Hipogamaglobulinemia secundária reversível causada por terapia anticonvulsivante em adultos: relato de três casos / Reversible hypogammaglobulinemia secondary to anticonvulsant therapy in adult patients: report of three cases

A redução dos níveis de imunoglobulina relacionada ao uso de anticonvulsivantes e que cursa com infecções de repetição tem sido descrita nas últimas quatro décadas. O objetivo deste estudo é relatar três casos de pacientes adultos que evoluíram para hipogamaglobulinemia quando foram tratados com anticonvulsivantes. Os níveis de imunoglobulinas e a população de linfócitos se normalizaram quando as drogas foram suspensas. Deficiências de IgA e IgM relacionadas ao uso de anticonvulsivantes resultam em infecções de repetição, apesar de níveis baixos de IgG terem sido relatados em poucos estudos e relatos de casos isolados. Os mecanismos patofisiológicos da hipogamaglobulinemia secundária a essas classes de drogas não estão completamente elucidados, mas diversos estudos mostram a possibilidade de reversão da imunodeficiência depois da suspensão da medicação, principalmente na infância.

Reduced immunoglobulin (Ig) levels related to anticonvulsant therapy and resulting in recurrent infections have been described in the past 4 decades. The objective of this study is to report three cases of adult patients who progressed with hypogammaglobulinemia after anticonvulsant therapy. Normalization of Ig levels and lymphocyte populations was achieved after drug suspension. IgA and IgM deficiencies related to anticonvulsant therapy lead to recurrent infections, although decreased serum IgG levels have been reported in few studies and isolated clinical cases. The pathophysiological mechanisms of hypogammaglobulinemia secondary to these types of drugs have not been completely understood, but several studies show the possibility of immunodeficiency reversion after drug suspension, especially in childhood.

Prevalence and factors associated with asthma in students from Montes Claros, Minas Gerais, Brazil.

We investigated the prevalence of asthma and factors related to asthma development in schoolchildren aged 6 to 14, living in central and peripheral areas of the city of Montes Claros, Minas Gerais and who were registered with the Family Health Strategy program. Initially, a standard written questionnaire, based on ISAAC (International Study of Asthma and Allergies in Childhood), was administered to collect personal data, information regarding income, asthma prevalence, allergic rhinitis and eczema (N = 1,131). Secondly, a case-control study was performed by grouping the patients as either asthmatic (A; N = 172) or non-asthmatic (NA; N = 379). Potential factors associated with the occurrence of asthma were evaluated using the complementary questionnaire from ISAAC phase II. Skin tests for immediate hypersensitivity (STIH) and parasitological tests were also performed. The odds ratio, estimated by multivariate analysis, indicated that asthma cases were related to kindergarten attendance, household smoking, family history of asthma, rhinitis and positive STIH. It was concluded that, in the studied population, the prevalence of asthma was related to genetic predisposition, in addition to individual history, social demographics, exposure to pollutants such as tobacco smoke and a positive response to allergy testing.

Prevalência e fatores associados à asma em escolares de Montes Claros, MG, Brasil / Prevalence and factors associated with asthma in students from Montes Claros, Minas Gerais, Brazil

Resumo Investigou-se a prevalência de asma e fatores relacionados ao seu desenvolvimento em escolares de 6 a 14 anos residentes em área central e periférica da cidade de Montes Claros, MG e cadastrados no programa Estratégia da Saúde da Família. Na primeira etapa, aplicou-se o questionário escrito padrão do através de questionários do ISSAC (International Study of Asthma and Allergies in Childhood) para coleta de dados pessoais, renda e prevalência de asma, rinite alérgica e eczema (N = 1131). Na segunda etapa (estudo do tipo caso-controle) dividiu-se a amostra em asmáticos (A; N = 172) e não asmáticos (NA; N = 379) para avaliar potenciais fatores associados à ocorrência de asma na população utilizando-se o questionário complementar do ISAAC fase II. Realizou-se também teste cutâneo de hipersensibilidade imediata (TCHI) e parasitológico. As razões de probabilidade (RP) estimadas por análise multivariada mostraram que os casos de asma estavam relacionados à frequência no jardim de infância, tabagismo intradomiciliar, antecedente familiar, rinite e resposta positiva ao TCHI. Conclui-se que na população estudada a prevalência da asma não está apenas relacionada à predisposição genética, mas também é associada ao histórico do indivíduo, sua condição social, exposição a poluentes como fumaça de tabaco e resposta positiva a alérgenos.

Abstract We investigated the prevalence of asthma and factors related to asthma development in schoolchildren aged 6 to 14, living in central and peripheral areas of the city of Montes Claros, Minas Gerais and who were registered with the Family Health Strategy program. Initially, a standard written questionnaire, based on ISAAC (International Study of Asthma and Allergies in Childhood), was administered to collect personal data, information regarding income, asthma prevalence, allergic rhinitis and eczema (N = 1,131). Secondly, a case-control study was performed by grouping the patients as either asthmatic (A; N = 172) or non-asthmatic (NA; N = 379). Potential factors associated with the occurrence of asthma were evaluated using the complementary questionnaire from ISAAC phase II. Skin tests for immediate hypersensitivity (STIH) and parasitological tests were also performed. The odds ratio, estimated by multivariate analysis, indicated that asthma cases were related to kindergarten attendance, household smoking, family history of asthma, rhinitis and positive STIH. It was concluded that, in the studied population, the prevalence of asthma was related to genetic predisposition, in addition to individual history, social demographics, exposure to pollutants such as tobacco smoke and a positive response to allergy testing.