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Eur J Pediatr ; 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-32157460


Ethnic classification does not correlate well with skin tone. As there are no neonatal skin color scales, we aimed to create and validate one of our own. After creating the scale and briefly training our staff, we conducted a prospective, observational study to assess reproducibility and correlation of each scale color with the melanin and erythema indexes and transcutaneous bilirubin. The reliability of our color scale was measured using Kappa agreement (and its 95% confidence interval) and the concordance index by comparing inter-observer classification of neonatal skin color. We also calculated inter-rater agreement with the intraclass correlation coefficient (ICC). The Kendall tau-b correlation coefficient was used to test the correlation between our color scale and the Mexameter® MX 18. We obtained data from 258 newborns. Inter-observer agreement on color assignment was 83.2%. Median melanin index was significantly different among the 4 color groups, whereas erythema index and transcutaneous bilirubin were not.Conclusions: Our proposed neonatal skin color scale correlates well with the melanin index at 24 h of life, increasing from colors 1 to 4, and the only chromophore different among our four color groups is melanin. Scale color assignment is reproducible. Therefore, it can be used to classify neonatal skin color. Further research is warranted to assess the clinical relevance of these findings.What is known:• Classifying neonates by skin color is difficult because to date there are no skin color scales available based on real skin tone regardless of ethnicity or country of origin.• Skin color differs among individuals from a given ethnic group and depends, among others, on melanin and hemoglobin.What is new:• We created a neonatal skin color scale based on real skin color.• We conducted a study to validate it, and confirmed a good inter-observer agreement in color assignment as well as a good correlation between each color in the scale and the median melanin level.

J Dermatolog Treat ; 31(2): 204-209, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30821591


Background: The real-life data on the effectiveness and safety of omalizumab in chronic spontaneous urticaria (CSU) with validated methods are scarce. There is also a lack of information on the use of combination treatments.Methods: A retrospective cohort study was done to evaluate the effectiveness and safety of omalizumab in real-life conditions. The patients with CSU treated with omalizumab between 2015 and 2018 were included. The response to therapy was evaluated using urticaria activity score over 7 days (UAS7) and urticaria control test (UCT).Results: A total of 106 patients were included. A complete response (CR) (UAS7:0) and a well-controlled activity (WCA) (UAS7:1 to <6) were observed in 50 (47.2%) and 35 (33%) patients, respectively. The number of patients with an UCT score ≥12 was also significantly increased. Higher rates of CR/WCA were observed with omalizumab monotherapy compared to combination with antihistamines. The combination of dapsone, colchicine, and omalizumab provided additional benefit in a small group.Conclusion: Treatment with omalizumab provided a rapid and sustainable improvement in real-life settings. The use of omalizumab as monotherapy or combined with antihistamines does not show differences in the treatment response. The combination of omalizumab with immunomodulatory agents might be of benefit in selected cases.

Antialérgicos/uso terapêutico , Urticária Crônica/tratamento farmacológico , Omalizumab/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alopecia/etiologia , Antialérgicos/efeitos adversos , Doença Crônica , Urticária Crônica/patologia , Colchicina/uso terapêutico , Dapsona/uso terapêutico , Quimioterapia Combinada , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Omalizumab/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
Clin Transl Allergy ; 9: 24, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31007896


Skin microdialysis (SMD) is a versatile sampling technique that can be used to recover soluble endogenous and exogenous molecules from the extracellular compartment of human skin. Due to its minimally invasive character, SMD can be applied in both clinical and preclinical settings. Despite being available since the 1990s, the technique has still not reached its full potential use as a tool to explore pathophysiological mechanisms of allergic and inflammatory reactions in the skin. Therefore, an EAACI Task Force on SMD was formed to disseminate knowledge about the technique and its many applications. This position paper from the task force provides an overview of the current use of SMD in the investigation of the pathogenesis of chronic inflammatory skin diseases, such as atopic dermatitis, chronic urticaria, psoriasis, and in studies of cutaneous events during type 1 hypersensitivity reactions. Furthermore, this paper covers drug hypersensitivity, UVB-induced- and neurogenic inflammation, and drug penetration investigated by SMD. The aim of this paper is to encourage the use of SMD and to make the technique easily accessible by providing an overview of methodology and applications, supported by standardized operating procedures for SMD in vivo and ex vivo.

