Nasal allergies in the Latin American population: results from the Allergies in Latin America survey.

Allergies in Latin America is the first cross-national survey that describes the symptoms, impact, and treatment of nasal allergies (NAs) in individuals >or=4 years old in Latin America (LA). In total, 22,012 households across the Latin American countries of Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Peru, and Venezuela were screened for children, adolescents, and adults with a diagnosis of NA and either symptoms or treatment in the past 12 months. A total of 1088 adults and 457 children and adolescents were included and the sample was probability based to ensure valid statistical inference to the population. Approximately 7% of the LA population was diagnosed with NAs with two of three respondents stating that their allergies were seasonal or intermittent in nature. A general practice physician or otolaryngologist diagnosed the majority of individuals surveyed. Nasal congestion was the most common and bothersome symptom of NAs. Sufferers indicated that their symptoms affected productivity and sleep and had a negative impact on quality of life. Two-thirds of patients reported taking some type of medication for their NAs, with a roughly equal percentage of patients reporting taking over-the-counter versus prescription medications. Changing medications was most commonly done in those reporting inadequate efficacy. The most common reasons cited for dissatisfaction with current medications were related to inadequate effectiveness, effectiveness wearing off with chronic use, failure to provide 24-hour relief, and bothersome side effects (e.g., unpleasant taste and retrograde drainage into the esophagus). Findings from this cross-national survey on NAs have confirmed a high prevalence of physician-diagnosed NAs and a considerable negative impact on daily quality of life and work productivity as well as substantial disease management challenges in LA. Through identification of disease impact on the LA population and further defining treatment gaps, clinicians in LA may better understand and treat NAs, thus leading to improvements in overall patient satisfaction and quality of life.

Respiratory infection, exposure to mouse allergen and breastfeeding: role in recurrent wheezing in early life.

BACKGROUND: Environmental factors may influence the development of allergen sensitization and asthma. The aim of this study was to evaluate the role of endotoxin and allergen exposure in early life as a risk factor for recurrent wheezing. METHODS: One hundred and four infants from low-income families, at high risk of asthma, were enrolled at birth. Dust samples were collected from the bedding and bedroom floor within 6 months after birth. Recurrent wheezing was defined as 3 or more wheezing episodes in the past year. Endotoxin was determined by Limulus amebocyte lysate assay, and major indoor allergens were quantitated by ELISA in dust extracts. IgE antibodies were measured by ImmunoCAP at 30 months of age. RESULTS: At 30 months, 51 of the 99 infants who completed the study (51.5%) had recurrent wheezing. Respiratory infection was strongly associated with recurrent wheezing (OR 6.67, 95% CI 1.96-22.72), whereas exclusive breastfeeding for at least 1 month was a protective factor (OR 0.09, 95% CI 0.01-0.51). Exposure to high levels of mouse allergen was more frequent among non-recurrent wheezers, approaching significance (OR 0.12, 95% CI 0.01-1.13; p = 0.064). None of the children were sensitized to mouse. Sensitization to mite was found in 26/90 (28.8%) children, with no association with recurrent wheezing. CONCLUSION: Respiratory infection was strongly associated with recurrent wheezing in the first 30 months of life, in children at high risk of asthma, living in a socially deprived community in Brazil.

Is the prevalence of asthma and related symptoms among Brazilian children related to socioeconomic status?

OBJECTIVE: To evaluate the relationship between socioeconomic status (SES) and the prevalence of asthma and related symptoms among Brazilian children. METHODS: The International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire was applied to 23,457 six- to seven-year-old schoolchildren (SC) and 58,144 thirteen- to fourteen-year-old adolescents (AD) from 20 Brazilian cities. SES was evaluated by infant mortality index, poverty index, and average nominal income for people older than 10 years of age. RESULTS: Current asthma ranged from 16.5% to 31.2% among SC and from 11.8% to 30.5% among AD and severe asthma from 2.9% to 8.5% (SC) and 2.6% to 9.1% (AD). Higher values were observed in Brazilian-Northern, -Northeastern and -Southeastern centers. No significant association between SES and prevalence of asthma and related symptoms was observed. CONCLUSIONS: In Brazil, the prevalence of asthma and related symptoms is quite variable and independent of SES.

Prevalence of rhinitis among Brazilian schoolchildren: ISAAC phase 3 results.

