Egg allergy and yellow fever vaccination.

OBJECTIVE: Evaluate biomarkers capable of safely guiding Yellow fever vaccine (YFV) vaccination among individuals suspicious of hen's egg allergy, and identify factors associated with a higher risk for adverse events after immunization (AEAI). METHODS: Patients underwent skin prick test (SPT) for standardized allergens: whole egg, egg white, egg yolk; YFV (1:10 dilution; Biomanguinhos-Fiocruz), and intradermal test (IDT; YFV 0.02 mL, 1:100 dilution) and positive and negative controls. Serum levels of specific IgE (sIgE) for a whole egg, egg white, egg yolk, egg albumin, ovomucoid, lysozyme, and conalbumin (ImmunoCap®; ThermoFisher®) were obtained. Patients sensitized to YFV were submitted to YFV desensitization, and those negatives received YFV (0.5mL) and remained under surveillance for at least one hour. RESULTS: 103 patients were enrolled, 95% under 12 years old. 71% (81/103) of patients had reactions: 80% immediate, 11% mixed, and 9% delayed. There was an association between positive skin test results with YFV and the severity of the reaction (OR:7.64; 95%CI:1.61-36.32; p = 0,011). Only the presence of sIgE to ovomucoid was associated with clinical symptoms (p = 0,025). Thirty patients underwent the YFV desensitization protocol. CONCLUSION: There is a relationship between the positivity of the egg's components and the severity of the clinical reaction. Furthermore, the relationship between the positivity of the tests with the YFV and egg's components may show a tendency to look at ovomucoid and conalbumin, but it is not a certainty. Therefore, further studies are needed to confirm these associations, and for now, the authors still recommend using the vaccine for testing when necessary.

Egg allergy and yellow fever vaccination

Abstract Objective Evaluate biomarkers capable of safely guiding Yellow fever vaccine (YFV) vaccination among individuals suspicious of hen's egg allergy, and identify factors associated with a higher risk for adverse events after immunization (AEAI). Methods Patients underwent skin prick test (SPT) for standardized allergens: whole egg, egg white, egg yolk; YFV (1:10 dilution; Biomanguinhos-Fiocruz), and intradermal test (IDT; YFV 0.02 mL, 1:100 dilution) and positive and negative controls. Serum levels of specific IgE (sIgE) for a whole egg, egg white, egg yolk, egg albumin, ovomucoid, lysozyme, and conalbumin (ImmunoCap®; ThermoFisher®) were obtained. Patients sensitized to YFV were submitted to YFV desensitization, and those negatives received YFV (0.5mL) and remained under surveillance for at least one hour. Results 103 patients were enrolled, 95% under 12 years old. 71% (81/103) of patients had reactions: 80% immediate, 11% mixed, and 9% delayed. There was an association between positive skin test results with YFV and the severity of the reaction (OR:7.64; 95%CI:1.61-36.32; p =0,011). Only the presence of sIgE to ovomucoid was associated with clinical symptoms (p =0,025). Thirty patients underwent the YFV desensitization protocol. Conclusion There is a relationship between the positivity of the egg's components and the severity of the clinical reaction. Furthermore, the relationship between the positivity of the tests with the YFV and egg's components may show a tendency to look at ovomucoid and conalbumin, but it is not a certainty. Therefore, further studies are needed to confirm these associations, and for now, the authors still recommend using the vaccine for testing when necessary.

Dermatite atópica grave: guia prático de tratamento da Associação Brasileira de Alergia e Imunologia e Sociedade Brasileira de Pediatria / Severe atopic dermatitis: a practical treatment guide from the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

A dermatite atópica (DA) é uma doença cutânea inflamatória, crônica, comum, complexa e de etiologia multifatorial, que se manifesta clinicamente com prurido muitas vezes incapacitante, lesões recorrentes do tipo eczema, xerose e que pode evoluir para liquenificação. Embora o conhecimento sobre a sua fisiopatologia venham crescendo nos últimos anos, ainda as formas graves são frequentes e representam um desafio para o clínico. Para o presente guia realizou-se revisão não sistemática da literatura relacionada à DA grave refratária aos tratamentos habituais com o objetivo de elaborar um documento prático e que auxilie na compreensão dos mecanismos envolvidos na DA, assim como dos possíveis fatores de risco associados à sua apresentação. A integridade da barreira cutânea é um dos pontos fundamentais para a manutenção da homeostase da pele. Além dos cuidados gerais: evitação dos agentes desencadeantes e/ou irritantes, o uso de hidratantes, suporte emocional, entre outros, o uso de agentes anti-inflamatórios/imunossupressores de uso tópico e/ou sistêmico também foi revisado. A aquisição de novos agentes, os imunobiológicos e as pequenas moléculas, melhorou a terapêutica para os pacientes com formas graves de DA, sobretudo as refratárias aos tratamentos convencionais.

Atopic dermatitis is a chronic, common, and complex inflammatory skin disease with a multifactorial etiology. It manifests clinically with often disabling pruritus, recurrent eczema-like lesions, and xerosis, and can progress to lichenification. Although understanding of the disease's pathophysiology has been growing in recent years, severe forms are still frequent and represent a challenge for clinicians. A non-systematic review of the literature on severe atopic dermatitis refractory to conventional treatment was conducted to develop the present guide, whose purpose is to help clarify the mechanisms involved in the disease and possible risk factors. The integrity of the skin barrier is fundamental for maintaining skin homeostasis. In addition to general care, patients should avoid triggering and/or irritating agents and moisturizers and seek emotional support, etc.; the use of topical and/or systemic anti-inflammatory/immunosuppressive agents was also reviewed. New agents, immunobiologicals, and small molecules have led to a broader range of therapies for patients with severe forms of the disease, especially cases refractory to conventional treatment.

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.

Guia prático de atualização: medicamentos biológicos no tratamento da asma, doenças alérgicas e imunodeficiências / Practical update guide: biological drugs in the treatment of asthma, allergic diseases and immunodeficiencies

O presente guia apresenta revisão extensa sobre imunobiológicos utilizados, liberados e ainda sob estudo, para o tratamento da asma, doenças alérgicas e imunodeficiências. Além das características físico-químicas de alguns desses fármacos, são revisadas as indicações e os resultados de estudos clínicos realizados para avaliar eficácia e segurança. Separados por doença específica, são apresentados os principais agentes disponíveis e aprovados para utilização segundo as normas regulatórias nacionais.

This guide presents an extensive review of immunobiological drugs used, approved and/or under investigation for the treatment of asthma, allergic diseases and immunodeficiencies. In addition to the physicochemical characteristics of some of these drugs, their indications and results of clinical studies evaluating efficacy and safety are reviewed. The main agents available and approved for use in each specific disease according to national regulatory standards are presented.

Fatores associados a alergias oculares em crianças atendidas em serviço especializado / Factors associated with ocular allergies in children treated at a specialized service

Introdução: A conjuntivite alérgica (CA) é uma doença inflamatória da conjuntiva ocular causada principalmente por mecanismo IgE-mediado. É o tipo mais comum de alergia ocular. O presente estudo teve por objetivo identificar fatores associados à CA de diferentes intensidades em pacientes acompanhados em ambulatório pediátrico especializado em doenças alérgicas, visando, assim, facilitar o diagnóstico, a terapêutica e a profilaxia dessa morbidade. Métodos: Este estudo retrospectivo analisou prontuários de pacientes (n = 120) com diagnóstico clínico de CA acompanhados em ambulatório especializado por pelo menos um ano. O diagnóstico de CA foi realizado por oftalmologista, e, segundo os medicamentos utilizados, os pacientes foram classificados em CA grave (corticosteroide oral, imunossupressor tópico ou sistêmico e/ou com lesão corneana) ou não grave. Todos foram submetidos a testes cutâneos de leitura imediata com bateria padronizada de aeroalérgenos. Quinze pacientes foram escolhidos aleatoriamente e submetidos à pesquisa de IgE sérica específica (ImmunoCap-ISAC; Thermo Scientific). Resultados: Formas graves de CA ocorreram em 36/120 pacientes, com predomínio de sexo masculino (86,1%), presença de história familiar de CA e uso de lubrificantes e de imunossupressores tópicos. Não houve diferenças quanto à sensibilização a aeroalérgenos, mas entre as formas graves predominou a polissensibilização. Houve predomínio de sensibilização aos ácaros da poeira domiciliar. Conclusão: Nosso estudo-piloto mostrou que formas graves de CA foram associadas ao sexo masculino, ter história familiar de conjuntivite alérgica, e ser sensibilizado a ácaros da poeira domiciliar. Estudos adicionais são necessários para melhor caracterizar os possíveis fatores de risco associados à maior gravidade da CA.

Introduction: Allergic conjunctivitis (AC) is an inflammatory disease of the ocular conjunctiva mainly caused by IgE-mediated mechanism. It is the most common type of ocular allergy. The present study aimed to identify factors associated with AC of different degrees of severity in patients followed in a pediatric outpatient clinic specializing in allergic diseases, in order to facilitate the diagnosis, therapy and prophylaxis of this morbidity. Methods: This retrospective study assessed medical records of patients (n = 120) with clinical diagnosis of AC followed at a specialized outpatient clinic for at least one year. The diagnosis of AC was performed by an ophthalmologist and, according to the medications used, the patients were classified as having severe AC (oral corticosteroid, topical or systemic immunosuppressive drug and/or corneal injury) or non-severe AC. All patients underwent skin prick tests with a standardized battery of aeroallergens. Fifteen patients were randomly selected to undergo serum specific IgE screening (ImmunoCap-ISAC; Thermo Scientific). Results: Severe forms of AC occurred in 36/120 patients with predominance of male sex (86.1%), presence of family history of AC, and use of lubricants and topical immunosuppressive drugs. There were no differences in sensitization to aeroallergens, but polysensitization prevailed among the severe forms. There was a predominance of sensitization to house dust mites. Conclusion: Our pilot study showed that severe forms of AC were associated with being male, having a family history of allergic conjunctivitis and being sensitized to house dust mites. Additional studies are needed to better characterize possible risk factors associated with increased AC severity.

Polymorphisms in inflammasome genes and risk of asthma in Brazilian children.

Considering its role in inflammation and recently described "alternative" roles in epithelial homeostasis and Th1/Th2 balance, we hypothesize that inflammasome genetics could contribute to the development of asthma. Selected functional polymorphisms in inflammasome genes are evaluated in a cohort of asthmatic children and their families. Gain-of-function NLRP1 variants rs11651270, rs12150220 and rs2670660 resulted significantly associated to asthma in trios (TDT) analysis; and rs11651270 and rs2670660 also with asthma severity and total IgE level in asthmatic children. NLRP1 activators in humans are still unknown, however we hypothesized that individuals with gain-of-function SNPs in NLRP1 could be more prone in activating inflammasome in the presence of asthma-related cell stressors (i.e. ER stress or ROS), and this activation contribute to exacerbate inflammatory response and asthma development. Gain-of-function IL1A rs17561 resulted significantly associated with a reduced pulmonary capacity in asthmatic children. IL18 rs5744256 which lead to lower serum level of IL-18 appeared to be associated to a worse response to bronchodilators. Concluding, this work provides evidences about the contribution of inflammasome genetics in the development of paediatric asthma, both considering its inflammatory role in alveolar macrophages (i.e.: NLRP1) or its homeostatic role in lung epithelial cells (i.e.: IL1A, IL18).

Guia prático de atualização em dermatite atópica - Parte I: etiopatogenia, clínica e diagnóstico. Posicionamento conjunto da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria / Updated practical guide on atopic dermatitis - Part I: etiopathogenesis, clinical features, and diagnosis. Joint position paper of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

A dermatite atópica (DA) é uma doença crônica e recidivante que acomete principalmente pacientes da faixa etária pediátrica. A fisiopatologia inclui fatores genéticos, alterações na barreira cutânea e imunológicas. A prevalência da DA no Brasil, entre adolescentes, oscila entre 7,1% e 12,5%, com tendência à estabilização. O diagnóstico é clínico, e exames complementares auxiliam na determinação dos fatores desencadeantes. A identificação dos fatores irritantes e/ou desencadeantes envolvidos permite melhor controle das crises. Entre os fatores desencadeantes destacam-se os agentes infecciosos, alérgenos alimentares e aeroalérgenos. Tomando-se como ponto de partida o "Guia Prático para o Manejo da Dermatite Atópica ­ opinião conjunta de especialistas em alergologia da Associação Brasileira de Alergia e Imunopatologia e da Sociedade Brasileira de Pediatria" publicado em 2006, foi realizada revisão e atualização dos conceitos apresentados por grupo de alergologistas, dermatologistas e pediatras especializados no tratamento de pacientes com DA. O objetivo desta revisão foi elaborar um documento prático e que auxilie na compreensão dos mecanismos envolvidos na DA, assim como dos possíveis fatores de risco associados a sua apresentação, bem como sobre a avaliação subsidiária disponível para a identificação dos fatores associados à DA.

