ABSTRACT
The Phadiatop Infant® (PhInf) is a panel developed to assess allergic sensitization (immunoglobulin E [IgE]) in children aged <5 years and combines inhalant and food allergens. The test has not been evaluated outside Europe. This is a cross-sectional study conducted at 11 pediatric allergy centers to evaluate PhInf as an allergic disease screening method in Brazilian children. Children as controls and patients (aged 6 months-18 years) were grouped according to their primary disease and age group. PhInf and specific serum IgE (sIgE) screening was performed for Dermatophagoides pteronyssinus (DP), cat and dog epithelia, a mix of grasses and pollens, eggs, cow's milk, peanuts, and shrimp. Values ≥ 0.35 kUA/L (or PAU/L) were considered positive. A total of 470 children and adolescents, which included 385 patients and 85 controls, participated in the study (47.7% boys, average age: 6.3 years). In all, 72.6% of the participants had positive PhInf test (n = 341), with a higher proportion of those having food allergy (92.6%), atopic dermatitis (91.9%), and those aged >13 years having allergy (95%). The PhInf and sIgE agreement between patients (Kappa = 0.94, P < 0.001) and controls (Kappa = 0.84, P < 0.001) was high. PhInf and DP agreement in patients aged >13 years was excellent (Kappa = 0.936, P < 0.001). Compared with sIgE dosage, PhInf had high sensitivity (97%) and specificity (93%). Positivity of PhInf test in this population was high and had an excellent correlation with the allergens comprising the panel. It is a useful method for screening children suspected of having allergic diseases in a non-European country.
Subject(s)
Food Hypersensitivity , Laboratories , Adolescent , Allergens , Animals , Cats , Cattle , Cross-Sectional Studies , Dogs , Female , Food Hypersensitivity/diagnosis , Food Hypersensitivity/epidemiology , Humans , Immunoglobulin E , InfantABSTRACT
The clinical history is of importance in the investigation of allergic diseases but does have limitations. Many allergic conditions will be over-diagnosed if anamnesis alone is used for diagnostic criteria. Serum total immunoglobulin E (TIgE) quantification, as well as panels containing allergens prevalent in the studied population, may serve as screening tests and facilitate the diagnosis of allergic disease or its exclusion. We assessed the positivity of two versions of these tests, Phadiatop Europe® (PhEU) and Phadiatop Infant® (PhInf), as well as total IgE (TigE) values in patients with a medical diagnosis of allergic disease and non-allergic individuals. METHODS: A cross-sectional study performed in eleven Brazilian pediatric allergy centers with patients divided into groups according to the primary condition and a group of assessed control subjects. They were submitted to TIgE measurement and screening tests (PhEu and PhInf). RESULTS: TIgE mean serum levels were significantly higher among allergic patients, especially those with asthma/rhinitis or atopic dermatitis. The positivity of the screening tests, considering the total population, was 63.8% for PhEU and 72.6% for PhInf. These increased when we evaluated only the allergic subjects. The concordance index of the two tests was Kappa = 0.7 and higher among those of greater age. CONCLUSIONS: In the assessed population, there were significantly higher levels among those with positive screening tests and PhInf showed better performance in the identification of sensitized individuals, regardless of age. This is the first study to evaluate Phadiatop and Phadiatop Infant in the same population
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Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Hematologic Tests/methods , Hypersensitivity/diagnosis , Immunoglobulin E/blood , Immunologic Techniques/methods , Hypersensitivity/immunology , Brazil , Cross-Sectional Studies , Allergens/immunology , Dermatitis, Atopic/immunology , Asthma/immunology , Rhinitis, Allergic/immunology , Sensitivity and SpecificityABSTRACT
The clinical history is of importance in the investigation of allergic diseases but does have limitations. Many allergic conditions will be over-diagnosed if anamnesis alone is used for diagnostic criteria. Serum total immunoglobulin E (TIgE) quantification, as well as panels containing allergens prevalent in the studied population, may serve as screening tests and facilitate the diagnosis of allergic disease or its exclusion. We assessed the positivity of two versions of these tests, Phadiatop Europe® (PhEU) and Phadiatop Infant® (PhInf), as well as total IgE (TigE) values in patients with a medical diagnosis of allergic disease and non-allergic individuals. METHODS: A cross-sectional study performed in eleven Brazilian pediatric allergy centers with patients divided into groups according to the primary condition and a group of assessed control subjects. They were submitted to TIgE measurement and screening tests (PhEu and PhInf). RESULTS: TIgE mean serum levels were significantly higher among allergic patients, especially those with asthma/rhinitis or atopic dermatitis. The positivity of the screening tests, considering the total population, was 63.8% for PhEU and 72.6% for PhInf. These increased when we evaluated only the allergic subjects. The concordance index of the two tests was Kappa=0.7 and higher among those of greater age. CONCLUSIONS: In the assessed population, there were significantly higher levels among those with positive screening tests and PhInf showed better performance in the identification of sensitized individuals, regardless of age. This is the first study to evaluate Phadiatop and Phadiatop Infant in the same population.
Subject(s)
Age Factors , Hypersensitivity/diagnosis , Skin Tests/methods , Adolescent , Allergens/immunology , Brazil/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Hypersensitivity/epidemiology , Immunoglobulin E/metabolism , Infant , Male , PrevalenceABSTRACT
A rinite no pré-escolar configura um grande desafio diagnóstico e terapêutico, tanto para pediatras, como para especialistas. Os poucos dados existentes nesta faixa etária, além da sobreposição dos sintomas também comuns às doenças respiratórias virais, tornam o diagnóstico de rinite extremamente raro e/ou frequentemente ignorado. A melhor compreensão e identificação da rinite nos pré-escolares pode ajudar a melhorar a qualidade de vida destes pacientes, através da instituição do diagnóstico e tratamento corretos. Além disso, o diagnóstico mais precoce, possivelmente possibilitará caracterizar melhor a história natural da rinite, comorbidades, fatores de risco e o acompanhamento do desenvolvimento dos diferentes fenótipos da rinite ao longo da vida.
Rhinitis in preschool children is a major diagnostic and therapeutic challenge for both pediatricians and specialists. The diagnosis of rhinitis is extremely rare and/or often ignored in this specific age group, due to the few data available and the overlapping of symptoms common to viral respiratory diseases. A better understanding and identification of rhinitis in preschool children could improve the quality of life of these patients by making diagnosis more accurate and delivering appropriate treatment. In addition, an earlier diagnosis may help better understand the natural history of rhinitis, comorbidities, risk factors and follow-up of different phenotypes throughout life.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Quality of Life , Rhinitis , Risk Factors , Signs and Symptoms , Therapeutics , Growth and Development , Diagnosis , Pediatricians , Immunotherapy , Age GroupsABSTRACT
UNLABELLED: Allergic rhinitis affects 10-30% of the population, negatively impacting one's quality of life and productivity. It has been associated with sinusitis, otitis media, sleep disorders, and asthma. Rupatadine is a second generation antihistamine with increased affinity to histamine receptor H1; it is also a potent PAF (platelet-activating factor) antagonist. It starts acting quite quickly, offers long lasting effect, and reduces the chronic effects of rhinitis. AIM: this study aims to assess the efficacy and safety of rupatadine in the treatment of persistent allergic rhinitis. MATERIALS AND METHOD: this is a multi-centric open prospective study. This study included 241 patients from 13 centers in Brazil and was held between October of 2004 and August of 2005. Signs and symptoms of rhinitis and tolerance to medication were analyzed after one and two weeks of treatment. RESULTS: reduction on general scores from 8.65 to 3.21 on week 2 (p<0.001). All signs and symptoms improved significantly in the first day of treatment (p<0.001), except for nasal congestion and secretion, which improved from the second day of treatment (p<0.001). Adverse events occurred in 19.9% of the cases, 27.7% on week 1. CONCLUSION: rupatadine effectively controls persistent allergic rhinitis; it is safe and presents low incidence of side effects.
Subject(s)
Cyproheptadine/analogs & derivatives , Histamine H1 Antagonists, Non-Sedating/therapeutic use , Rhinitis, Allergic, Perennial/drug therapy , Adult , Cyproheptadine/adverse effects , Cyproheptadine/therapeutic use , Female , Histamine H1 Antagonists, Non-Sedating/adverse effects , Humans , Male , Prospective Studies , Severity of Illness IndexABSTRACT
Allergic rhinitis affects 10-30 percent of the population, negatively impacting one's quality of life and productivity. It has been associated with sinusitis, otitis media, sleep disorders, and asthma. Rupatadine is a second generation antihistamine with increased affinity to histamine receptor H1; it is also a potent PAF (platelet-activating factor) antagonist. It starts acting quite quickly, offers long lasting effect, and reduces the chronic effects of rhinitis. AIM: this study aims to assess the efficacy and safety of rupatadine in the treatment of persistent allergic rhinitis. MATERIALS AND METHOD: this is a multi-centric open prospective study. This study included 241 patients from 13 centers in Brazil and was held between October of 2004 and August of 2005. Signs and symptoms of rhinitis and tolerance to medication were analyzed after one and two weeks of treatment. RESULTS: reduction on general scores from 8.65 to 3.21 on week 2 (p<0.001). All signs and symptoms improved significantly in the first day of treatment (p<0.001), except for nasal congestion and secretion, which improved from the second day of treatment (p<0.001). Adverse events occurred in 19.9 percent of the cases, 27.7 percent on week 1. CONCLUSION: rupatadine effectively controls persistent allergic rhinitis; it is safe and presents low incidence of side effects.
A rinite alérgica acomete 10 a 30 por cento da população, interferindo na qualidade de vida e na capacidade produtiva. Está associada à sinusite, otite, roncopatias e asma. A Rupatadina é um anti-histamínico de segunda geração, com elevada afinidade ao receptor histamínico H1 e potente inibição do fator ativador plaquetário (PAF). Tem rápido início de ação, longa duração e reduz os efeitos crônicos da rinite. OBJETIVO: Avaliar a eficácia e segurança da rupatadina no tratamento da rinite alérgica persistente. MATERIAL E MÉTODO: Estudo multicêntrico, aberto, prospectivo. Foram selecionados 241 pacientes em 13 centros no Brasil durante o período de outubro de 2004 a agosto de 2005. Foram analisados os sinais e sintomas da rinite e a tolerabilidade após 1 e 2 semanas. RESULTADOS: Redução do escore geral de 8,65 para 3,21 na semana 2 (p<0,001). Todos os sinais e sintomas melhoraram significativamente, e no primeiro dia de tratamento (p<0,001), com exceção da obstrução e secreção nasal, a partir do segundo dia (P<0,001). A frequência de eventos adversos foi 19,9 por cento, sendo 27,7 por cento na 1ª semana. CONCLUSÕES: A rupatadina é eficaz no controle da rinite alérgica persistente, é segura e apresenta baixos índices de efeitos colaterais.
Subject(s)
Adult , Female , Humans , Male , Cyproheptadine/analogs & derivatives , Histamine H1 Antagonists, Non-Sedating/therapeutic use , Rhinitis, Allergic, Perennial/drug therapy , Cyproheptadine/adverse effects , Cyproheptadine/therapeutic use , Histamine H1 Antagonists, Non-Sedating/adverse effects , Prospective Studies , Severity of Illness IndexABSTRACT
Nesta Parte de Reações de Hipersensibilidade a Medicamentos abordamos as graves síndromes caracterizadas por acometimento da pele e mucosas e, seguir, as particularidades das reações observadas nos pacientes infectados pelo HIV.
Subject(s)
Humans , Chemical Reactions , Drug Hypersensitivity , Hypersensitivity, Immediate , Pharmaceutical Preparations , Methods , Diagnostic Techniques and ProceduresABSTRACT
As reações de hipersensibilidade a medicamentos são comuns na prática clínica. A maioria das reações ocorrem por mecanismos não-imunológicos e não existem provas diagnósticas aplicáveis a todas as situações. O diagnóstico é particularmente complexo em pacientes em uso de vários medicamentos. Na Parte II do artigo sobre Hipersensibilidade a Medicamentos os autores analisam especificamente as reações a determinados qrupos de medicamentos: analgésicos e AINE, antibióticos, anticonvulsivantes, anestésicos locais, látex no ambiente cirúrgico, relaxantes neuromusculares, contrastes radiológicos e a situação especial de pacientes sensíveis a vários grupos de fármacos. O conhecimento das características das reações e da conduta mais apropriada determinam o sucesso no diagnóstico e orientação do paciente.
Adverse drug reactions are common conditions in clinical practice. The majority of these reactions occurs through non-immunologic mechanisms and there are no available validated diagnostic methods for all the situations. Diagnosis is specially difficult in patients who are using many medications. In Part II of Drugs Hypersensitivity authors analyse reactions to specifics drugs groups, as analgesics and NSAID, antibiotics, anticonvulsivants, local anesthetics, latex on surgical environment, neuromuscular relaxants, radiologic contrasts, and the special condition of patients with multiple drugs sensitivities. The knowledge of charatcteristics of the reactions and more appropriate management determine success in diagnosis and patient's guidance.
Subject(s)
Humans , Anesthetics, Local , Anti-Inflammatory Agents, Non-Steroidal , beta-Lactams , Contrast Media , Drug Hypersensitivity , Latex Hypersensitivity , Neuromuscular Agents , Methods , Patients , Diagnostic Techniques and ProceduresABSTRACT
Reações adversas a drogas são eventos comuns na pratica clínica. As reações de hipersensibilidade representam aproximadamente de 25 a 30% das reações a medicamentos. A pele é o órgão mais frequetemente acometido sendo comuns erupção morbiliformes e urticária. Dermatites graves como TEN, SJT e DRESS também são associadas a medicamentos, porém tem menor incidência. O risco dessas reações e a crescente disponibilidade de novas drogas mantém o tema atual e determinam a necessidade de atualização constante. Na parte I deste Guia sobre Hipersensibilidade a Medicamentos os autores abordam os principais mecanismos e classificação das reações a drogas, avaliação diagnóstica e manejo terapêutico.
Adverse drug reactions are common conditions in clinicai practice. Hypersensitivity reactions represents 25 to 30% of total drug reactions. The skin is the most frequently affected organ and are common morbiliform and urticarial eruptions. Severe dermatitis as NET, SJS and DRESS also are associated to drug reactions but have less incidence. The risk which these reactions presents and current availability of new medications maintain the subject importance and determine needs of permanent update. In Part I of the Guide of Drug Hypersensitivity the authors explain the major mechanisms and classifycation of drug reactions, diagnosis evaluation and therapeutic management.
Subject(s)
Humans , Dermatitis , Drug Eruptions , Drug Hypersensitivity , Drug Tolerance , Exanthema , Pharmaceutical Preparations/adverse effects , Methods , Diagnostic Techniques and ProceduresABSTRACT
Objetivo: O objetivo do Grupo de Estudos de Alergia a Drogas da ASBAI é apresentar um projeto operacional diagnóstico, acoplado a uma estratégia de conduta alergológica, que auxilie o profissional da área da saúde no Brasil a conduzir adequadamente o paciente que possa ser alérgico à penicilina, em conformidade com os atuais parâmetros da literatura médica internacional. Métodos: O diagnóstico de alergia à penicilina é muitas vezes exagerado de maneira inapropriada, sem que haja uma adequada documentação imunológica. Muitos indivíduos são incorretamente rotulados de alérgicos e os antibióticos betalactâmicos passam, infelizmente, a ser evitados pelo resto da vida. Torna-se, portanto, necessária a correlação entre a história clínica apresentada e a investigação alergoimunológica padronizada. Resultados: Cerca de 95 das moléculas de penicilina se combinam a proteínas, e o determinante antigênico benzil peniciloil formado é então denominado de determinante maior ou principal da penicilina, responsável por urticária e/ou angioedema. Além deste determinante maior, outros componentes menores ou secundários da penicilina são formados e podem induzir respostas IgE-mediadas. Estes determinantes menores são importantes, participando dos graves quadros anafiláticos. A mistura dos determinantes menores consiste em: benzil penicilina, benzil peniciloato (hidrólise alcalina) e benzil peniloato (hidrólise ácida). Conclusões: Os testes alérgicos cutâneos para detecção de alergia à penicilina estão indicados quando houver história clínica de suspeição, doença grave requerendo a sua utilização em paciente com história sugestiva de alergia específica, e quando não houver antibióticos alternativos. Nesta última situação e quando os testes alérgicos padronizados forem positivos recomenda-se a dessensibilização cuidadosa e controlada.
Subject(s)
Humans , Drug Hypersensitivity , Penicillins , Diagnosis , Skin TestsABSTRACT
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.
