease both alum and phosphate contents were a pharmaceutical improvement for antiallergic vaccines formulation. Safety and efficacy in this vaccine are crucial for future human clinical trials.

Rastreamento da hipersensibilidade metálica pelos profissionais e estudantes de saúde na prática clínico-cirúrgica / Seguimiento de la hipersensibilidad metálica por profesionales y estudiantes de salud en la práctica clínico-quirúrgica / Screening of metallic hypersensitivity by health professionals and students in clinical-surgical practice

Objetivo: investigar o rastreamento da hipersensibilidade metálica realizada pelos profissionais e estudantes de saúde durante a prática clínico-cirúrgico. Método: estudo exploratório-descritivo realizado com 228 profissionais e estudantes da área da saúde, por meio de questionário eletrônico semiestruturado, aplicado durante abril e maio de 2021, analisado por meio da estatística descritiva e da frequência de palavras. Resultados: 11,0% dos participantes realizaram a investigação sobre a hipersensibilidade metálica. 67,1% declararam que muito provavelmente poderiam incluir essa temática durante a triagem em seus atendimentos. Falta de conhecimento sobre alergia a metais e causas multifatoriais durante a prática clínico-cirúrgica foram citadas como barreiras para a implementação do rastreamento da hipersensibilidade metálica. Conclusão: pouco se evidencia o rastreamento da hipersensibilidade metálica em pacientes durante a prática clínico-cirúrgica dos profissionais e estudantes de saúde.

Objetivo: investigar el rastreo de la hipersensibilidad metálica realizada por los profesionales y estudiantes de salud durante la práctica clínico-quirúrgica. Método: estudio exploratorio-descriptivo realizado con 228 profesionales y estudiantes del área de la salud, por medio de cuestionario electrónico semiestructurado, aplicado durante abril y mayo de 2021, analizado por medio de la estadística descriptiva y de la frecuencia de palabras. Resultados: 11,0% de los participantes realizaron la investigación sobre la hipersensibilidad metálica. El 67,1% declaró que muy probablemente podrían incluir esa temática durante la selección en sus atenciones. La falta de conocimientos sobre la alergia a los metales y las causas multifactoriales durante la práctica clínico-quirúrgica se citaron como barreras para la implementación del seguimiento de la hipersensibilidad metálica. Conclusión: poco se evidencia el rastreo de la hipersensibilidad metálica en pacientes durante la práctica clínico-quirúrgica de los profesionales y estudiantes de salud.

Objective to investigate the screening of metallic hypersensitivity performed by health professionals and students during clinical-surgical practice. Method: an exploratory-descriptive study conducted with 228 health professionals and students, through a semi-structured electronic questionnaire, applied during April and May 2021, analyzed through descriptive statistics and the frequency of words. Results: 11.0% of participants conducted research on metallic hypersensitivity. 67.1% stated that they could very likely include this theme during screening in their care. Lack of knowledge about metal allergy and multifactorial causes during clinical-surgical practice were cited as barriers to the implementation of metallic hypersensitivity screening. Conclusion: there is little evidence of metallic hypersensitivity screening in patients during the clinical-surgical practice of health professionals and students.

Prevalence of allergic rhinitis symptoms and associated factors in six-year-old children in a municipality in southern Brazil / Prevalência de sintomas de rinite alérgica e fatores associados em crianças de seis anos em um município do sul do Brasil

ABSTRACT Objective: To estimate the prevalence of allergic rhinitis symptoms and associated factors in six-year-old children. Methods: Cross-sectional epidemiological study involving 956 six-year-old schoolchildren from Palhoça, Santa Catarina, Brazil. Home interviews were conducted with mothers in which socio-demographic and house environmental conditions information were obtained, and the International Study of Athma and Allergies in Childhood (ISAAC) questionnaire for allergic rhinitis symptoms was applied. Bivariate and multivariate hierarchical analyses were performed using Poisson regression with a robust estimator. Results: The prevalence of allergic rhinitis symptoms was 21.7%. Children whose mothers had over 8 years of education, or who had air conditioning equipment in the house, or whose bedroom walls presented mold or moisture showed statistically significant and independent 5% higher prevalence of allergic rhinitis. Similarly, children of smoker mothers or those who lived with fur or feather animals indoors showed a 4% higher prevalence. Conclusion: Significant associations were observed between socio-demographic factors and environmental conditions in child's home and allergic rhinitis symptoms in children aged six years.