Atopic dermatitis (AD) is a chronic, recurrent skin disease that mainly affects pediatric patients. The pathophysiology of AD includes genetic factors, skin barrier abnormalities, and immunological factors. The prevalence of AD in Brazil, among adolescents, ranges from 7.1% to 12.5%, with a trend towards stabilization. The diagnosis of AD is clinical, and complementary tests can help determine the triggering factors. Identification of the irritating and/or triggering factors involved allows better control of exacerbations. Among the triggering factors, infectious agents, food allergens, and aeroallergens stand out. Taking as a starting point the Practical Guide for the Management of Atopic Dermatitis ­ joint opinion of specialists in allergology of the Brazilian Association of Allergy and Immunopathology and of the Brazilian Society of Pediatrics, published in 2006, the present paper describes the results of the review and update of different concepts related to AD, conducted by a group of allergists, dermatologists, and pediatricians specializing in the treatment of patients with AD. The objective of this review was to design a practical document that can help improve our understanding of the mechanisms involved in AD, possible risk factors associated with its presentation, as well as ancillary tests available to identify factors associated with AD.

Guia prático de atualização em dermatite atópica - Parte II: abordagem terapêutica. Posicionamento conjunto da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria / Updated practical guide on atopic dermatitis - Part II: treatment approach. Joint position paper of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

Nas últimas décadas o conhecimento sobre a etiopatogenia da dermatite atópica (DA) avançou muito. Além da identificação dos principais agentes desencadeantes e/ou agravantes envolvidos na expressão clínica da DA, verificou-se ser a integridade da barreira cutânea um dos pontos fundamentais para a manutenção da homeostase da pele. Assim, no tratamento do paciente com DA, além da evitação dos agentes desencadeantes e/ou irritantes, o uso de hidratantes é parte fundamental, e acredita-se que tenha ação preventiva de surtos agudos. Além disso, a aquisição de agentes anti-inflamatórios de uso tópico tem permitido o controle de pacientes com formas leves a moderadas da DA. Embora tenham uso mais restrito, os agentes imunossupressores sistêmicos também têm sido empregados no tratamento de pacientes com DA grave ou refratária aos procedimentos habituais. Comenta-se também a imunoterapia alérgeno-específica como tratamento adjuvante da DA para alguns pacientes, sobretudo alérgicos aos ácaros e com manifestações respiratórias associadas. A aquisição de novos agentes, os imunobiológicos, também são apresentados à luz das evidências científicas e clínicas atuais. O presente guia prático de atualização em dermatite atópica ­ abordagem terapêutica teve por objetivo rever os esquemas de tratamento disponíveis e empregados no acompanhamento de pacientes com DA, além de apresentar terapêuticas futuras, como os agentes imunobiológicos que em breve estarão à disposição para o tratamento de formas mais graves e/ou refratárias da DA.

Over the last few decades, knowledge of the etiopathogenesis of atopic dermatitis (AD) advanced greatly. The main triggering and/or aggravating factors involved in the clinical expression of AD have been identified, and cutaneous barrier integrity has been found to be key for the maintenance of skin homeostasis. Thus, when treating patients with AD, in addition to avoiding triggering and/ or irritating agents, recommending the use of skin moisturizers is paramount ­ and believed to have a preventive action against acute outbreaks. Moreover, topical anti-inflammatory agents have allowed AD control in patients with mild to moderate forms of the disease. Although more restricted, systemic immunosuppressive agents have also been used in the treatment of patients with severe or refractory AD. Specific allergen immunotherapy is presented as a possible adjunctive treatment for AD in some patients, especially those allergic to mites and presenting associated respiratory manifestations. Finally, the use of new immunobiological agents is discussed in the light of the scientific and clinical evidence currently available. The objectives of this updated practical guide on atopic dermatitis ­ treatment approach were to review the treatment regimens available and used in the follow-up of patients with AD and to present new therapies (e.g., immunobiological agents) that will soon be available for the treatment of more severe and/ or refractory forms of AD.