OBJECTIVE: The International Study of Asthma and Allergies in Childhood (ISAAC) is a standardized method that allows international and regional comparisons of asthma and allergic diseases prevalence. The objective of this study was to evaluate the prevalence of rhinitis and related symptoms among 6-7 year-old children (SC) and 13-14 year-old adolescents (AD) from 20 Brazilian cities applying the ISAAC's standardized written questionnaire (WQ). METHODS: ISAAC's WQ was applied to 23,422 SC and 58,144 AD living in different regions of Brazil: North (N), Northeast (NE), Middle West (MW), Southeast (SE), and South (S). RESULTS: The prevalence of rhinoconjunctivitis in the last year ranged from 10.3% to 17.4% and from 8.9% to 28.5% among SC and AD, respectively. Considering SC the highest values were observed in SE region. In NE, the prevalence in countryside centres was higher than those along the coast. Among AD, the highest values were observed in N and S regions, mainly in Pará (Belém). The evaluation of populations probably with the same genetic background has shown higher prevalence among those living in urban centres (capital) in comparison to those in the countryside. CONCLUSIONS: The prevalence of rhinitis and related symptoms were variable and predominate in Brazilian N and NE centres.

Prevalence of atopic eczema and related symptoms in Brazilian schoolchildren: results from the International Study of Asthma and Allergies in Childhood (ISAAC) phase 3.

BACKGROUND: International comparisons of the prevalence of atopic eczema and related symptoms are scarce. The standardized protocol of the International Study of Asthma and Allergies in Childhood (ISAAC) facilitates investigation of prevalence all over the world. OBJECTIVE: To apply the ISAAC written questionnaire to evaluate the prevalence of atopic eczema and related symptoms among 6-7 year-old children and 13-14 year-old adolescents living in 20 Brazilian cities. METHODS: The ISAAC written questionnaire was filled in by 23,422 children aged 6-7 years and 58,144 adolescents aged 13-14 years living in 2 population centers in the north, 8 in the northeast, 1 in the midwest, 5 in the southeast, and 5 in the south. RESULTS: The prevalence of flexural eczema (itchy rash ever in characteristic places in the last 12 months) ranged from 5.3% to 13.0% for children and was lower among the adolescents (range, 3.4%-7.9%). Among children, the highest rates were observed in population centers in the northeast, mainly along the coast. Among adolescents the highest rates were observed in the north and northeast, mainly in Natal, Aracaju, and Vitória da Conquista. The northeastern countryside had higher prevalence rates of severe eczema (kept awake at night by this itchy rash in the last 12 months) in comparison to northeastern coastal centers. There was a significant correlation between the prevalence of flexural eczema and severe eczema for both age groups, separately (6-7 year-olds, prho= 0.756, P<.004; 13-14 year-olds, rho=0.874, P<.0001) or grouped (6-7 plus 13-14 years-olds, rho=0.696, P<.0001). CONCLUSION: The prevalence of eczema and related symptoms is variable in Brazil, where the highest prevalence is found in the north and northeast; on the other hand, a higher prevalence of severe eczema was observed in Brazilian centers in the south.

Prevalence of symptoms of asthma, rhinitis, and atopic eczema among Brazilian children and adolescents identified by the International Study of Asthma and Allergies in Childhood (ISAAC) - Phase 3.

OBJECTIVES: To determine the prevalence of symptoms of asthma, rhinitis, and atopic eczema among schoolchildren aged 6 to 7 years and adolescents aged 13 to 14 years in 20 Brazilian cities by using the standardized ISAAC written questionnaire, and to assess the association of this prevalence with latitude, altitude and average annual temperature of collaborating centers. METHODS: Schoolchildren and adolescents from five Brazilian regions participated in the study, totaling 23,422 ISAAC questionnaires answered by schoolchildren's parents and 58,144 questionnaires answered by adolescents. The values for latitude, altitude and average annual temperature were obtained from the Brazilian Institute of Geography and Statistics. RESULTS: The mean prevalence rates among schoolchildren and adolescents were respectively 24.3 and 19.0% for active asthma; 12.6 and 14.6% for rhinoconjunctivitis; and 8.2 and 5.0% for atopic eczema. A significant negative association was observed between latitude and physician-diagnosed asthma among schoolchildren, severe asthma, physician-diagnosed asthma, eczema and atopic eczema among adolescents. No association with altitude was found. CONCLUSIONS: The prevalence of asthma, rhinitis and atopic eczema in Brazil varies considerably. Higher prevalence rates, especially of asthma and eczema, were found at centers located closer to the equator.

Risk factors for asthma and atopy.

PURPOSE OF REVIEW: The aim of this article is to provide information on risk factors associated with the development of atopy and asthma in childhood. RECENT FINDINGS: Several gene polymorphisms have been associated with susceptibility to asthma and allergy; complex gene-environmental interactions, however, appear to play a key role in the development of the disease. Early life sensitization to aeroallergens, presence of atopic dermatitis or allergic rhinitis, maternal smoking during pregnancy and children's environmental exposure to tobacco smoke, lower respiratory tract infections with respiratory syncytial virus and potentially with other viruses including rhinovirus and metapneumovirus, exposure to air pollutants, several perinatal factors other than maternal smoking, are among factors associated with an increased risk for development of chronic asthma. SUMMARY: The prevalence of asthma and allergic diseases is increasing progressively. Those who are involved in the care of young children should be prepared to recognize risk factors for development of these diseases and to appreciate the role of gene-environment interactions. Preventive measures established at an early age may modify the natural history of asthma and other allergic diseases.

[Adaptation and validation of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) in Brazilian asthmatic children and adolescents]. / Adaptação e validação do Pediatric Asthma Quality of Life Questionnaire (PAQLQ-A) em crianças e adolescentes brasileiros com asma.

OBJECTIVES: To translate the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) into Portuguese and adapt it to the Brazilian context, for use in children and adolescents with asthma and to validate the adapted version of the questionnaire (PAQLQ-A). METHODS: Children and adolescents (7 to 17 years old) with asthma answered the PAQLQ-A on admission and were assessed using a clinical severity score. According to this score, patients were classified as mild (> or = 2) or moderate/severe (< 2). They were reassessed on at least two occasions at an interval of 2 to 4 weeks. Furthermore, patients in whom asthma was properly controlled were classified as stable, and those in whom it could not be controlled, as unstable. RESULTS: The reproducibility of the PAQLQ-A was evaluated in stable patients by comparing the mean domain scores: symptoms, emotions, activities, and the overall clinical severity score on two predefined occasions with an interval of 15 to 30 days in between. Responsiveness was evaluated among unstable patients. The mean domain scores and the overall score were different on both occasions, and so was the clinical severity score. The validity of the questionnaire was determined by the application of Cronbach's alpha reliability coefficient (alpha = 0.909). CONCLUSIONS: The translation of the PAQLQ into Portuguese did not modify the framework of the original questionnaire; the PAQLQ-A is easy to use, with easy reproducibility, constituting a valuable instrument for the evaluation of the quality of life in children and adolescents with asthma.

International Study of Asthma and Allergies in Childhood (ISAAC): validation of the written questionnaire (eczema component) and prevalence of atopic eczema among Brazilian children.

Although Hanifin and Rajka's criteria have been used for the diagnosis of atopic eczema (AE), there is no instrument destined for epidemiological studies on AE that actually uses them. Written questionnaires (WQ) have generally been used, but when translated into another language they must be validated. The Intemational Study of Asthma and Allergies in Childhood (ISAAC) WQ was previously validated in a comprehensive study, but its validation in Brazil had not been done. Our objective was to validate the eczema component of the self-applicable ISAAC's WQ following its translation into Portuguese. The group of 10 pediatricians and 10 pediatric allergologists graded the questions from 0 to 2 and established the maximum score for each question. The WQ was answered by parents or guardians of children with atopic dermatitis (AE), aged 6-7 years (n = 23) and of non-AE control children of the same age (n = 46) as well as by AE (n = 24) and non-AE (n = 48) adolescents, aged 13-14 years. In order to evaluate the reproducibility of the ISAAC WQ, half of these individuals answered the same questionnaire after 2 to 4 weeks. The maximum possible global scores were 13 for the children aged 6-7 years and 11 for the adolescents, and the cutoff level for both groups was 3. In both age periods the WQ was reproducible (Kappa and McNemar tests) in a significant way (6-7 years, Kw = 0.79; 13-14 years, Kw = 0.73). The prevalence of AE, using the validated WQ, was then studied. The WQ was applied to the parents of 3,005 children aged 6-7 years and to 3008 children aged 13-14 years. Response rates were 72% and 94% for the 6-7-year-old children and the 13-14-year-old children, respectively. There was a slight predominance of male children in the studied population. In the group of the 6-7-year-old children, the cumulative prevalence of AE was 13.2% for boys and for girls; in the group of the 13-14-year-old children, it was 12.5% and 15.4%, respectively. AE severity was similar for both age groups. Using the criteria of global cutoff score, in the group of the 6-7-year-old children, the prevalence of AE was 12.6% for boys and 13.8 for girls; in the group of the 13-14-year-old children, it was 11.7% and 12.4%, respectively. There were no significant differences between them. In conclusion, the AE component of the ISAAC WQ proved to be reproducible, adequate, and able to discriminate between AE and control children. A significant concordance was observed between the criteria utilized in this study (ISAAC x global cutoff score).

[Prevalence of atopic eczema and associated symptoms in school children]. / Prevalência de eczema atópico e sintomas relacionados entre estudantes.

OBJECTIVE: To determine the prevalence of atopic dermatitis and associated symptoms in schoolchildren from the city of São Paulo in 1996 and 1999. METHODS: The International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire was applied to the parents of 6 to 7-year-old children in 1996 and 1999 (3,005 in 1996 and 3,033 in 1999) and to 13 to 14-year-old adolescents (3,008 in 1996 and 3,487 in 1999). In the ISAAC, the option eczema ever indicates that a diagnosis of atopic eczema was made by a physician at least once in the subject's life. This was used to define "medical diagnosis" in the present study. The concomitant report of lesions in the last year in characteristic places constitutes the "combined criterion" for the diagnosis of atopic eczema and was also employed in the present study. Data were analyzed using the Epi-Info 6.0 software. RESULTS: In the 6 to 7-year-old group, there was a significant decrease in the number of "medical diagnoses" of atopic eczema in 1999 (11.4%) in comparison to 1996 (13.2%). The increase in the prevalence of "medical diagnoses" observed in 1999 among adolescents was not significant (14 vs. 15%). Considering the "combined criterion," there were no significant differences between 1996 and 1999 in either group (6.6% vs. 6.8% for 6 to 7 year-old children; 3.7% vs. 4.4% for adolescents). CONCLUSIONS: Despite the increase in the prevalence of atopic diseases worldwide, we documented a reduction in the prevalence of "medical diagnoses" of atopic eczema in 6 to 7-year-old children. Nevertheless, atopic eczema remains as a relevant disease in the pediatric population.

[Sensitization to inhalant and food allergens in Brazilian atopic children by in vitro total and specific IgE assay. Allergy Project--PROAL]. / Sensibilização a alérgenos inalantes e alimentares em crianças brasileiras atópicas, pela determinação in vitro de IgE total e específica--Projeto Alergia (PROAL).

OBJECTIVE: To determine the frequency of sensitization to inhalant and food allergens in children seen at Brazilian allergy services. PATIENTS AND METHODS: Total and specific IgE serum levels to inhalant and food allergens (RAST, UniCAP - Pharmacia) were measured in 457 children accompanied in pediatric allergy services and in 62 control children age matched. RAST equal or higher than class 1 was considered as positive (R+). RESULTS: Frequency of R+ was significantly higher among atopics (361/457, 79%) when compared to controls (16/62, 25.8%). There were no differences according to gender. The frequency of R+ to all allergens evaluated was higher among atopics when compared to controls. Significantly higher total IgE serum levels were observed among the atopics with R+ in comparison to those with R-. The frequency of R+ to main inhalant allergens were: D. pteronyssinus = 66.7% x 14.5% (p < 0.05), D. farinae = 64.5% x 17.8% (p < 0.05), B. tropicalis = 55.2% x 19.4% (p < 0.05), cockroach = 32.8% x 9.7% (p < 0.05), and cat = 12% x 8.1%. In relation to food allergens we observed: fish = 29.5% x 11.3% (p < 0.05), egg = 24.4% x 4.8% (p < 0.05), cow's milk = 23.1% x 3.2% (p < 0.05), wheat = 20% x 8.1% (p < 0.05), peanuts = 14% x 4.8% (p < 0.05), soy = 11.8% x 4.8% (p < 0.05), and corn = 10.6% x 4.8% (p < 0.05). With respect of age, food allergen sensitization predominates in young children whereas the inverse occurs with inhalant allergens. CONCLUSIONS: There was a predominant frequency of sensitization to inhalant allergens, mainly house dust mites in the evaluated patients. Food allergens were also responsible for a significant proportion of sensitization, mainly in infants.

