Polinose no Rio de Janeiro é possível? Relato de caso / Is pollinosis in Rio de Janeiro possible? Case report

A polinose é uma doença comum dos países de clima temperado, onde as estações do ano são bem definidas. Apresenta-se clinicamente como rinoconjuntivite e/ou asma sazonal ou perene com exacerbação na primavera. No Brasil, há relatos de casos de polinose por polens de gramíneas que são os principais causadores dessa patologia, principalmente na Região Sul, apesar do clima subtropical. A expansão da população e desmatamento com crescente urbanização de áreas florestais são alguns dos responsáveis pelo aumento de casos em vários locais do país. Neste relato de caso, descrevemos um caso de polinose por polens de gramínea em um paciente militar que morou em países da Europa e que atualmente reside em uma zona de mata nativa no Rio de Janeiro, RJ, Brasil. Apesar de a polinose não ser uma doença encontrada no RJ, este diagnóstico não deve ser excluído em pacientes com conjuntivite/rinoconjuntivite sazonal, principalmente quando têm uma história pregressa de morar vários anos fora país.

Pollinosis is a common disease in temperate countries, which have well-defined seasons. It presents clinically as rhinoconjunctivitis and/or seasonal or perennial asthma that is exacerbated in spring. In Brazil, cases of pollinosis due to grass pollens have been reported, especially in the south, despite its subtropical climate. The expansion of the population and deforestation, including increasing urbanization of forest areas, are contributing to the rise in cases in various regions of the country. This case report describes a case of pollinosis due to grass pollens in a military patient who lived in Europe and currently resides in a region of native forest in Rio de Janeiro metropolitan area. Although pollinosis is not found in the state of Rio de Janeiro, this diagnosis should not be excluded in patients with seasonal conjunctivitis/ rhinoconjunctivitis, especially when they have lived outside the country for several years.

[Prosopis spp. in allergic diseases]. / Prosopis spp. en enfermedades alérgicas.

OBJECTIVES: To demonstrate cutaneous reactivity and the participation of Prosopis pollen in patients with allergic diseases who attend the Allergy and Clinical Immunology Service of the General Hospital of Mexico, in Mexico City. METHODS: A retrospective and cross-sectional study was carried out by analyzing clinical records that had a complete medical history of patients between the ages of 3 and 79 years, with diagnoses of allergic rhinitis, asthma, and rhinoconjunctivitis. RESULTS: 1285 patients were studied; the frequency of positive skin reactivity for Prosopis was 27.78 %; 82.97 % had a diagnosis of allergic rhinitis, 4.39 % had a diagnosis of asthma, and 12.64 % had a diagnosis of rhinoconjunctivitis. CONCLUSIONS: Prosopis pollen plays an important role in diseases of allergic etiology. It is important to consider the antigenic combination with other families such as Chenopodiaceae.

Objetivos: Demostrar la reactividad cutánea y la participación del polen de Prosopis en los pacientes con enfermedades alérgicas que acuden al Servicio de Alergia e Inmunología Clínica del Hospital General de México, en la Ciudad de México. Métodos: Se llevó a cabo un estudio retrospectivo y transversal de expedientes clínicos que contaran con historia clínica completa, de pacientes entre tres y 79 años de edad con diagnósticos de rinitis, asma y rinoconjuntivitis alérgica. Resultados: Se estudiaron 1285 pacientes. La frecuencia de reactividad cutánea positiva para Prosopis fue de 27.78 %; 82.97 % cursaba con diagnóstico de rinitis alérgica, 4.39 % de asma y 12.64 % de rinoconjuntivitis. Conclusión: El polen de Prosopis participa importantemente en enfermedades de etiología alérgica. Es importante considerar el cruce antigénico con otras familias como las Chenopodiaceas.

Prevalence of asthma, allergic rhinitis and pollinosis in a city of Brazil: A monitoring study.