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.

Índice de congestão nasal (CQ-7)na avaliação da obstrução nasalde crianças e adolescentes com rinite alérgica / Índice de congestão nasal (CQ-7) na avaliação da obstrução nasal de crianças e adolescentes com rinite alérgica

Verificar se o questionário Congestion Quantifier Seven-Item (CQ-7) permite avaliar a intensidade da rinite alérgica em crianças e adolescentes com rinite alérgica persistente (RAP) comparando-o amétodo objetivo (pico de fluxo inspiratório nasal, PFIN) e ao escore total de sintomas nasais recordatório (ETSNR).Pacientes e métodos: Pacientes (n = 64, 47 por cento gênero masculino,média idade 11 anos) acompanhados por RAP foram avaliados por: CQ-7 eETSNR (espirros, prurido, obstrução nasal e rinorreia; pontuados segundo escala de 0 = ausente a 4 = o tempo todo, tendo-se como base a última semana). A seguir realizou-se a medição do PFIN (Clements Dist®).Resultados: À avaliação clínica, 44,7 relataram obstrução nasale 51,9 respiração bucal a maior parte do tempo. Apesar disso, 84,3 não tiveram interferência da RAP com o trabalho/escola; 43,2 referiram acordar com o nariz obstruído pelo menos uma vez/semana assim comoo sono afetado (37,5 ). À admissão, o CQ-7 oscilou entre zero e 23 pontos (máximo de 28) e o ETSNR entre zero e 16 (média = 6,64) com correlação significante entre ambos (Spearman; rs = 0,748; Intervalo de Confiança [IC] de 95 :0,61-0,81). O mesmo não ocorreu ao confrontarmosos dois escores ao PFIN. Sintomas oculares foram avaliados em35 pacientes (média = 4,8, oscilando entre 0 e 12) e houve correlação significante entre o ESO e o ETSNR (média = 7,26; Spearman; rs = 0,57; IC95 :0,28-0,76).Conclusões: O CQ-7 mostrou-se comparável ao ETSNR, ambosrecordatórios, mas não à medida do PFIN posto que esta avalia a permeabilidade da cavidade nasal no momento da realização da prova. Quadros mais intensos de RAP se associaram à presença de conjuntivite.

To assess whether the Congestion Quantifier Seven-Item(QC-7) questionnaire was able to evaluate the severity of allergic rhinitis in persistent allergic rhinitis (PAR) children and adolescents in comparison to an objective method (nasal peak inspiratory flow, NPIF) and with the total nasal symptoms recordatory score (TNSRS).Casuistic and methods: Patients (n = 64, 47 percent male, mean age11 years) treated for PAR were assessed: CQ-7 and TNSRS (sneezing, itching, nasal obstruction and rhinorrhea; ranging from 0 = absent to 4 = all the time, taking as basis the last week). After this, they had the NPIF measured (Clements Dist ®).Results: Nasal obstruction and mouth breathing most of the timewere reported by 44.7 percent and 51.9 percent of the patients, respectively.Nevertheless, 84.3 percent had no work/school interference due to PAR, 43.2 percent reported waking up with a blocked nose at least once a week as well as had their sleep affected (37.5 percent). Upon admission, the CQ-7 ranged from zero to 23 points (maximum 28) and TNSRS ranged from zero to 16 (mean = 6.64) with a significant correlation between them (Spearman rs = 0.748, confidence interval [CI] 95 percent :0,61-0, 81). There were nosignificant correlation between both scores and NPIF measurement wasobserved. Ocular symptoms were evaluated in 35 patients (mean = 4.8, ranging between 0 and 12) and significant correlation between ESO and ETSNR (mean = 7.26, Spearman rs = 0.57, 95 percent CI 0.28 -0.76) wasobserved.Conclusions: CQ-7 was comparable to ETSNR, both recalls, but not with NPIF that measured nasal permeability at the evaluation. Moresevere episodes of PAR were associated with conjunctivitis.

