Allergic rhinits: impact on quality of life of adolescents.

SUMMARY: Adolescence is one of the most rapid phases of human development, in which biological maturity precedes psychosocial maturity. Rhinoconjunctivitis (ARC) is present in around 15 percent of 13-14-year-old children, which indicates a higher prevalence when compared with 6-7-year-old children (8.5 percent). During childhood (0-10 years) prevalence of Allergic Rhinitis (AR) is higher among males compared to females. Quite the reverse, during adolescence (11-17 years) females display higher prevalence of AR compared to males. However, when they reach adulthood (18-79 years), there is no difference in prevalence between genders. AR and ARC have significant physical and mental impacts on the QoL of adolescents and their parents. Apart from de adverse effects of first generation antihistamines, which include sedating effects, AR-ARC leads to school absences and poorer performance due to distraction, fatigue and irritability. The mobile technology facilitates an innovative investigatory approach to better and more precisely characterize allergy symptoms and their association with other allergic diseases. The success of treatment lies in the partnership between adolescents with AR and mobile technology, allowing them to have more information both on the disease and treatment. Adolescence is a special period in which AR is highly prevalent with some sex-dependent differences. There are also peculiarities on how AR affects QoL of adolescent patients.

Sleep disorders in Latin-American children with asthma and/or allergic rhinitis and normal controls.

BACKGROUND: Asthma and/or allergic rhinitis have been associated with sleep disorders. The aim of this study was to evaluate sleep disorders in Latin-American children (4-10 years) from nine countries, with persistent asthma (A) and/or allergic rhinitis (AR) and in normal controls (C). METHODS: Parents from 454 C children and 700 A and/or AR children followed up in allergy reference clinics completed the Children's Sleep Habits Questionnaire (CSHQ) which is a retrospective one-week questionnaire composed of 33 questions composed of seven subscales (bedtime resistance, sleep duration, sleep anxiety, night wakings, parasomnias, sleep-disordered breathing and daytime sleepiness). The total scale of CSHQ and the subscales were compared between groups C and A+AR, A (n=285) vs. AR (n=390), and between controlled A (CA, n=103) vs. partially controlled/uncontrolled A (UA, n=182). RESULTS: The comparison between C and A+AR showed no significant differences in age (6.7 years vs. 7.0 years, respectively), mean Body Mass Index and total scale of CSHQ (53.3 vs. 63.2, respectively) and the subscales were significantly higher in the A+AR group. Comparison between groups A and AR, except for sleep anxiety, showed significantly higher values for CSHQ total scale (66.9 vs. 61.0, respectively) and subscales for group A. The UA group showed significantly higher values for total CSHQ scale and subscales in comparison to CA (71.1 vs. 59.4, respectively). CONCLUSIONS: Latin-American children with asthma and/or allergic rhinitis showed sleep disorders identified by the CSHQ when compared to normal controls. Despite being treated, asthma causes sleep impairment, especially when uncontrolled.

Sleep-related disorders in Latin-American children with atopic dermatitis: A case control study.

BACKGROUND: Atopic dermatitis (AD) has been associated with impairment of sleep. The aim of this study was to evaluate sleep disorders in AD Latin-American children (4-10 years) from nine countries, and in normal controls (C). METHODS: Parents from 454 C and 340 AD children from referral clinics answered the Children Sleep Habits Questionnaire (CSHQ), a one-week retrospective 33 questions survey under seven items (bedtime resistance, sleep duration, sleep anxiety, night awakening, parasomnias, sleep-disordered breathing and daytime sleepiness). Total CSHQ score and items were analysed in both C and AD groups. Spearman's correlation coefficient between SCORAD (Scoring atopic dermatitis), all subscales and total CSHQ were also obtained. RESULTS: C and AD groups were similar regarding age, however, significantly higher values for total CSHQ (62.2±16.1 vs 53.3±12.7, respectively) and items were observed among AD children in comparison to C, and they were higher among those with moderate (54.8%) or severe (4.3%) AD. Except for sleep duration (r=-0.02, p=0.698), there was a significant Spearman's correlation index for bedtime resistance (0.24, p<0.0001), sleep anxiety (0.29, p<0.0001), night awakening (0.36, p<0.0001), parasomnias (0.54, p<0.0001), sleep-disordered breathing (0.42, p<0.0001), daytime sleepiness (0.26, p<0.0001) and total CSHQ (0.46, p<0.0001). AD patients had significantly higher elevated body mass index. CONCLUSION: Latin-American children with AD have sleep disorders despite treatment, and those with moderate to severe forms had marked changes in CSHQ.

Molecular-based diagnosis of respiratory allergic diseases in children from Curitiba, a city in Southern Brazil.