[Phadiatop in the diagnosis of respiratory allergy in children: Allergy Project--PROAL]. / Phadiatop no diagnóstico de alergia respiratória em crianças: Projeto Alergia (PROAL).

OBJECTIVES: To evaluate the positivity of Phadiatop in children from several Brazilian pediatric allergology centers and to compare its results with the presence of serum specific IgE to inhalant and food allergens. PATIENTS AND METHOD: Phadiatop and serum specific IgE levels (RAST) to inhalant and food allergens (UniCAP - Pharmacia) were measured in 457 children from several pediatric allergy centers and in a non-allergic control group (n = 62), distributed across five age groups. RESULTS: Phadiatop was positive in 305 atopic children (67.6%) and in 25.8% of controls (p < 0.001). Among atopic children the distribution of positive test varied according to age: 7.9% (24/305) among under 2 year-olds, 15.4% (47/305) in 2 to 3 year-olds, 22.0% (67/305) in 3 to 4 year-olds, 19.3% (59/305) in 4 to 5 year-olds and 35.4% (108/305) in 5 to 12 year-olds. No concordance between food allergens and Phadiatop was observed. Analysis of the relationship between positive inhaled allergen RASTs and positive Phadiatop showed best indices with house dust mites (D. pteronyssinus, D. farinae and Blomia tropicalis). CONCLUSIONS: Phadiatop is a useful tool for diagnosing domestic mite allergy.

Recommendations for treatment of intermittent mild persistent asthma in children and adolescents.

Many parents and caretakers of children and adolescents with mild persistent asthma (MPA) do not follow proposed guidelines, namely the daily and continuous administration of inhaled corticosteroids (ICS). Instead, parents and caretakers tend to use ICS and bronchodilators intermittently for short periods and restart such therapy only when symptoms reappear. It is our opinion that intermittent treatment of MPA in children and adolescents might achieve the same level of asthma control as has been achieved in adults. We propose, therefore, that after an initial period of stabilization with age-appropriate doses of oral glucocorticoids or high-dose ICS and short-acting beta-2 agonists (SABA), caretakers can stop treatment once there are no longer signs or symptoms of asthma. When asthmatic symptoms recur, treatment should be restarted with ICS and SABA, or oral corticosteroids if the exacerbation is severe. The perception of developing asthma symptoms remains an unsolved problem. Based on our clinical experience in children and adolescents with asthma, we list a number of signs and symptoms that precede an exacerbation of asthma, allowing for an early re-introduction of treatment to prevent an exacerbation.

Is rhinitis alone or associated with atopic eczema a risk factor for severe asthma in children?

The objective of this study was to evaluate the role of rhinitis (R) and atopic eczema (E) on asthma severity among asthmatic (A) schoolchildren identified by the International Study of Asthma and Allergies in Childhood written questionnaire (WQ). WQ was applied to parents of 6-7-yr-old schoolchildren (SC, n=3033), and to adolescents (AD, 13-14 yr old, n=3487), living in Sao Paulo, Brazil. An affirmative response to 'has your child/have you had wheezing/whistling in the last year' identified those with A, and an affirmative response to 'the last 12 months has your child/have you had sneezing/runny/blocked nose when he/she you did not have a cold/flu?' identified those with R. Subjects with an affirmative response to 'has your child/have you had this itchy rash at any time in the past 12 months?' were identified as having E. Subjects who had R associated with A were identified as AR and those with A associated with R and E as ARE. A who had at least two affirmative responses to questions for asthma severity: speech disturbance, more than four acute attacks, sleep disturbance, and wheezing with exercise were defined as having severe asthma. 22.1% AD and 24.3% SC were identified as A; 47.1% of those AD and 42.0% SC had AR and 10.0% of those AD and 12.8% of SC had ARE. Considering ARE, AR and A groups, speech disturbance during an acute episode of asthma was significantly higher among ARE AD (20.0% vs. 11.5% vs. 8.7%, p<0.05), and ARE SC (22.1% vs. 13.9% vs. 10.5%, p<0.05) in comparison with A. Likewise, more than four acute attacks in the last year was significantly higher among ARE AD (24.0% vs. 14.0% vs. 10.5%, p<0.05) and ARE SC (32.6% vs. 19.4% vs. 12.8%, p<0.05) as the frequency of sleep disturbance due to wheezing, for AD (61.3% vs. 42.0% vs. 38.4%, p<0.05) and SC (77.9% vs. 67.3% vs. 58.4%, p<0.001) and for 'wheezing associated with exercise' for AD (72.0% vs. 47.5% vs. 39.9%, p<0.001) and SC (36.8% vs. 31.4% vs. 14.1%, p<0.001). Prevalence of severe asthma was higher among ARE AD (57.3% vs. 31.9% vs. 27.0%, p<0.05) and ARE SC (52.6% vs. 36.9% vs. 22.5%). In patients with A, the presence of R or E are risk factors for severe asthma, and both together (R and E) are a higher risk.