Micronutrientes e sistema imunológico / Micronutrients, immunologic system and allergic diseases

Objetivo: A ingestão inadequada de alguns nutrientes pode estar associada a diferentes prejuízos na capacidade normal de defesa celular e/ou humoral, bem como na predisposição de doenças alérgicas. A presença de radicais livres parece ter papel relevante no desenvolvimento de doenças relacionadas ao sistema imunológico. Tendo em vista a elevada prevalência das deficiências de ferro, zinco e vitamina A em nosso meio, o objetivo dessa revisão foi abordar a relação entre a deficiência desses micronutrientes e o sistema imunológico. Fontes dos dados: O estudo foi realizado com base em artigos relacionados à prevenção de doenças alérgicas em crianças, disponíveis nos bancos de dados PUBMED, MEDLINE, SCIELO e LILACS nos últimos 10 anos, ou anteriores a esta data, mas relevantes do ponto de vista nutricional/epidemiológico. Síntese dos dados: A deficiência de ferro, zinco e vitamina A pode levar a diversos prejuízos na função imunológica normal, incluindo defeitos nas respostas inata e adaptativa, redução na produção de interferon-α pelos leucócitos, diminuição na linhagem precursora de células B e prejuízo na resposta de células fagocitárias, entre outros. A presença de radicais livres, traduzindo um estado de estresse oxidativo, está relacionada com o desenvolvimento de doenças alérgicas crônicas, especialmente a asma. Conclusões: A adequação nutricional de micronutrientes está intimamente relacionada ao bom funcionamento do sistema imunológico. Apesar de não haver evidências claras sobre os benefícios de uma dieta rica em antioxidantes sobre a prevenção de alergias, existem indícios de seu potencial papel protetor.

Aim: The inappropriate ingestion of some nutrients can be related to different damages on functional capacity of cellular or humoral defenses, as well as on the predisposition of allergic diseases. The presence of free radicais seems to be relevant on the development of immune system diseases. Due to the high prevalence of zinc, iron and vitamin A deficiencies in Brazil, the goal of this review is to approach the relationship between the lack of these micronutrients on immune system. Data source: The study was conducted based on related articles about prevention of allergic diseases in infants, available on PUBMED, MEDLINE, SCIELO and LILACS data bases in the last 10 years, or previous, but relevant regarding to nutritional or epidemiological point of view. Data synthesis: lron, zinc and vitamin A deficiency can lead to several damages on regular immune function, including defects on inate and adaptative responses, reduction of interferon a by leucocytes and failure on phagocytes function. Free radicals, present in oxidative stress conditions, are related to the development of chronic allergic diseases, especially asthma. Conclusion: Adequate ingestion of micronutrients is related to the good functioning of immune system. Although there are no clear evidences about benefits of a diet with high amounts of antioxidants, there are some signs of their potential protective role.

O papel da nutrição no primeiro ano de vida sobre a prevenção de doenças alérgicas / The role of nutrition in the first year of life on the prevention of allergic diseases

Objetivo: A prevalência das doenças alérgicas vem aumentando nas últimas décadas em todo o mundo. A prevenção primária em lactentes considerados de alto risco para atopias, com base na alimentação no primeiro ano de vida, pode constituir uma importante forma de atuação na tentativa se minimizar as manifestações da doença. Fontes dos dados: O estudo foi realizado com base em artigos relacionados à prevenção de doenças alérgicas em crianças, disponíveis nos bancos de dados PUBMED, MEDLINE, SCIELO e LILACS nos últimos 10 anos, ou anteriores a esta data, mas relevantes do ponto de vista nutricional/epidemiológico. Síntese dos dados: A determinação dos lactentes de alto risco para doenças alérgicas é um dado de alta relevância para a instituição de medidas nutricionais preventivas no primeiro ano de vida. Não há evidências de que a restrição dietética da mãe durante a gestação ou período de amamentação possa ter algum benefício na prevenção de atopia no feto/lactente. Aleitamento materno, diminuição da carga alergênica na substituição ou complementação do leite materno e a presença de determinados nutrientes na alimentação infantil são possíveis intervenções para se minimizar as alergias ao longo da infância. Conclusões: Aleitamento materno exclusivo por seis meses, a utilização de fórmulas hidrolisadas como complemento ou substituição do leite materno e a introdução de alimentos sólidos após o 4° mês de vida são apontadas como as possíveis estratégias na prevenção primária de doenças alérgicas, no que concerne à alimentação do primeiro ano de vida.