BACKGROUND: Allergic respiratory diseases such as asthma and allergic rhinitis have increased considerably in the last decades. OBJECTIVE: The present study estimates prevalence trends of asthma, allergic rhinitis and pollinosis in the population of a city of Southern Brazil, without restriction of age, from 2011 to 2018, using the ISAAC standardized questionnaire. METHODS: Data was collected from March to June of 2011 and during the same months in 2018, in order to verify trends in the prevalence of these allergic conditions. The total sample consisted of 3132 individuals of both sexes living in the municipality of Santo Ângelo, in the state of Rio Grande do Sul, Brazil. RESULTS: No differences were observed in the prevalence of asthma diagnosis (15.1% in 2011 and 13.8% in 2018), however the prevalence of current wheeze was significantly reduced from 24.7% in 2011 to 21.2% in 2018 (p<0.05). Regarding allergic conditions in 2011 and in 2018, a significant reduction was observed (p<0.001) in reported current rhinitis (63.3% vs. 50.5%), rhinoconjunctivitis (48.9% vs. 38.8%), hay fever (52.0% vs. 43.3%), and pollinosis (29.0% vs 17.0%). Moreover, we observed an inverse relation between age and rhinoconjunctivitis and hay fever, and all symptoms were more frequent in females. Rhinoconjunctivitis and hay fever, as well as current rhinitis and pollinosis were highly prevalent among 30-39 years-old individuals, whereas current wheeze affected mainly the age group 10-19 years-old. CONCLUSION: While the prevalence of asthma remained similar after seven years, allergic rhinitis and pollinosis declined between 2011 and 2018.

Prevalence of symptoms of asthma and allergic rhinitis in children in Southern Brazil: a ten-year monitoring study.

Objective: This study analyzes and describes trends in prevalence of asthma and rhinitis in children 6-7 years old living in Santo Ângelo, Brazil, by comparing data from 2007, 2012, and 2017. Methods: The ISAAC (International Study of Asthma and Allergies in Childhood) standardized written questionnaire was used in a three cross-sectional survey. The questionnaire was applied between March and May of 2007, 2012 and 2017. Results: A total of 701 children participated in the survey: 225 children in 2007, 229 in 2012, and 247 in 2017. There were no differences in the prevalence of current wheeze in the years of this study. On the other hand, a higher percentage of children were diagnosed with asthma in 2012 (26.2%) than in 2007 (10.2%) and 2017 (10.1%) (p < 0.05); however, the severity of asthma was lower in 2012 when compared to other years. Regarding cases of probable asthma - which included patients with suspected asthma or wheezing and nocturnal cough without a diagnosis of asthma - these corresponded to 15.7, 17.0, and 25.1% of the cases in 2007, 2012 and 2017, respectively. For other allergic diseases, we found no statistical difference in the frequency of symptoms of current rhinitis (55.5%, 54.6%, 51.8% in 2007, 2012, and 2017, respectively), allergic rhinitis (45.3%, 45.0%, 36.4% in 2007, 2012, and 2017, respectively), or pollinosis (17.8%, 12.7%, 14.2% in 2007, 2012, and 2017, respectively). Conclusions: The prevalence of probable asthma increased from 2007 to 2017. The prevalence of symptoms and diagnosis of allergic rhinitis and pollinosis was relatively high and these allergies must be considered in the pediatric population of the region.

Cashew Tree Pollen: An Unknown Source of IgE-Reactive Molecules.

Pollinosis is sub-diagnosed and rarely studied in tropical countries. Cashew tree pollen has been reported as an allergen source although the knowledge of its immunoglobulin E (IgE)-reactive molecules is lacking. Therefore, this work aimed to identify IgE-reactive molecules and provide a proteomic profile of this pollen. From the 830 proteins identified by shotgun analysis, 163 were annotated to gene ontology, and a list of 39 proteins filtered for high confidence was submitted to the Allfam database where nine were assigned to allergenic families. Thus, 12 patients from the northeast of Brazil with persistent allergic rhinitis and aggravation of symptoms during cashew flowering season were selected. Using a 2D-based approach, we identified 20 IgE-reactive proteins, four already recognized as allergens, including a homolog of the birch isoflavone-reductase (Bet v 6). IgE-reactivity against the extract in native form was confirmed for five patients in ELISA, with three being positive for Bet v 6. Herein, we present a group of patients with rhinitis exposed to cashew tree pollen with the first description of IgE-binding proteins and a proteomic profile of the whole pollen. Cashew tree pollen is considered an important trigger of rhinitis symptoms in clinical practice in the northeast of Brazil, and the elucidation of its allergenic molecules can improve the diagnostics and treatment for allergic patients.