Immunological evaluation of allergic respiratory children with recurrent sinusitis.

The objective of this study was to evaluate humoral immunity of allergic respiratory children with chronic/recurrent sinusitis. Twenty-seven allergic respiratory (persistent mild/moderate asthma and persistent allergic rhinitis) children (7-15-year old) with chronic or recurrent sinusitis were evaluated. Patients had symptoms and abnormal computer tomography scan even after two adequate treatments (long-lasting antibiotics, decongestants, and short-term oral corticosteroids). clinical examination, sweat test, total blood cell count, measurement of serum levels of: total and specific IgE, immunoglobulins (G, M, A), IgG subclasses, antibodies to Haemophilus influenza type b (IgG anti-Ps Hib) and pneumococcal serotypes (IgG anti-Ps 1, 3, 5, 6B, 9V, and 14) before and after active immunization (Act-Hib and Pneumo23, Aventis Pasteur SA, Lyon, France), Rubella neutralizing antibody titers and human immunodeficiency virus antibodies. Specific IgE to inhalant allergens higher than class III were observed in 24/27 patients. One patient had IgA plus IgG2 deficiency and other an IgG3 deficiency. Eight and 12 of 27 patients had IgG2 and IgG3 serum levels below 2.5th percentile, respectively. Immunological responses to protein and polysaccharide antigens were normal in all patients. Although our patients have been appropriately treated of their allergic diseases, they persisted with chronic/recurrent sinusitis and 60% of them had a documented osteomeatal complex blockade. In spite of the diagnosis of IgA plus IgG2 deficiency and an isolated IgG3 deficiency, in all patients an adequate response to Ps antigens was observed. Primary and/or secondary humoral immunodeficiency seems not to be the main cause of chronic/recurrent sinusitis in patients with respiratory allergic disease.

Exercise-induced bronchoconstriction in children: montelukast attenuates the immediate-phase and late-phase responses.

BACKGROUND: Montelukast, a leukotriene receptor antagonist, attenuates exercise-induced bronchoconstriction. We and others have shown that there is a late-phase response 3 to 8 hours after exercise in a subset of asthmatic patients. OBJECTIVE: We sought to evaluate the protective effect of montelukast on immediate-phase and late-phase responses after exercise challenges. METHODS: Twenty-two atopic asthmatic children aged 7 to 16 years with reproducible exercise-induced bronchoconstriction (minimum of 15% decrease of FEV(1) from baseline) were enrolled in this placebo-controlled crossover study. Exercise challenges were performed while breathing cold dry air, and FEV(1) measurements were taken up to 480 minutes after exercise. Patients underwent exercise challenges on a screening day and 1 week after placebo treatment. Subsequently, after a week with no treatment, pulmonary function was assessed after breathing dry cold air (control day). Finally, an exercise challenge was carried out after a week of treatment with montelukast. RESULTS: Reproducible late-phase reactions occurred in 5 of 22 patients, which correlated with the extent of the immediate response (P <.05). After 1 week of treatment with montelukast, a significant decrease of immediate responses was observed. Montelukast treatment compared with placebo was associated with a lower mean maximum decrease of FEV(1) (mean +/- SEM: 17.3% +/- 2.4% and 35.1% +/- 2.6%, respectively), decrease of the area above the curve (267.8% +/- 42.7%/min and 868.0% +/- 103.8%/min, respectively), and shorter time for recovery (6.9 +/- 1.1 minutes and 30.9 +/- 4.0 minutes, respectively; P <.05). Treatment with montelukast also abolished late-phase responses. CONCLUSION: Once daily treatment with oral montelukast attenuated the immediate-phase response and abolished the late-phase response induced by means of exercise challenge in asthmatic children.

Daycare centers and schools as sources of exposure to mites, cockroach, and endotoxin in the city of São Paulo, Brazil.

BACKGROUND: Public places, including schools, have been identified as sources of exposure to allergens derived from mites, cockroach, cat, and dog and to endotoxin. OBJECTIVES: The purposes of this study were to assess and compare exposure to allergens and endotoxin in 4 types of public child-care facilities in Brazil and to investigate whether the presence of children and the performance of cleaning procedures could have an influence on allergen and endotoxin levels. METHODS: We have analyzed dust from bedding, floors, chairs, and tables of daycare centers (DCs), preschools, kindergartens, and elementary schools (ESs). Major allergens from mites, cockroach, cat, and dog were quantitated by means of ELISA, and endotoxin content was determined by using the Limulus Amebocyte Lysate assay. RESULTS: Group 1 mite allergens were greater than 2 microg/g in 67% of DC and preschool samples and in 8.9% and 2.2% of kindergarten and ES samples, respectively. The presence of bedding in DCs and preschools accounted for increased levels of mite allergens in these settings. Levels of Bla g 1 were higher in ES floors compared with those found in DC and preschool floors. Low levels (<1 microg/g) of Fel d 1 e Can f 1 were found in most samples. Levels of endotoxin in DCs and preschools were 3 times higher than in ESs. CONCLUSIONS: DCs and schools in Brazil should be considered as important sources of exposure to dust mites and cockroach allergens and to endotoxin. Recommendations for mite allergen avoidance should include appropriate care of bedding in DCs and preschools.

Prevalência de sintomas de asma, rinite e eczema atópico entre crianças e adolescentes brasileiros identificados pelo International Study of Asthma and Allergies (ISAAC): fase 3 / Prevalence of symptoms of asthma, rhinitis, and atopic eczema among Brazilian children and adolescents identified by the International Study of Asthma and Allergies in Childhood (ISAAC): phase 3

OBJETIVO: Determinar a prevalência de sintomas relacionados à asma, rinite e eczema atópico em escolares (EC) entre 6 e 7 anos e adolescentes (AD) entre 13 e 14 anos, residentes em 20 cidades brasileiras, empregando o questionário escrito padronizado do ISAAC, e avaliar a sua associação com a latitude, altitude e temperatura média anual dos centros de residência. MÉTODOS: Participaram do estudo EC e AD das cinco regiões do Brasil, totalizando 23.422 questionários ISAAC respondidos pelos pais de EC e 58.144 pelos próprios AD. Os índices de latitude, altitude e temperatura média anual foram obtidos do Instituto Brasileiro de Geografia e Estatística. RESULTADOS: As prevalências médias para os EC e AD, respectivamente, foram: asma ativa, 24,3 e 19,0 por cento; rinoconjuntivite, 12,6 e 14,6 por cento; e eczema flexural, 8,2 e 5,0 por cento. Associação significante e negativa foi observada entre latitude e prevalência de asma diagnosticada por médico para os EC, asma grave, asma diagnosticada por médico, eczema e eczema flexural para os AD. Não houve associação com a altitude dos centros. CONCLUSÃO: A prevalência de asma, rinite e eczema atópico no Brasil foi variável. Valores mais altos, sobretudo de asma e eczema, foram observados nos centros localizados mais próximos ao Equador.

OBJECTIVE: To determine the prevalence of symptoms of asthma, rhinitis, and atopic eczema among schoolchildren aged 6 to 7 years and adolescents aged 13 to 14 years in 20 Brazilian cities by using the standardized ISAAC written questionnaire, and to assess the association of this prevalence with latitude, altitude and average annual temperature of collaborating centers. METHODS: Schoolchildren and adolescents from five Brazilian regions participated in the study, totaling 23,422 ISAAC questionnaires answered by schoolchildren's parents and 58,144 questionnaires answered by adolescents. The values for latitude, altitude and average annual temperature were obtained from the Brazilian Institute of Geography and Statistics. RESULTS: The mean prevalence rates among schoolchildren and adolescents were respectively 24.3 and 19.0 percent for active asthma; 12.6 and 14.6 percent for rhinoconjunctivitis; and 8.2 and 5.0 percent for atopic eczema. A significant negative association was observed between latitude and physician-diagnosed asthma among schoolchildren, severe asthma, physician-diagnosed asthma, eczema and atopic eczema among adolescents. No association with altitude was found. CONCLUSIONS: The prevalence of asthma, rhinitis and atopic eczema in Brazil varies considerably. Higher prevalence rates, especially of asthma and eczema, were found at centers located closer to the equator.

Adaptação e validação do Pediatric Asthma Quality of Life Questionnaire (PAQLQ-A) em crianças e adolescentes brasileiros com asma / Adaptation and validation of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) in Brazilian asthmatic children and adolescents

OBJETIVOS: Traduzir e adaptar ao português (cultura brasileira) o Pediatric Asthma Quality of Life Questionnaire (PAQLQ) para uso em crianças e adolescentes com asma e validar a versão adaptada (PAQLQ-A). MÉTODOS: Crianças e adolescentes (7 a 17 anos) com asma foram entrevistados e responderam o PAQLQ-A à admissão, sendo avaliados por escore clínico de gravidade. Segundo o escore clínico de gravidade, os pacientes foram classificados em leves (< 2) ou moderados/graves (> 2). Eles foram reavaliados em pelo menos mais duas ocasiões, com intervalo de 2 a 4 semanas. RESULTADOS: Durante o seguimento, alguns se mantiveram sem mudança no escore clínico de gravidade e foram identificados como estáveis; já os que variaram foram identificados como instáveis. A reprodutibilidade do PAQLQ-A foi avaliada entre os estáveis comparando-se as médias dos domínios sintomas, emoções, atividades e total e do escore clínico de gravidade em dois tempos predeterminados (15 a 30 dias de intervalo), sem diferenças entre elas. A avaliação da suscetibilidade à alteração foi feita entre os pacientes instáveis. As médias dos domínios e o total em dois tempos foram significantemente diferentes, assim como o escore clínico de gravidade. A validação do instrumento foi realizada pela aplicação do teste de confiabilidade de Cronbach (a = 0,909). CONCLUSÕES: A tradução do PAQLQ para a língua portuguesa não modificou estruturalmente o questionário original; o PAQLQ-A é de fácil aplicação, reprodutível, capaz de detectar mudanças e constitui-se em instrumento valioso para a avaliação da qualidade de vida em crianças e adolescentes com asma.

Risk factors for atopic eczema in school children

OBJETIVOS: identificar fatores de risco relacionados ao eczema atópico (EA) em escolares do município de São Paulo. MÉTODOS: 1972 pais de escolares de 6-7 anos da região centro-sul de São Paulo responderam a questionários escritos (questionário padrão do International Study of Asthma and Allergies in Childhood e questionário complementar sobre história familiar de doenças alérgicas e exposição ambiental a potenciais fontes de alérgenos e irritantes). A presença de manchas na pele com coceira nos últimos 12 meses, definiu os escolares com EA. Os fatores de risco foram analisados por regressão logística. RESULTADOS: as variáveis significantemente associadas ao EA foram: história materna (OR: 4,1; IC95 por cento: 2,4 a 7,1) e paterna de eczema (OR: 2,6; IC95 por cento: 1,4 a 5,0), presença de pó no dormitório (OR: 1,6; IC95por cento: 1,1 a 2,4), menor escolaridade materna (OR: 1,7; IC95 por cento: 1,1 a 2,7), relato de sibilos no último ano (OR: 1,9; IC95 por cento: 1,2 a 2,8) e de rinite alguma vez (OR: 1,7; IC95 por cento: 1,1 a 2,9). CONCLUSÕES: a análise dos dados sugeriu haver um padrão específico de herança genética para o EA. A presença de pó no quarto foi o único fator de risco ambiental encontrado. Sintomas e diagnóstico de outras doenças atópicas associaram-se fortemente às manifestações de EA.