Aim: The prevalence of allergic diseases has been increasing in the past decades around the world. Primary prevention in high risk infants to develop allergies, based on some feeding aspects in the first year of life seems to be an important form of sction in order to minimize allergic symptoms. Data source: The study was conducted based on related articles about prevention of allergic diseases in infants, available on PUBMED, MEDLINE, SCIELO and LILACS data bases in the last 10 years, or previous, but relevant regarding to nutritional or epidemiological point of view. Data synthesis: The recognition of high risk infants for developing allergic diseases is the most relevant information for establishing preventive feeding measurements in the first year of life. There is no evidence that restriction diet during pregnancy or breastfeeding are effective for reducing atopy in the fetus/infant. Breastfeeding, decreasing intake of allergenic proteins and the presence of appropriate nutritional elements are possibly effective interventions for prevention of allergy during the infancy. Conclusion: Exclusive breastfeeding up to six months of life, hydrolyzed formula as complementation or substitution to breast milk and delayed solid food introduction after the fourth month are possibly some strategies for the primary prevention of allergic diseases, regarding to feeding in the first year of life.

Sepse por S. aureus em paciente com dermatite atópica e eczema herpético: relato de caso / Sepsis by S. aureus in a patient with atopic dermatitis and herpeticum eczema: a case report

O objetivo deste relato de caso foi apresentar uma paciente com dermatite atópica (DA) e que no primeiro ano de vida desenvolveu quadro infeccioso grave com eczema difuso em face pescoço e tórax, acompanhado de celulite periorbitária bilateral, febre alta, gemência, hipoatividade e acentuado comprometimento do estado geral. Pele xerótica com lesões vesículares, umbilicadas e com secreção purulenta. O isolamento de Staphy/occus aureus em hemocultura confirmou a suspeita de septicemia e o tratamento antimicrobiano efetivo (Ceftriaxona e Oxacilina) permitiu o seu controle e evidenciou a presença de Eczema herpeticum em face. O tratamento com Aciclovir intra-venoso e cuidados locais possibilitaram o seu controle. A infecção viral funcionou como porta de entrada para o S.aureus causando a septicemia, pouco comum em DA não complicada.

The aim of this report is to relate a one year-old female patient with atopic dermatitis (AD) that developed a severe infectious clinical picture associated with diffuse eczema in face, neck and thorax, bilateral per orbital cellulite, elevated fever, groaning, underactivity, and accentuated commitment of general condition. Pustule umbilicated vesicles over a xerotic skin were observed. Hemoculture reveals Growing of Staphy/occus aureus in hemoculture confirmed septicemia diagnose and specific antibiotic therapy (Ceftriaxona e Oxacilina) allowed its control and put in evidencethe presence of facial Herpeticum eczema. The intravenous treatment with Acyclovir associated with local care enable its control. Virus infection was the S. aureus entrance door causing septicemia, uncommon in no complicated DA patients.

Is the prevalence of asthma and related symptoms among Brazilian children related to socioeconomic status?

OBJECTIVE: To evaluate the relationship between socioeconomic status (SES) and the prevalence of asthma and related symptoms among Brazilian children. METHODS: The International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire was applied to 23,457 six- to seven-year-old schoolchildren (SC) and 58,144 thirteen- to fourteen-year-old adolescents (AD) from 20 Brazilian cities. SES was evaluated by infant mortality index, poverty index, and average nominal income for people older than 10 years of age. RESULTS: Current asthma ranged from 16.5% to 31.2% among SC and from 11.8% to 30.5% among AD and severe asthma from 2.9% to 8.5% (SC) and 2.6% to 9.1% (AD). Higher values were observed in Brazilian-Northern, -Northeastern and -Southeastern centers. No significant association between SES and prevalence of asthma and related symptoms was observed. CONCLUSIONS: In Brazil, the prevalence of asthma and related symptoms is quite variable and independent of SES.