Allergic sensitization pattern of patients in Brazil

Abstract Objective Allergic sensitization is one of the key components for the development of allergies. Polysensitization seems to be related to the persistence and severity of allergic diseases. Furthermore, allergic sensitization has a predictive role in the development of allergies. The aim of this study was to characterize the pattern of sensitization of atopic patients treated at different pediatric allergy referral centers in Brazil. Methods A nation-wide transversal multicenter study collected data on patients attended in Brazil. Peripheral blood samples were collected to determine the serum levels of allergen-specific IgE. If allergen-specific IgE was higher than 0.1 kUA/L, the following specific components were quantified. Results A total of 470 individuals were enrolled in the study. Mite sensitization was the most frequent kind in all participants. A high frequency of sensitization to furry animals and grasses featured in the respiratory allergies. Regarding components, there was a predominance of sensitization to Der p 1 and Der p 2. It has been verified that having a food allergy, atopic dermatitis, or multimorbidity are risk factors for the development of more severe allergic disease. Conclusion Studies on the pattern of allergic sensitization to a specific population offer tools for the more effectual prevention, diagnosis, and treatment of allergic diseases. Sensitization to dust mites house was the most prevalent in the evaluated sample. High rates of sensitization to furry animals also stand out. Patients with food allergy, atopic dermatitis, or multimorbidity appear to be at greater risk for developing more severe allergic diseases.

Allergic sensitization pattern of patients in Brazil.

OBJECTIVE: Allergic sensitization is one of the key components for the development of allergies. Polysensitization seems to be related to the persistence and severity of allergic diseases. Furthermore, allergic sensitization has a predictive role in the development of allergies. The aim of this study was to characterize the pattern of sensitization of atopic patients treated at different pediatric allergy referral centers in Brazil. METHODS: A nation-wide transversal multicenter study collected data on patients attended in Brazil. Peripheral blood samples were collected to determine the serum levels of allergen-specific IgE. If allergen-specific IgE was higher than 0.1 kUA/L, the following specific components were quantified. RESULTS: A total of 470 individuals were enrolled in the study. Mite sensitization was the most frequent kind in all participants. A high frequency of sensitization to furry animals and grasses featured in the respiratory allergies. Regarding components, there was a predominance of sensitization to Der p 1 and Der p 2. It has been verified that having a food allergy, atopic dermatitis, or multimorbidity are risk factors for the development of more severe allergic disease. CONCLUSION: Studies on the pattern of allergic sensitization to a specific population offer tools for the more effectual prevention, diagnosis, and treatment of allergic diseases. Sensitization to dust mites house was the most prevalent in the evaluated sample. High rates of sensitization to furry animals also stand out. Patients with food allergy, atopic dermatitis, or multimorbidity appear to be at greater risk for developing more severe allergic diseases.

Accuracy of serum IgE concentrations and papule diameter in the diagnosis of cow's milk allergy / Acurácia de concentrações de IgE séricas e de diâmetros de pápulas no diagnóstico de alergia ao leite de vaca

Abstract Objective To compare serum concentrations of specific IgE and mean papule diameters induced in the immediate skin reactivity test with cow's milk and its fractions with results of the oral challenge test, and to establish cutoff points capable of predicting clinical reactivity to cow's milk in patients treated at a referral service. Methods One hundred and twenty-two children (median of 17 months) with a history of immediate reactions to cow's milk and presence of specific IgE for cow's milk and/or its fractions (positive skin and/or IgE serum tests) were submitted to open oral challenge test with cow's milk. Results The oral challenge test was positive in 59.8% of the children, 49% of whom were males. Serum levels of specific IgE, as well as mean cow's milk papule diameters, were significantly higher in allergic patients (medians: 3.39 kUA/L vs. 1.16 kUA/L, 2.5 mm vs. 0 mm). The optimal cutoff points (Youden's index) of serum IgE specific for cow's milk and its fractions capable of predicting cow's milk reactivity (positive oral challenge test) were: 5.17 kUA/L for cow's milk, 0.95 kUA/L for α-lactalbumin, 0.82 kUA/L for β-lactoglobulin, and 0.72 kUA/L for casein, whereas for papule diameters the cutoff points were 3.5 mm for cow's milk and 6.5 mm, 9.0 mm, and 3.0 mm for the α-lactalbumin, β-lactoglobulin, and casein fractions, respectively. Conclusions The cutoff points capable of predicting clinical reactivity to cow's milk were: 5.17 kUA/L for serum-specific IgE and 3.5 mm for papule diameter measurement, values considered discriminatory for the diagnosis of cow's milk allergy.

Resumo Objetivo Comparar concentrações séricas de IgE específica e diâmetros médios das pápulas induzidas no teste cutâneo de leitura imediata com leite de vaca e suas frações com resultados do teste de provocação oral e estabelecer pontos de corte, capazes de predizer reatividade clínica ao leite de vaca em pacientes atendidos em um serviço de referência. Métodos Cento e vinte e duas crianças (mediana 17 meses), com história de reações imediatas ao leite de vaca e presença de IgE específicas para leite de vaca e/ou frações (testes cutâneos e/ou IgE sérica positivos) foram submetidas ao teste de provocação oral aberto com leite de vaca. Resultados O teste de provocação oral foi positivo em 59,8% das crianças, 49% eram do sexo masculino. Os níveis séricos de IgE específica, assim como os diâmetros médios das pápulas para leite de vaca, foram significantemente maiores nos alérgicos (medianas: 3,39kUA/L vs. 1,16 kUA/L; 2,5 mm vs. 0 mm). Os "pontos de corte ótimos" (Índice de Youden) das IgE séricas específicas para o leite de vaca e suas frações capazes de predizer a reatividade ao leite de vaca (teste de provocação oral positivo) foram: 5,17kUA/L para o leite de vaca, 0,95 kUA/L para α-lactoalbumina, 0,82kUA/L para β-lactoglobulina e 0,72kUA/L para caseína e para os diâmetros de pápulas foram 3,5 mm para leite de vaca e 6,5 mm, 9,0 mm e 3,0 mm para as frações α-lactoalbumina, β-lactoglobulina e caseína, respectivamente. Conclusões Os níveis de corte capazes de predizer reatividade clínica ao leite de vaca foram: 5,17kUA/L para IgE sérica específica e 3,5 mm para a medida do diâmetro da pápula, valores considerados discriminatórios para o diagnóstico da alergia ao leite de vaca.

Accuracy of serum IgE concentrations and papule diameter in the diagnosis of cow's milk allergy.

OBJECTIVE: To compare serum concentrations of specific IgE and mean papule diameters induced in the immediate skin reactivity test with cow's milk and its fractions with results of the oral challenge test, and to establish cutoff points capable of predicting clinical reactivity to cow's milk in patients treated at a referral service. METHODS: One hundred and twenty-two children (median of 17 months) with a history of immediate reactions to cow's milk and presence of specific IgE for cow's milk and/or its fractions (positive skin and/or IgE serum tests) were submitted to open oral challenge test with cow's milk. RESULTS: The oral challenge test was positive in 59.8% of the children, 49% of whom were males. Serum levels of specific IgE, as well as mean cow's milk papule diameters, were significantly higher in allergic patients (medians: 3.39kUA/L vs. 1.16kUA/L, 2.5mm vs. 0mm). The optimal cutoff points (Youden's index) of serum IgE specific for cow's milk and its fractions capable of predicting cow's milk reactivity (positive oral challenge test) were: 5.17kUA/L for cow's milk, 0.95kUA/L for α-lactalbumin, 0.82kUA/L for ß-lactoglobulin, and 0.72kUA/L for casein, whereas for papule diameters the cutoff points were 3.5mm for cow's milk and 6.5mm, 9.0mm, and 3.0mm for the α-lactalbumin, ß-lactoglobulin, and casein fractions, respectively. CONCLUSIONS: The cutoff points capable of predicting clinical reactivity to cow's milk were: 5.17kUA/L for serum-specific IgE and 3.5mm for papule diameter measurement, values considered discriminatory for the diagnosis of cow's milk allergy.

Primary Immunodeficiency May Be Misdiagnosed as Cow's Milk Allergy: Seven Cases Referred to a Tertiary Pediatric Hospital.

Introduction. The presence of eczema and gastrointestinal manifestations are often observed in cow's milk allergy (CMA) and also in some primary immunodeficiency diseases (PID). Objective. To describe 7 patients referred to a tertiary allergy/immunology Center with a proposed diagnosis of CMA, who were ultimately diagnosed with PID. Methods. This was a retrospective study based on clinical and laboratory data from medical records. Results. Seven patients (6 males) aged between 3 mo and 6 y were referred to our clinic with a proposed diagnosis of CMA. They presented with eczema and/or gastrointestinal symptoms. Five were receiving replacement formula. All patients presented with other clinical features, including severe/recurrent infections unrelated to CMA, and two of them had a positive family history of PID. Laboratory tests showed immune system dysfunctions in all patients. Hyper-IgE and Wiskott-Aldrich syndromes, CD40L deficiency, severe combined immunodeficiency, X-linked agammaglobulinemia, transient hypogammaglobulinemia of infancy, and chronic granulomatous disease were diagnosed in these children. In conclusion, allergic diseases and immunodeficiency are a result of a different spectrum of abnormalities in the immune system and may be misdiagnosed. Educational programs on PID among clinical physicians and pediatricians can reduce the occurrence of this misdiagnosis.

Sensibilização a aeroalérgenos em pacientes com suspeita de alergia respiratória atendidos na rede pública e privada no município de Aracaju / Sensitization to inhalant allergens in patients with suspected respiratory allergy treated at public and private health care clinics in the city of Aracaju

OBJETIVO: Identificar e comparar os padrões de sensibilização a alérgenos inalantes entre pacientes com suspeita de alergias respiratórias atendidos em ambulatórios públicos e privados do município de Aracaju.MÉTODOS: Foram analisados 1.514 resultados de testes cutâneos (TC) de punctura, realizados de abril de 2006 a setembro de 2009. Destes, 872 TC foram realizados em consultório de setor privado, e 642 nos ambulatórios do setor público. Os extratos alergênicos utilizados em TC foram: Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, Periplaneta americana, Blattella germanica, penas, mistura de fungos e epitélios de cão e de gato. RESULTADOS: Asensibilização a pelo menos um alérgeno foi de 55% (58,4% no setor privado vs 50,3% no setor público; p < 0,05). Houve predomínio de TC positivos para ácaros domiciliares (total 53%; 57,3% vs. 47,2%; p < 0,0001), seguido de baratas (total 19,9%; 22,1% vs. 16,8%; p < 0,05) e animais domésticos (total 18,4%; 24,4% vs. 10,3%; p < 0,0001). Foram encontradas frequências significativamente maiores de TC positivos no setor privado quando comparado ao setor público para D. farinae (50,1% vs. 37,5%; p < 0,0001), D. pteronyssinus (47,7% vs. 35,7%; p < 0,0001), B. tropicalis (50,8% vs. 35,5%; p < 0,0001), epitélio de gato (18,1% vs. 6,2%; p < 0,0001), epitélio de cão (12,0% vs. 4,2%; p < 0,0001), penas (4,8% vs. 2,6%; p = 0,03) e B. germanica (16,1% vs. 11,5%; p = 0,01). Não se observou diferença significante quanto à sensibilização a fungos do ar e a P. americana.CONCLUSÃO: Ácaros domiciliares, baratas e animais domésticos foram as principais fontes de sensibilização alérgica na população estudada. Indivíduos atendidos no setor público apresentaram menor frequência de sensibilização a alérgenos inalantes quando comparados àqueles atendidos em clínica privada na cidade de Aracaju.

Socio-environmental conditions and geographical variability of asthma prevalence in Northeast Brazil.

BACKGROUND: This study aims to evaluate the association between environmental and socio-economic conditions with asthma prevalence in the eight ISAAC centres in North-East Brazil. METHODS: Estimates on occurrence, severity and medical diagnoses of asthma in the previous 12 months were compared using environmental and socioeconomic indicators. Associations were assessed using simple linear regression and Pearson correlation coefficient. RESULTS: There was no difference in asthma prevalence between centres. Active asthma prevalence increased with increasing water privation, and this would explain 62 % of the observed prevalence. Median temperature increase was inversely related to active asthma (r=0.81; p<0.05). There was a positive association between latitude and active asthma prevalence (r=0.82; p<0.005), a negative association between severe asthma and yearly medium temperature (r=-0.89; p<0.05), and a positive association with latitude (r=0.78; p<0.05). CONCLUSION: Relation between the tropical weather and high prevalence of asthma was not confirmed. There were associations with water privation and latitude.