RESUMO Objetivo: Estimar a prevalência de sintomas de rinite alérgica e fatores associados em crianças de seis anos de idade. Métodos: Estudo epidemiológico de delineamento transversal envolvendo 956 escolares de seis anos de idade do município de Palhoça, Santa Catarina, Brasil. Foram realizadas entrevistas domiciliares com as mães sobre as informações sociodemográficas e as condições ambientais da casa e foi aplicado o questionário ISAAC para sintomas de rinite alérgica. Análises bivariada e multivariada hierarquizada foram realizadas por meio da Regressão de Poisson com estimador robusto. Resultados: A prevalência de sintomas de rinite alérgica foi de 21,7%. Crianças cujas mães apresentavam escolaridade maior que oito anos ou com presença de aparelho de ar condicionado ou mofo/umidade nas paredes do quarto em que dormiam apresentaram prevalência 5% maior, estatisticamente significativa e independente, de rinite alérgica. Da mesma forma, crianças com mães tabagistas ou que conviviam com animais de pelo ou pena dentro de casa apresentaram prevalência 4% maior. Conclusão: Foram observadas associações significativas entre fatores sociodemográficos e condições ambientais da casa da criança e sintomas de rinite alérgica em crianças de seis anos de idade.

A case of Kounis syndrome characterized by cardiac arrest / 中国综合临床

Kounis syndrome is an acute coronary syndrome associated with mast cell and platelet activation in the case of allergy or allergic injury. This case of Kounis syndrome type Ⅱ patients with myocardial infarction and cardiac arrest is rare. The patient came to the clinic because of wasp sting. During the treatment, he had cardiac arrest. After cardiopulmonary resuscitation, anti allergy, antithrombotic and coronary revascularization, his condition improved. After discharge, he was followed up regularly. After 1 month and 1 year follow-up, the patient had no chest pain, chest tightness, discomfort and allergic reaction.

Importância e aspectos clínicos da dermatite de contato por própolis / Importance and clinical aspects of propolis contact dermatitis

Objetivos: própolis é a substância resinosa que as abelhas coletam de plantas para a construção de suas colmeias. O objetivo dessa revisão foi ressaltar a importância do diagnóstico de dermatite de contato relacionada com própolis e aspectos clínicos relevantes dessa doença. Métodos: revisão narrativa da literatura realizada através da pesquisa nas bases de dados National Library of Medicine (PubMed) e Scientific Eletronic Library Online (SciELO). Resultados: foram encontrados 246 artigos e, após o processo de seleção e leitura, foram incluídas 32 publicações. Conclusões: a hipersensibilidade tardia ao própolis é de extrema importância pois a prevalência dessa alergia é crescente em diversas partes do mundo. Precisamos de estudos nacionais para avaliar nossa realidade. A comprovação de alta prevalência em nosso meio permitirá a inclusão desta substância em outras baterias de testes de contato em nosso país

Aims: propolis is the resinous substance that bees collect from plants to build their hives. The aim of this review was to highlight the importance of diagnosing propolis-related contact dermatitis and relevant clinical aspects of this disease. Methods: narrative literature review carried out by searching the National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO) databases. Results: a total of 246 articles were found and, after the selection and reading process, 32 publications were included. Conclusions: delayed-type hypersensitivity to propolis is extremely important because the prevalence of this allergy is increasing in various parts of the world. We need national studies to assess our reality. Proof of the high prevalence in our country will allow this substance to be included in other patch tests series in our country

Association between 25-hydroxyvitamin D levels and incidence of allergy and infection in infants aged 0–6 months

@#Introduction: Vitamin D levels are known to be related to prevalence of allergy and infection in children. However, vitamin D levels in infants’ umbilical cord blood need to be investigated. Therefore, this study aimed to determine association between 25-hydroxyvitamin D [25(OH)D] levels and incidence of allergy and infection in children. Methods: A longitudinal study involving 38 full-term newborns was conducted. Serum 25(OH)D levels in infants’ umbilical cord and venous blood were measured at birth and six months, respectively. 25(OH)D levels were classified as insufficient (<20 ng/mL) and sufficient (>20 ng/mL). Parents filled out questionnaires about their children’s allergy and infection symptoms. Paired t-test was performed to compare the 25(OH)D levels at birth and at six months. Chisquared test was conducted to determine relationship between 25(OH)D levels and incidence of infection and allergy in children. Results: 25(OH)D levels in venous blood of 6-month-old infants were significantly higher than in umbilical cord blood (50.44±13.59 ng/mL vs. 20.70±6.60 ng/mL, p<0.001). In addition, 25(OH)D level insufficiency in umbilical cord blood was associated with infection (p<0.05). However, there was no incidence of allergy, and exclusive breastfeeding and sun exposure were not associated with vitamin D levels in 6-month-old infants. Conclusion: We conclude that 25(OH)D level insufficiency in umbilical cord blood was associated with incidence of infection in the first six months of life.