Atopy in Elite Endurance Athletes.

OBJECTIVE: To assess the frequency of atopy (specific IgE levels), to evaluate the allergic symptoms using the Allergy Questionnaire for Athletes (AQUA), and to determine whether atopy is associated with allergic symptoms in elite endurance athletes. DESIGN: Cross-sectional study. SETTING: Assessments were performed at Hospital das Clinicas-São Paulo University Medical School. PARTICIPANTS: Fifty-nine elite endurance athletes (triathletes and runners). MAIN OUTCOME MEASURES: Allergic symptoms were assessed by a validated self-report AQUA questionnaire and atopy by specific IgE level. RESULTS: The frequency of atopy (specific IgE to at least one inhalant allergen) and allergic symptoms was 57.6% and 54.2%, respectively. In addition, no association was observed between atopy and allergic symptoms. CONCLUSIONS: A possible implication from our results is that atopy screening in elite athletes should be performed using AQUA questionnaire and measuring specific IgE simultaneously.

Can patients with common variable immunodeficiency have allergic rhinitis?

BACKGROUND: Rhinosinusitis is highly prevalent in patients with common variable immunodeficiency (CVID), and probably allergic rhinitis (AR) may be masked by a history of repeated respiratory infections. The diagnosis of AR is based on the patient's symptoms and detection of specific immunoglobulin E (IgE) to aeroallergens. This study was designed to identify rhinitis of probable allergic cause in patients with CVID. METHODS: This study included 72 adult CVID patients. The patients were divided into three groups according to their history: suggestive of AR, nonallergic rhinitis, and without rhinitis. They were tested for total and specific IgE (in vivo and in vitro). RESULTS: The patients' mean age was 38.2 years. A history of chronic rhinitis was observed in 59 (81.9%) of the cases, 31 of which (43%) had a history suggestive of AR. Patients with a history of rhinitis (whether allergic or nonallergic) presented an earlier onset of symptoms and diagnosis of CVID. Total IgE was undetectable in 86.1% of patients. AR was confirmed by detection of specific IgE to aeroallergens in only 5.6% of the patients. CONCLUSION: In CVID patients, chronic rhinitis may be allergic, because many have personal and family histories suggestive of atopy. However, in this study, allergy was confirmed by specific IgE detection in only 5.6% of cases. CVID patients with a history suggestive of AR commonly present negative results on traditional testing, so additional experiments may be necessary. One suggestion for the investigation of AR in CVID patients would be nasal provocation with the most prevalent allergens.

Imunossenescência / Immunosenescence

Objetivo: Revisar as principais alterações do sistema imunológico que ocorrem com o envelhecimento. Fontes dos dados: O método adotado foi a revisão narrativa da literatura. Foram analisados 33 artigos originais e de revisão indexados nos bancos de dados MEDLINE e LILACS de janeiro de 2000 a junho 2012. Síntese dos dados: A imunossenescência é definida como um estado de função imunológica desregulada, nos idosos, que contribui para o aumento da suscetibilidade a infecções, câncer e autoimunidade, e redução da resposta vacinal. O processo de envelhecimento afeta ambos os ramos da imunidade, embora a imunidade inata pareça estar mais bem preservada. A capacidade de renovação das células do sistema imunológico, a partir das células-tronco hematopoéticas, diminui com a idade. As alterações nos precursores dos linfócitos B levam à diminuição do número de células maduras que deixam a medula óssea, enquanto a involução tímica leva a alterações substanciais no compartimento de células T. A imunossenescência caracteriza-se por um estado inflamatório crônico, denominado "inflamm-aging". Algumas associações entre infecção crônica virais e o envelhecimento são descritas, como por exemplo, a infecção crônica pelo CMV. A persistência viral no hospedeiro imunocompetente modula o sistema imunológico e dados científicos mostram que a infecção pelo CMV pode acelerar o envelhecimento do sistema imunológico e levar à inflamação crônica subclínica. Conclusões: É importante considerar que todo indivíduo acima de 60 anos tem seu sistema imunológico sob suspeita e deve ser tratado de modo a minimizar as intervenções que possam comprometer ainda mais as funções efetoras/reguladoras da resposta imune.

Objective: To review the main changes of the immune system that occur with aging. Sources: The research method adopted was the narrative review of literature. A total of 33 original and review articles indexed in MEDLINE and LILACS from January 2000 to June 2012 were analysed. Data summary: The immunosenescence is defined as a state of dysregulated immune function in elderly, which contributes to increased susceptibility to infections, cancer and autoimmunity, and poor vaccine response. The aging process affects both arms of the immune system, however, innate immunity appears to be better preserved. The renewal capacity of immune cells, from hematopoietic stem cells decreases with age. Changes in the precursors of B lymphocytes lead to a decrease in the number of mature B cells leaving the bone marrow while thymic involution related to aging leads to substantial changes in the T cell compartment. Immunosenescence is characterized by a chronic inflammatory state, known as “Inflamm-aging.” Some association between chronic infection with virus and aging are reported in the literature, for example, chronic infection with CMV. The viral persistence in immunocompetent host modulates the immune system and scientific data show that chronic infection with CMV may accelerate the aging of the immune system and lead to subclinical chronic inflammation. Conclusions: It is important to consider that all individuals over age 60 have their immune system under suspicion and must be treated to minimize interventions that might further compromise the effector functions/ regulating of immune response.

Anticorpos monoclonais no tratamento da asma / Monoclonal antibodies in asthma treatment

Objetivo: Revisar a aplicação dos principais anticorpos monoclonais já utilizados em estudos clínicos de asma, bem como detalhar os que já estão disponíveis para uso clínico. Fontes de dados: Artigos originais indexados nos bancos de dados MEDLINE e LILACS de janeiro de 1975 a dezembro de 2011, nos idiomas português e inglês, e livros-textos selecionados. Síntese dos dados: Os principais anticorpos monoclonais já estudados no tratamento da asma são os antagonistas de algumas citocinas de perfil TH2 (anti-IL-4, Anti-IL-5, Anti-IL-9 e Anti-IL-13) e da IgE (anti-IgE), embora outros anticorpos, como anti-TNF e anti-CD11a, já tenham sido pesquisados.Conclusões: Embora diversos anticorpos monoclonais já tenham sido utilizados na pesquisa clínica em asma, apenas o omalizumabe (anti-IgE) está disponível comercialmente, porque há evidências demonstrando sua eficácia.

Objective: To review the application of the main monoclonal antibodies which have already been used in clinical studies of asthma,as well as detailing those already available for clinical practice. Sources: Original articles indexed in the databases MEDLINE and LILACS January 1975 to December 2010, Languages: Portuguese and English and selected textbooks. Data synthesis: The main monoclonal antibodies which have already been studied for asthma are cytokines TH2 antagonists (anti-IL-4, Anti-IL-5, Anti-IL-9 e Anti-IL-13) and IgE antagonist (anti-IgE), although otherantibodies, as anti-TNF and anti-CD11a, have already been utilized. Conclusions: Despite the fact that many monoclonal antibodies havebeen utilized in asthma clinical research, only omalizumab (anti-IgE) iscommercially available, because many studies have shown its efficacy.