BACKGROUND: Prevalence of respiratory allergic diseases has increased worldwide. Identification of the aeroallergens involved in allergenic sensitisation is important for diagnosis, treatment and prevention. OBJECTIVE: To verify the molecular pattern of sensitisation to aeroallergens in patients with allergic respiratory diseases using microarray technique for specific IgE antibody detection. METHODS: Cross-sectional study of 101 children with allergic rhinitis was followed in an outpatient clinic. All patients had positive skin prick tests (SPT) to at least one of the following antigens: Dermatophagoides pteronyssinus, Blomia tropicalis, Blattella germanica, Lolium multiflorum, and dog and cat epithelium. Serum specific IgE antibodies (sIgE) to mites, animal epithelia, fungi, cockroach and pollens components were determined by ImmunoCAP ISAC. RESULTS: sIgE to group 1 and 2 mite allergens showed higher positive rates: Der p 1 (74.2%), Der p 2 (73.3%), Der f 1 (74.2%), Der f 2 (72.3%). sIgE to animal epithelia were less frequent, Can f 1, Can f 2, Can f 3 in 4.9%, 2.9%, 1.9% respectively and Fel d 1, Fel d 2, Fel d 4 in 16.8%, 0.9% and 1.9%. respectively. Sensitisation to fungi and cockroach were rare, except for Bla g 7, to which 16.8% were positive. There was no significant recognition for tree pollens group. For grass, sIgE were detected to Cyn d 1 in 16.8%, Phl p 1 and Phl p 4 in 14.8% and 12.9%, respectively. CONCLUSION: Knowing that the pattern of allergic sensitisation varies according to environment and population, our results reinforce the need for local studies, using molecular-based diagnosis.

Allergic rhinitis in preschool children from Southern Brazil.

There are few published studies on prevalence of allergic rhinitis in preschool children. The aims of this study were to verify the prevalence, clinical characteristics, and treatment of allergic rhinitis (AR) symptoms in the first year of life adding supplementary questions to the EISL instrument. A cross-sectional study used Phase III EISL written questionnaire in addition to modified allergic rhinitis ISAAC questions. One thousand and three parents of infants answered the questionnaire: 484 (48.3%) had at least one sneezing, or a runny or blocked nose episodes without cold or flu in the first year of life. A quarter of infants had recurrent wheezing (≥3 episodes) and more frequent in the presence of AR symptoms. Physician diagnosis of AR and the use of intranasal steroids and both antihistamines and intranasal steroids were more common among those infants with AR symptoms. The prevalence of AR symptoms was high and starting early in life.

Anaphylaxis in Latin American children and adolescents: the Online Latin American Survey on Anaphylaxis (OLASA).

OBJECTIVES: To identify the main clinical manifestations, triggers, and treatment of severe allergic reactions (SAR) in children and adolescents (n=191, up to 18 years of age) seen by allergologists and registered in the Online Latin American Survey of Anaphylaxis (OLASA). RESULTS: 53.0% of the patients were males and the aetiological agent was identified in 85.5% of them as follows: foods (36.1%), drugs (27.7%), and insect stings (26.2%). The most common symptoms during an acute episode were cutaneous (94.2%), and respiratory (78.5%). Most patients were treated in emergency setting, yet only 34.6% received parenteral epinephrine and 14.3% had to be hospitalised. CONCLUSION: Cutaneous symptoms ranked the order of clinical presentation of SAR. Food was the main triggering agent in the younger cases and insect sting and drugs in the adolescents. Treatment provided for SAR was not appropriate. It is necessary to improve educational programmes in order to enhance the knowledge on this potentially fatal emergency.

Are we overtreating recurrent wheezing in infancy?

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Studying specific IgE: in vivo or in vitro

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Changes in the prevalence of asthma and allergic diseases among Brazilian schoolchildren (13-14 years old): comparison between ISAAC Phases One and Three.

The present study is aimed to describe the changes in the prevalence of symptoms of asthma, rhinitis and eczema among Brazilian adolescents (AD, 13-14 years old) between Phases 1 and 3 of the International Study of Asthma and Allergies in Childhood (ISAAC). The prevalence of self-reported symptoms of asthma, rhinitis and eczema in AD from five Brazilian cities (Curitiba, Porto Alegre, Recife, Salvador and São Paulo), obtained during ISAAC Phase 1 (n = 15 419) and Phase 3 (n = 15 684), was compared to determine the trend of prevalence in a 7-year interval. There was a trend to reduction in the current prevalence of wheezing and increasing of nocturnal cough when averaging figures from the five cities. The prevalence of wheezing in the last 12 months was 27.7 vs. 19.9% (p < 0.01); asthma ever 14.9 vs. 14.7% (p > 0.05); severe episode of wheezing 5.2 vs. 5.2%; nocturnal cough 32.6 vs. 34.9% (p < 0.01); exercise wheezing 23.6 vs. 23.0% (p > 0.05) and awake with wheezing 11.8 vs. 11.2% (p > 0.05). Similar things were observed with the prevalence of current symptoms of rhinitis and eczema. In Brazil, there was a small but significant mean decrease in the prevalence of two asthma-related symptoms, wheezing and nocturnal cough, though this trend was not consistent in the surveyed cities. The prevalence of asthma symptoms in Brazil, despite its mean trend to a decrease, is still one of the highest in Latin America.

Increase in prevalence of rhinoconjunctivitis but not asthma and atopic eczema in teenagers.

OBJECTIVE: We sought to assess changes in the prevalence of asthma and other allergic diseases in schoolchildren of Curitiba between 1995 and 2001. METHODS: Schoolchildren (aged 13-14) were evaluated by a self-reported written questionnaire of ISAAC protocol for symptoms of asthma and allergic diseases. The diagnoses of asthma, rhinoconjunctivitis and atopic eczema were considered according to the ISAAC protocol. Probable asthma was considered: more than 4 attacks of wheezing in the last 12 months; 1 to 3 attacks of wheezing in the last 12 months with dry cough at night, and/or with sleep disturbance due to wheezing, and/or with wheezing after exercise. The data obtained in 2001 were compared with the data obtained in 1995 for the same age group. RESULTS: We evaluated 2,946 schoolchildren in 1995 and 3.628 in 2001. The prevalence of symptoms of asthma, probable asthma, rhinoconjunctivitis and eczema in 1995 and 2001 was 18.4% and 18.7%, 11.6% and 12.4%, 14.2% and 17.2%, 3.8% and 3.7%, respectively. There was a 23.7% increase in the prevalence of rhinoconjunctivitis symptoms (p < 0.05). CONCLUSIONS: The prevalence of symptoms of asthma, probable asthma and eczema did not change over the past 6 years but a significant increase of the rhinoconjunctivitis symptoms was detected.

[Inflammatory mediators, cell counts in nasal lavage and computed tomography of the paranasal sinuses in atopic children] / Mediadores inflamatórios, citograma em lavado nasal e tomografia computadorizada de seios paranasais em crianças atópicas.

OBJECTIVE: The aims of this study were to evaluate inflammatory cells, the profile of inflammatory mediators in nasal lavage (NL), and the involvement of the paranasal mucosa in atopic infants with no symptoms of sinusitis. METHODS: 48 atopic patients with allergic rhinitis (AR), and 33/48 patients with asthma were studied; the control group consisted of 13 nonatopic children. Those individuals with acute, chronic or recurrent sinusitis were excluded. The involvement of the paranasal mucosa was assessed by coronal computed tomography (CT) and graded by a standard protocol (0-30). A CT score greater than or equal to 12 indicated extensive involvement. Nasal lavage was used to quantify total and differential nasal cell counts. An aliquot of the supernatant was used for determining inflammatory mediators: interleukin-8 (IL-8), myeloperoxidase (MPO), and eosinophil cationic protein (ECP). Albumin was used as a marker for increased vascular permeability. These measurements were performed on all of the atopic patients and in 6/13 patients in the control group. The three groups were submitted to spirometry and complete blood cell count. RESULTS: Extensive involvement of the paranasal mucosa was observed in 7/33 (21%) of asthmatic patients (Group I) and 2/15 (13%) of those with allergic rhinitis (Group II). The highest CT score in the control group (Group III) was 7. Total cell and eosinophil count/ml and albumin concentration in nasal fluid were higher in asthmatic patients whose CT score was greater than 12. Interleukin-8 concentration, number of neutrophils and epithelial cells/ml in nasal fluid were similar in the three groups. A positive correlation between CT score, peripheral blood eosinophilia, number of eosinophils/ml and eosinophil cationic protein concentration was found in the nasal fluid of atopic children (n=48). There was an association between number of neutrophils and titers of interleukin-8 and myeloperoxidase, and between interleukin-8 and eosinophil count. CONCLUSIONS: in asthmatic patients with no symptoms of sinusitis, the extensive involvement of the paranasal mucosa is associated with blood and nasal lavage eosinophilia and cellular activation. Neutrophil infiltration and activation were not related to increased involvement of the paranasal mucosa.

[Clinical findings of sensitivity to analgesics and nonsteroidal antiinflammatory drugs]. / Achados clínicos da sensibilidade a analgésicos e antiinflamatórios não-hormonais.