J. investig. allergol. clin. immunol ; 29(5): 338-348, 2019. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-188769


Chronic spontaneous urticaria (CSU) is a heterogeneous condition that can severely impact quality of life. Consequently, rapid disease control is essential. First-line treatment of the symptoms of CSU is the licensed dose of second-generation H1 antihistamines. For second-line treatment, this dose may be increased by up to 4 times. In patients who fail to respond to higher doses of H1 antihistamines, omalizumab for up to 24 weeks is recommended to achieve disease control. After this 24-week period, the patient's response to omalizumab should be assessed in order to identify refractory patients. Optimal management of refractory patients has not been established. Therefore, the aim of the present consensus document, which was drafted by allergists and dermatologists with specific expertise in treating urticaria, was to define specific patient profiles based on differences in their response to omalizumab. We also developed a treatment algorithm based on the specific response profile. After a comprehensive literature review, a group meeting was held to discuss issues related to the therapeutic management of patients with CSU that had not been addressed in previous studies. The experts considered both the available evidence and their own clinical experience with omalizumab. We believe that implementation of the proposed algorithm will optimize management of CSU patients who are refractory to antihistamines, reduce disease-related costs, and improve quality of life

La urticaria crónica espontánea (UCE) es una afección heterogénea que puede afectar gravemente la calidad de vida, por lo que el control rápido de la enfermedad es esencial. El tratamiento sintomático de primera línea de CSU es la dosis autorizada de antihistamínicos H1 de segunda generación. Para el tratamiento de segunda línea, esta dosis se puede aumentar hasta cuatro veces. En pacientes que no responden a estas dosis más altas de antihistamínicos H1, se recomienda el tratamiento con omalizumab (hasta 24 semanas) para lograr el control de la enfermedad. Después de este período de 24 semanas, se debe definir el perfil de respuesta del paciente a omalizumab para identificar a los pacientes refractarios. El enfoque de manejo óptimo para pacientes refractarios no ha sido establecido. En este contexto, el objetivo del presente estudio de consenso de expertos que involucró a un grupo de especialistas (alergólogos y dermatólogos) con experiencia específica en el tratamiento de la urticaria fue definir perfiles de pacientes específicos en función de sus diferentes respuestas a omalizumab. Otro objetivo fue desarrollar un algoritmo de tratamiento basado en el perfil de respuesta específico. Primero, se realizó una revisión exhaustiva de la literatura. Luego, se llevó a cabo una reunión grupal para discutir todos los temas relacionados con el manejo terapéutico de estos pacientes que no se habían abordado en ningún estudio previo. En todos los casos, los expertos consideraron tanto la evidencia disponible como su propia experiencia clínica con omalizumab. Creemos que la implementación de este algoritmo propuesto ayudará a optimizar la gestión de los pacientes con CSU que son refractarios al tratamiento con antihistamínicos, reduciendo los costos relacionados con la enfermedad y mejorando la calidad de vida de los pacientes

Humanos , Antialérgicos/administração & dosagem , Omalizumab/administração & dosagem , Urticária/tratamento farmacológico , Antialérgicos/efeitos adversos , Ensaios Clínicos como Assunto , Gerenciamento Clínico , Omalizumab/efeitos adversos , Qualidade de Vida , Resultado do Tratamento , Doença Crônica
Dermatology ; 229(3): 163-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25323638


BACKGROUND: Cutaneous adverse drug reactions (CADRs) due to bisphosphonates (BPs) have been scarcely described in the literature. OBJECTIVE: To discuss the diagnostic value and limitations of cutaneous provocation tests with BPs. METHODS: A descriptive case series study with a control group of CADRs due to BPs studied using patch testing from 2005 to 2010 is presented. RESULTS: Patient 1 showed a positive D4++ with alendronate at 1% in petrolatum and D4+++ with alendronate at 1 and 0.1% in water. Patient 2 showed a positive intradermal test D3++ with alendronate at 0.1% in water. Patient 3 showed a positive patch test D4+ with ibandronate at 1% in petrolatum and D4++ with ibandronate at 1% in water, and a positive intradermal test D3+++ with ibandronate at 0.1% in water. CONCLUSION: Establishing a correct interpretation of a patch test reaction is difficult based just on cutaneous test results. Too high concentrations of the drug can cause irritation and too low concentrations can be responsible of false-negative test reactions.

Difosfonatos/efeitos adversos , Erupção por Droga/diagnóstico , Erupção por Droga/etiologia , Testes do Emplastro/métodos , Idoso , Alendronato/efeitos adversos , Alendronato/uso terapêutico , Estudos de Casos e Controles , Difosfonatos/uso terapêutico , Feminino , Humanos , Ácido Ibandrônico , Masculino , Valores de Referência , Estudos Retrospectivos , Amostragem , Sensibilidade e Especificidade , Índice de Gravidade de Doença
Contact Dermatitis ; 65(5): 286-92, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21767276