ESTUDIO DE LA SENSIBILIZACIÓN POR AEROALÉRGENOS CON ESPECIAL ENFOQUE EN LA POLINOSIS COMO FACTOR DE SENSIBILIZACIÓN / Sensitizen by aeroalergens study with special focus on polinosis as sensitizen factor

Fundamento. Las alergias son importantes en Salud Pública; entre distintos tipos, la sensibilidad polínica (SP), en su forma de hipersensibilidad a pólenes, son patologías que afectan a parte de la población. Objetivo. Valorar la importancia del problema de SP en la región y relacionarlas con rinitis, asma, valores de IgE y otras alergias. Lugar de aplicación. Servicio Cátedra de Alergia e Inmunología (SAEI) del Hospital Nacional de Clínicas (HNC), Región Centro del País. Diseño. Estudio de corte. Estudio descriptivo útil para el administrador sanitario ya que permite determinar la carga que significa la enfermedad en la población. Permite conocer la prevalencia (P) de enfermedad. Población. Se analizaron historias clínicas (HC) de los pacientes que concurrieron al SAEI, ubicado en Córdoba capital. Método. Se procesaron las HC de los pacientes que acudieron al SAEI durante los años 2008-09 y a los que se les realizó el prick test, usando el programa Epi-Info 2000 versión 3.3.2. Se las analizó estadísticamente determinando Chicuadrado e intervalo de confianza. Resultados. La P de SP fue de 51,96%. Del total de la muestra, el 24,24% era monosensibilizado el 12,50% de estos lo era a pólenes. Del 75,76% de la muestra restante (polisensibilizado), el 65,33% estaba sensibilizado a pólenes. Conclusión. Analizando la P obtenida se desprende que las SP constituyen una problemática que afecta a más de la mitad de la población estudiada. También se observó que dicha problemática tiene, para la mayoría de los pacientes, una comorbilidad asociada a otros tipos de alergia. (AU)

Background. Allergies are important in Public Health, among the different types Pollen sensitivity, as hypersensitivity to pollen, are pathologies affecting part of the population. Objective. To appreciate the importance of the Pollen sensitivity problem in our region and to relate them to Rhinitis, Asthma, IgE values, and other allergies. Setting. Allergy and Immunology Service (AAIS) of the Hospital Nacional de Clínicas (HNC), in Córdoba city, Central Region of the country. Design. A Cross-sectional study was developed. This is a descriptive study of usefulness for the healthcare administrator because it allows estimating the disease burden significance on the population. It lets to know the sickness Prevalence (P). Population. Clinical Histories (CH) of the patients that attended the AAIS, located in Córdoba city were analyzed. Methods. CH of the patients that attended the AAIS during the years 2008 and 2009 and that the Prick Test was carried out, were processed by using the 2000 Epi-Info Program, 3.3.2. version. Statistically, Chi-square and Confidence Interval were calculated. Results. The Prevalence of Pollen sensitivity was 51.96%. From the total sample, 24.24% was monosensitized patients. Among them, 12.5% were monosensitized to pollens. The rest of the sample (75.76%) were poly-sensitized, from these, 65.33% were sensitized to pollens. Conclusion. Analyzing the obtained Prevalence emerges that Pollen sensitivity represent a problematic that affect more than a half of the studied population. Also it was observed that the pathology presented a comorbidity associated to other types of allergy produced by mites or fungus, among others, for the majority of the patients.(AU)

Caracterización y registro del polen atmosférico en la ciudad de Temuco / Characterization and registry of the atmospheric pollen in Temuco, Chile

Se realizó un estudio con el objetivo de cuantificar y caracterizar la carga polínica en la ciudad de Temuco, entre los años 2006-2009. Para el muestreo aerobiológico se utilizó un captador volumétrico Burkard Seven Day Volumetric Spore-Trap®. Las muestras obtenidas fueron analizadas semana tras semanas durante el período en estudio. Con los resultados del conteo polínico semanal se determinaron las 11 principales especies de flora urbana anemófilas de Temuco más susceptibles de producir polinosis. Las mayores concentraciones de polen se obtienen entre septiembre y marzo, siendo las especies más importantes: Pastos (Gramineae/Poaceae), Ciprés (Cupressus sp) y Acedera (Rumex sp).

The aim of this study was to quantify and to characterize the amount ofpollen in the atmosphere of the city of Temuco, Chile from 2006 to 2009. Aerobiological sampling was carried out by using a Seven Day Volumetric Spore-Trap Burkard and the samples were analyzed weekly during the period of study. Results: We determined the 11 principal anemophilus species of urban flora in Temuco responsible for pollinosis. The highest concentration ofpollen were present from september till march, being the most important species the Grasses (Gramineae/Poaceae), Cypress (Cupressus sp), and Sorrell (Rumex sp.).

Síndrome de alergia oral / Oral allergy syndrome

A síndrome de alergia oral (SAO) é uma condição caracterizada por sintomas alérgicos mediados por IgE, que se restringem à mucosa oral. Em situações em que as manifestações são decorrentes da ingestão de frutas e vegetais em indivíduos sensibilizados aos pólens, o termo mais específico é síndrome pólen-frutas (SPF). Uma vez que as porções proteicas dos alérgenos envolvidos são degradadas pelo calor e enzimas digestivas, os sintomas são imediatos, restringem-se geralmente à cavidade oral e a forma cozida ou processada dos mesmos alimentos costuma ser bem tolerada.

IgE cross-reactivity between Lolium multiflorum and commercial grass pollen allergen extracts in Brazilian patients with pollinosis

Lolium multiflorum (Lm) grass pollen is the major cause of pollinosis in Southern Brazil. The objectives of this study were to investigate immunodominant components of Lm pollen allergens and the cross-reactivity of IgE with commercial grass pollen allergen extracts. Thirty-eight serum samples from patients with seasonal allergic rhinitis (SAR), 35 serum samples from patients with perennial allergic rhinitis (PAR) and 30 serum samples from non-atopic subjects were analyzed. Allergen sensitization was evaluated using skin prick test and serum IgE levels against Lm pollen extract were determined by ELISA. Inhibition ELISA and immunoblot were used to evaluate the cross-reactivity of IgE between allergens from Lm and commercial grass pollen extracts, including L. perenne (Lp), grass mix I (GI) and II (GII) extracts. IgE antibodies against Lm were detected in 100 percent of SAR patients and 8.6 percent of PAR patients. Inhibition ELISA demonstrated IgE cross-reactivity between homologous (Lm) and heterologous (Lp or GII) grass pollen extracts, but not for the GI extract. Fifteen IgE-binding Lm components were detected and immunoblot bands of 26, 28-30, and 32-35 kDa showed >90 percent recognition. Lm, Lp and GII extracts significantly inhibited IgE binding to the most immunodominant Lm components, particularly the 55 kDa band. The 26 kDa and 90-114 kDa bands presented the lowest amount of heterologous inhibition. We demonstrated that Lm extract contains both Lm-specific and cross-reactive IgE-binding components and therefore it is suitable for measuring quantitative IgE levels for diagnostic and therapeutic purposes in patients with pollinosis sensitized to Lm grass pollen rather than other phylogenetically related grass pollen extracts.