BACKGROUND: Analgesics (ANA) and nonsteroidal antiinflammatory drugs (NSAID) may simulate an allergic reaction or aggravate asthma and urticaria. OBJECTIVE: The aim of this study was the analysis of the clinical findings in patients sensitive to ANA/NSAID. METHODS AND SUBJECTS: The charts of 183 patients with history of reacting to these drugs were retrospectively analysed. RESULTS: There were 93 (51%) females and 90 (49%) males; 63 (34%) were aged 15 years or less. Females predominate in the age group older than 15 years (p = 0,02). The age by the time of the first reaction varied from 7 months to 65 years (median 15 years). Skin tests to inhalant allergens were positive to at least one antigen in 100/138 patients (72%). Clinical presentation was angioedema (86%); urticaria (39%); systemic reaction (30%); nasal and ocular (15%); and asthma (14%). The frequency of symptoms was not related to age. Family history of ANA/NSAID sensitivity was present in 3.8% of patients. Associated diseases were rhinitis (55%), chronic urticaria (47%), asthma (37%) and conjuntivitis (18%). Among asthmatics 16 (23,5%) had had attacks with ANA/NSAID. Nine non asthmatics (7.7%) had had bronchospasm as clinical presentation. This difference was statistically significant. Repeated reactions occurred in 107 (58%) patients. CONCLUSIONS: Sensitivity to ANA/NSAID was frequent in atopics; children and adults responded similarly; reactions were more common in adult females; palpebral angioedema was the most frequent clinical presentation; bronchosphasm was usually seen in asthmatics and most patients reacted repeatedly to different drugs.

Achados clínicos da sensibilidade a analgésicos e antiinflamatórios näo-hormonais / Clinical findings of sensitivity to analgesics and nonsteroidal antiinflammatory drugs

Analgésicos (ANA) e antiinflamatórios nao-hormonais (AINH) podem causar reaçoes que simulam as alérgicas ou agravam asma e urticária. OBJETIVO: Verificar as manifestaçoes clínicas de pacientes com história de reaçao a analgésicos (ANA) e antiinflamatórios nao-hormonais (AINH). MÉTODO: Análise e retrospectiva de prontuários de 183 pacientes com história de sensibilidade a ANA e AINH. RESULTADOS: Eram 93 (51 por cento) pacientes do sexo feminino e 90 (49 por cento) do sexo masculino; 63 (34 por cento) com idade igual ou inferior a 15 anos e 120 (66 por cento) com idade superior a 15 anos. Havia um predomínio de pacientes do sexo feminino com idade superior a 15 anos que foi estatisticamente significativo (p = 0,02). A idade por ocasiao da primeira reaçao com medicamentos variou de 7 meses a 65 anos (média de 15 anos). Testes cutâneos para aeroalérgenos foram positivos para pelo menos um alérgeno testado em 100/138 (72 por cento). As manifestaçoes clínicas encontradas foram angioedema (86 por cento), urticária (39 por cento), reaçoes sistêmicas (30 por cento), reaçoes nasais e oculares (15 por cento) e crise de asma (14 por cento). Nao havia diferença quanto à freqüência de sintomas com relaçao à idade. Havia história familiar de sensibilidade a ANA/AINH em sete pacientes (3,8 por cento). As doenças associadas foram rinite (55 por cento), urticária crônica (47 por cento), asma (37 por cento) e conjuntivite (17,5 por cento). As drogas causavam crise de asma com maior freqüência em asmáticos do que em nao asmáticos (p = 0,001). Reaçoes repetidas a mais de uma droga ocorreram em 107 (58 por cento) pacientes. CONCLUSOES: Reaçoes a ANA e AINH foram freqüentes em atópicos; crianças e adultos reagiam igualmente; foram mais comuns em adultos do sexo feminino; angioedema palpebral foi a manifestaçao clínica mais freqüente; broncoespasmo foi mais comum nos asmáticos e a maioria dos pacientes tinha reaçoes repetidas a mais de uma droga

Geographic heterogeneity of 4 common worldwide cystic fibrosis non-DF508 mutations in Brazil.

Cystic fibrosis (CF) is an autosomal recessive disease caused by at least 750 different mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The frequency of the most common mutation (DF508) in Brazilian patients of European origin is 47%. To determine the frequency of 4 other common CF mutations (G542X, G551D, R553X, and N1303K) in Brazilian patients of European origin, we used direct polymerase chain reaction (PCR) amplification of DNA obtained from dried blood spots on Guthrie cards. The DNA came from 247 non-DF508 chromosomes from 172 Brazilian CF patients ascertained from 5 different states of Brazil. The results show that the 4 mutations account for 17% of the non-DF508 alleles and only 9% of the total number of Brazilian CF alleles. Overall, the frequency of each mutation is different from northern European and North American populations but similar to southern European populations, mainly the Italian and Spanish populations. When Brazilian patients of European origin are grouped according to state of birth, the frequencies of the mutations are significantly different between southern and southeastern states of Brazil. Therefore there are serious implication for risk assessment of DNA-based tests in heterogeneous populations such as Brazilians. Further studies are needed to identify the remaining 44% of CF mutations for the different populations and regions of Brazil.