Subject(s)
Immunoglobulin E/blood , Radioallergosorbent Test/methods , Respiratory Hypersensitivity/diagnosis , Age Distribution , Allergens/immunology , Animals , Case-Control Studies , Chi-Square Distribution , Child , Child, Preschool , Demography , Female , Food Hypersensitivity/diagnosis , Food Hypersensitivity/immunology , Humans , Infant , Male , Mass Screening , Respiratory Hypersensitivity/immunologyABSTRACT
OBJETIVO: Determinar a freqüência de sensibilização a alérgenos inalantes e alimentares em crianças atendidas em serviços brasileiros de alergia. PACIENTES E MÉTODOS: IgE sérica total e específica (RAST) a alérgenos inalantes e alimentares (UniCAP® - Pharmacia) foram determinados em 457 crianças acompanhadas em serviços de alergia pediátrica e em um grupo de controles (n = 62). Resultados classe igual ou maior que 1 foram considerados positivos (R+). RESULTADOS: A freqüência de R+ foi significantemente maior entre os atópicos (361/457, 79 por cento) quando comparados aos controles (16/62, 25,8 por cento). Não houve diferenças quanto ao sexo. A prevalência de R+ entre os atópicos foi significantemente maior para todos os alérgenos avaliados. Os níveis séricos de IgE total foram significantemente mais elevados entre os atópicos com R+ quando comparados aos com R-. Comparando-se atópicos e controles, a freqüência de R+ para os principais alérgenos inalantes foi como segue: D. pteronyssinus = 66,7 versus 14,5 por cento (p < 0,05), D. farinae = 64,5 versus 17,8 por cento (p < 0,05), B. tropicalis = 55,2 versus 19,4 por cento (p < 0,05), barata = 32,8 versus 9,7 por cento (p < 0,05) e gato = 12 versus 8,1 por cento. Com os alimentos, observou-se: peixe = 29,5 versus 11,3 por cento (p < 0,05), ovo = 24,4 versus 4,8 por cento (p < 0,05), leite de vaca = 23,1 versus 3,2 por cento (p < 0,05), trigo = 20 versus 8,1 por cento (p < 0,05), amendoim = 14 versus 4,8 por cento (p < 0,05), soja = 11,8 versus 4,8 por cento (p < 0,05) e milho = 10,6 versus 4,8 por cento (p < 0,05). Segundo a idade, os R+ aos alimentares predominaram entre as crianças mais jovens, e o inverso ocorreu com os inalantes. CONCLUSÕES: Nesta população, predominou a sensibilização aos aeroalérgenos, sobretudo aos ácaros domiciliares, e os alimentos foram importantes em crianças mais jovens.
Subject(s)
Humans , Animals , Male , Female , Infant , Child, Preschool , Child , Allergens/immunology , Food Hypersensitivity/immunology , In Vitro Techniques , Immunoglobulin E/blood , Immunoglobulin E/immunology , Respiratory Hypersensitivity/immunology , Age Distribution , Allergens/analysis , Biomarkers , Brazil/epidemiology , Case-Control Studies , Chi-Square Distribution , Food Hypersensitivity/blood , Food Hypersensitivity/epidemiology , Mites , Radioallergosorbent Test/methods , Respiratory Hypersensitivity/blood , Respiratory Hypersensitivity/epidemiology , Statistics, NonparametricABSTRACT
OBJETIVO: Avaliar a positividade do Phadiatop® em crianças acompanhadas em serviços brasileiros de alergologia e compará-la aos resultados de IgE sérica específica a alérgenos inalantes e alimentares. CASUíSTICA E MÉTODO: Em 457 crianças acompanhadas em serviços de alergia pediátrica e um grupo de crianças controle não-alérgicas (n = 62), distribuídas em cinco faixas etárias, foram determinados em amostra de soro: Phadiatop® e IgE específica (RAST) a alérgenos inalantes e alimentares (UniCAP - Pharmacia®). RESULTADOS: O Phadiatop® foi positivo em 305 crianças atópicas (67,6 por cento) e em 25,8 por cento das controles (p < 0,001). Entre as crianças atópicas, a distribuição de positividade variou de acordo com a faixa etária: 7,9 por cento (24/305) entre as abaixo de 2 anos, 15,4 por cento (47/305) nas de 2 a 3 anos, 22,0 por cento (67/305) nas de 3 a 4 anos, 19,3 por cento (59/305) nas de 4 a 5 anos e 35,4 por cento (108/305) nas de 5 a 12 anos. Não houve concordância entre os alérgenos alimentares e a presença de Phadiatop® positivo. O estudo da relação entre os RAST positivos para alérgenos inalados e o Phadiatop® positivo mostrou melhores índices com os ácaros domiciliares (D. pteronyssinus, D. farinae e Blomia tropicalis). CONCLUSÕES: O Phadiatop®é método útil no diagnóstico de alergia aos ácaros domiciliares.