Calendario polínico en una región de Ciudad de La Habana / Pollinical calendar in an area of the City of Havana

El polen constituye un importante alergeno capaz de producir enfermedades alérgicas (polinosis). Con el objetivo de identificar sus principales características, así como su comportamiento anual, se desarrolló esta investigación observacional-descriptiva en un reparto del municipio Boyeros de Ciudad de La Habana. Previo a su ejecución se obtuvo la aprobación de la Dirección Municipal de Salud y Medioambiental del àrea. En este estudio piloto aerobiológico se utilizó el método gravimétrico, exponiéndose durante 24 h diferentes làminas portaobjetos vaselinadas a una altura de 20 m en la azotea de un hospital de esa región. Posteriormente, las làminas se colorearon con la solución de Calberla y se realizó, mediante microscopia óptica, el conteo del polen presente en un àrea de 6,6 cm2 de cada làmina teñida. Los resultados obtenidos demostraron la presencia de polen durante todo el año investigado. El polen de los àrboles, en especial las casuarinas, así como el de las gramíneas fueron los màs detectados. La mayor incidencia polínica se observó en las preparaciones correspondientes a los meses de febrero y marzo. Esta investigación demostró la existencia de polen con importancia alergológica en un àrea urbana, región con predominio de la vegetación y pocas industrias. Se sugiere realizar estudios similares en otras zonas geogràficas del país para valorar la influencia que ejercen estos alergenos aéreo-transportables en la salud de los individuos y contribuir al diagnóstico de las enfermedades alérgicas y su tratamiento con vacunas hiposensibilizantes(AU)

Pollen is an important allergen able to produce allergic diseases (pollinosis). An observational-descriptive research was conducted in the municipality of Boyeros in order to identify the main characteristics of pollinosis as well as its annual behavior. The approval from the municipality direction of health and of the environmental unit was obtained before starting the study. The gravimetric method was used in this aerobiological pilot study, different vaseline slides were exposed at 20 m in the roof of a hospital during 24 h. Subsequently the slides were stained with Calberla solution and the count of pollen was performed by optical microscopy in an area of 6.6 cm2 of each stained slide. Results revealed the presence of pollen in all the year under study. Pollen was more frequently detected from Casuarina trees and Gramineae plants. The highest incidence was observed during February and March. This study demonstrated the existence of pollen with allergenic importance in an urban area, where vegetation is predominant and has few industries. It is suggested to carry out similar studies in other geographical areas of the country to assess the influence of these airborne allergens in health and to contribute to the diagnosis and treatment of allergic disease with hyposensitizing vaccines(AU)

Prevalência de polinose em soldados do exército no sul do Brasil / Prevalence of pollinosis in Brazilian Army soldiers in southern Brazil

Objetivo: Estabelecer a prevalência de polinose (rinite sazonal), em soldados do Exército Brasileiro, em áreas com agricultura modificada pela introdução extensiva de Lolium multiflorum (Missões) e outra não-modificada (Pampa), localizadas no Estado do Rio Grande do Sul. Métodos: Utilizou-se o questionário escrito do International Study of Asthma and Allergies in Childhood modificado e previamente validado em Curitiba. A amostra foi de 3.028 militares do exército brasileiro; 1.392 pertenciam à região das Missões, e 1.636, à região do Pampa. A análise estatística para cálculo de prevalência foi limitada para residência (≥ 2 anos na região e permanência ≥ 4 dias na cidade/semana). Resultados: Presença de sintomas nasais e oculares nos últimos doze meses, com respostas afirmativas foram em Missões (31,4%; IC95%: 28,9-33,9) e Pampa (18,5%; IC95%: 16,6-20,5). Nos sintomas nasais em setembro, outubro e novembro (primavera), a frequência afirmativa foi, respectivamente, em Missões (20,8%, 12,2% e 5,8%) e Pampa (6,1%, 4,1% e4,2%). Responderam “sim” sobre a alergia ao pólen na primavera, em Missões (24,6%) e Pampa (11,2%). Conclusões: Os sintomas naso-oculares, associados à resposta afirmativa para alergia ao pólen na primavera, nos meses de setembro, outubro e novembro, permitem estabeleceruma prevalência de polinos e (21,6%; IC95%:19,1-24,3) em Missões e (3,2%; IC95%: 2,3-4,3) para a região do Pampa. A elevada prevalência de polinose encontrada em Missões poderia estar relacionada com a cultura atual extensiva de Lolium multiflorum.

Objective: To verify the prevalence of pollinosis (seasonal rhinitis) among Brazilian Army soldiers in an area with modified agriculture by introduction of Lolium multiflorum (Missões)compared to a non-modified environment (Pampa), both located in the state of Rio Grande do Sul Methods: The written questionnaire of the International Study of Asthma and Allergies in Childhood previously adapted and validated in Curitiba, was applied to a total of 3.028 soldiers, being 1.392 subjects living in the Missões region and 1.636 located at the Pampa region. Statistical analysis for prevalence was limited only to residents in those regions (≥ 2years living in the region and ≥ 4 days/week in the area). Results: The prevalence of nasal and ocular symptoms in the last 12 months was (31.4%: 95% CI: 28.9 – 33.9) in the Missões area versus (18.5%; 95% CI: 16,6 – 20,5) in the Pampa. Specifically, when the evaluation of nasal symptoms was limited to the spring season (September, October and November), positive responses were observed in (20.8%: 12.2%:5.8%) in the Missões region and (6.1%: 4:1%: 4,2%) in the Pampa. Regarding the presence of pollen allergy in the spring, 24.6% of all questionnaires described positive answers in Missões area compared to 11.2% in the Pampa region Conclusions: Positive answers regarding the presence of nasal and ocular symptoms associated with spring pollen allergy allow the definition of the pollinosis rates in the Missões area (21.6%; 95%CI: 19.1 – 24.3) and in Pampa (3.2%; 95%CI: 2.3 – 4.3). The higher prevalence of pollinosis found in Missões could be related to the current extensive cultivation of Lolium multiflorum.

Concentração polínica de asteraceae na atmosfera de Caxias do Sul, RS, no período de 2001 a 2006 / Pollinic concentration of the asteraceae in the atmosphere of Caxias do Sul, RS, in the period from 2001 to 2006

Objetivo. Identificar e quantificar o tipo polínico Asteraceae na atmosfera de Caxias do Sul, durante o período de janeiro de 2001 a dezembro de 2006. Método. O monitoramento polínico foi realizado com o captador volumétrico de sucção modelo Burkard®, instalado no telhado do Hospital Geral, a uma altura de vinte metros aproximadamente. Resultados. Durante o período de estudo, foram contabilizados 112.235 grãos de pólen, 2.131 pertencentes à família das compostas, com total de 1,89% de grãos nos seis anos de estudo. O pólen da família Asteraceae se encontra na atmosfera praticamente na totalidade do ano, como consequência de uma grande quantidade de espécies cujas florações se sucedem durante um período de tempo. A maior concentração de grãos de pólen de Asteraceae ocorre na primavera e no verão. Conclusão. Numerosas espécies de Asteraceas são consideradas alergênicas por vários autores. Por isso, seria conveniente testar extratos com antígenos desse pólen em pacientes com polinose.

Objective. This study aimed to identify and quantify the type pollinic Asteraceae in the atmosphere of the city of Caxias do Sul, during the period from January 2001 to December 2006. Methods. The pollinic monitoring was carried out using the pickup Burkard® volumetric model of suction, installed on the roof of the General Hospital, at a height of approximately 20 metres. Results. During the study were counted 112235 grains of pollen, of which 2131 grains of pollen belong to the family compound, totaling 1,89% of the total grain in six years of study. The pollen of the Asteraceae family is in theair virtually the entire year, as a result of a large number of species whose blooms succeed during a period of time. The highest concentration of pollen grains of Asteraceae occurs in spring and summer. Conclusion. Many species of Asteraceas are considered alergenics by several authors. Because of this should be convenient test antigens extract in patients with pollinosis should be convenient.