BACKGROUND: Formaldehyde and formaldehyde-releasers are common causes of allergic contact dermatitis. OBJECTIVES: To determine the frequency of sensitization to formaldehyde and seven formaldehyde-releasers. To establish and characterize groups of patients according to the results of patch testing. MATERIALS AND METHODS: We performed a 5-year retrospective study, in six Spanish hospitals, of patients with positive patch test reactions to formaldehyde or any of seven formaldehyde-releasers. RESULTS: The most frequent allergens were formaldehyde (1.72%), imidazolidinyl urea (1.05%), quaternium-15 (0.88%), and diazolidinyl urea (0.79%). Patients with sensitization to only formaldehyde had a higher frequency of occupational dermatitis (25%) than patients with sensitization to only formaldehyde-releasers (9.5%). The most common sites of dermatitis were the hands (31.7%) in patients with sensitization to only formaldehyde and the face and legs (31.3% and 24.6%) in patients with sensitization to only formaldehyde-releasers. We found a subgroup of 25 patients who were sensitized to both imidazolidinyl urea and diazolidinyl urea, and only 6 of these (24%) were also sensitized to formaldehyde. CONCLUSIONS: The inclusion of imidazolidinyl urea and diazolidinyl urea in the baseline series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) should enable better classification of patients allergic to formaldehyde, and could aid in their management.

Alérgenos/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Formaldeído/efeitos adversos , Adulto , Dermatite Ocupacional/etiologia , Dermatoses Faciais/etiologia , Dermatoses da Mão/etiologia , Humanos , Hidantoínas/efeitos adversos , Dermatoses da Perna/etiologia , Masculino , Metenamina/efeitos adversos , Metenamina/análogos & derivados , Testes do Emplastro , Propilenoglicóis/efeitos adversos , Estudos Retrospectivos , Espanha , Triazinas/efeitos adversos , Ureia/efeitos adversos , Ureia/análogos & derivados
Contact Dermatitis ; 65(4): 213-9, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21702757


BACKGROUND: Hand eczema is common in children, but affected children are seldom patch tested. Relatively few studies have assessed patch testing in the paediatric population, and none has specifically evaluated its use in hand eczema in children. OBJECTIVES: The aim of this study was to determine the prevalence of contact allergy in children with hand eczema, and to identify the most frequent allergens and their relevance. MATERIAL AND METHODS: We performed a 5-year retrospective study of children (aged 0-15 years) with hand eczema tested with the Spanish baseline series at the Dermatology Departments of 11 Spanish hospitals. RESULTS: During the study period, 11 729 patients were patch tested, of whom 480 were children. Hand eczema was present in 111 (23.1%) of the children and in 3437 (30.5%) of the adults. Of the children with hand eczema, 46.8% had at least one positive reaction in the patch tests. Current relevance was found for 78% of the allergens detected. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, and fragrance mix I. Allergic contact dermatitis was the most frequent diagnosis (36%), followed by atopic dermatitis. CONCLUSIONS: Allergic contact dermatitis was the most usual diagnosis in our series of children with hand eczema. We recommend patch testing of all children with chronic hand eczema, as is already performed in adults.

Alérgenos , Eczema/diagnóstico , Dermatoses da Mão/diagnóstico , Testes do Emplastro , Adolescente , Criança , Pré-Escolar , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/epidemiologia , Eczema/epidemiologia , Feminino , Dermatoses da Mão/epidemiologia , Humanos , Masculino , Níquel/toxicidade , Perfumes/efeitos adversos , Prevalência , Estudos Retrospectivos , Espanha/epidemiologia , Tiazóis/toxicidade
Contact Dermatitis ; 61(1): 31-8, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19659962


BACKGROUND: Continual surveillance based on patch test results has proved useful for the identification of contact allergy. OBJECTIVES: To provide a current view on the spectrum of contact allergy to important sensitizers across Europe. PATIENTS/METHODS: Clinical and patch test data of 19 793 patients patch tested in 2005/2006 in the 31 participating departments from 10 European countries (the European Surveillance System on Contact Allergies' (ESSCA) were descriptively analysed, aggregated to four European regions. RESULTS: Nickel sulfate remains the most common allergen with standardized prevalences ranging from 19.7% (central Europe) to 24.4% (southern Europe). While a number of allergens shows limited variation across the four regions, such as Myroxylon pereirae (5.3-6.8%), cobalt chloride (6.2-8.8%) or thiuram mix (1.7-2.4%), the differences observed with other allergens may hint on underlying differences in exposures, for example: dichromate 2.4% in the UK (west) versus 4.5-5.9% in the remaining EU regions, methylchloroisothiazolinone/methylisothiazolinone 4.1% in the South versus 2.1-2.7% in the remaining regions. CONCLUSIONS: Notwithstanding residual methodological variation (affecting at least some 'difficult' allergens) tackled by ongoing efforts for standardization, a comparative analysis as presented provides (i) a broad overview on contact allergy frequencies and (ii) interesting starting points for further, in-depth investigation.

Alérgenos , Dermatite Alérgica de Contato/etiologia , Dermatite Atópica/etiologia , Dermatite Ocupacional/etiologia , Adulto , Dermatite Alérgica de Contato/epidemiologia , Dermatite Atópica/epidemiologia , Dermatite Ocupacional/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência