Perfil de Pacientes com Esofagite Eosinofílica e Associação com Doenças Atópicas: uma Série de Casos / Profile of Patients with Eosinophilic Esophagitis and Association with Atopic Diseases: a Case Series

Introdução: A esofagite eosinofílica (EEo) é uma doença que está ganhando cada vez mais destaque no cotidiano de gastroenterologistas e alergologistas, visto que sua prevalência vem aumentando e, hoje, é considerada a segunda causa mais comum de esofagite crônica, atrás da doença do refluxo gastroesofágico. A identificação do perfil clínico desses pacientes, da presença de outras doenças atópicas relacionadas ao quadro e o conhecimento dos principais arsenais terapêuticos disponíveis são de grande importância, pois é considerada uma doença relativamente recente, crônica e recidivante, para a qual ainda existem muitas controvérsias na literatura atual. Métodos: Estudo observacional retrospectivo, com coleta de dados secundários e abordagem quantitativa. Mediante prontuários de pacientes diagnosticados com EEo atendidos em consultório privado do sul de Santa Catarina de 2015 a 2018. Resultados: Foram incluídos 11 pacientes, com predomínio do sexo feminino (54,5%), idades entre 19 e 34 anos (90,1%), possuindo estado civil solteiro (66,7%). Entre as atopias associadas, ressaltaram-se a alergia alimentar (90,9%) e alergia a animais (54,5%). A maioria com história familiar de manifestações atópicas (81,8%). Quando avaliadas as comorbidades prevalentes, houve predomínio de intolerância à lactose (25%). Realizam algum tratamento para a EEo (100%), predominando uso exclusivo de Inibidores da Bomba de Prótons (IBP) (27,3%). Conclusão: Perfil dos pacientes com EEo atendidos em um consultório privado na região de Criciúma/SC é de mulheres com idade entre 19-34 anos, solteiras, apresentando atopias, principalmente alergia alimentar e alergia a animais, com história familiar de atopias, possuindo intolerância à lactose concomitante e em tratamento para EEo com IBP.

Introduction: Eosinophilic esophagitis (EoE) is a disease progressively gaining prominence in the daily lives of gastroenterologists and allergists since its prevalence has been increasing and, today, it is considered the second most common cause of chronic esophagitis, after the gastroesophageal reflux disease. The identification of the clinical and epidemiological profile of these patients, the presence of other atopic diseases related to the condition, and knowledge of the main therapeutic arsenals available is of great importance since it is considered a relatively recent, chronic, and recidivating disease, for which there are still many controversies in the current literature. Methods: This was a retrospective observational study, with secondary data collection and a quantitative approach. Using medical records of patients diagnosed with EoE seen in private practice in southern Santa Catarina from 2015 to 2018. Results: 11 patients were included, with a predominance of females (54.5%), ages between 19 and 34 years (90.1%), and most single (66.7%). Among the associated atopic manifestations, food allergy (90.9%) and animal allergy (54.5%) stood out. Most had a family history of atopic manifestations (81.8%). After evaluating the prevalent comorbidities, the study found a predominance of lactose intolerance (25%). They underwent some treatment for EoE (100%), predominantly the exclusive use of proton pump inhibitors (PPIs) (27.3%). Conclusion: The epidemiological profile of patients with EoE seen in private practice in the Criciúma region are women aged 19-34 years, single, presenting atopic diseases, mainly food allergy and animal allergy, with a family history of atopic diseases, concomitant lactose intolerance, and being treated for EoE with PPIs.

Investigation of oral atopic diseases: Correlation between geographic tongue and fungiform papillary glossitis.

INTRODUCTION: The correlation between oral lesions and atopy is not new, but few studies have investigated the prevalence of mucosal changes in diseases within the atopic spectrum, leading to conflicting data. Some studies found a possible relationship between geographic tongue, transient lingual papillitis and atopic diseases. AIM: To investigate the frequency of geographic tongue and fungiform papillary glossitis in patients with atopic diseases, and its correlation with serum IgE levels and skin test results. MATERIAL AND METHODS: The sample was comprised of participants with atopic diseases paired with participants who received negative puncture skin tests. All were submitted to stomatological and medical evaluations, prick test and oral cytopathological. RESULTS: The female sex was more numerous in both groups. Mean age was 21 years. A total of 60 diagnoses of atopic diseases were obtained, with allergic rhinitis being the most prevalent. Fungiform papillary glossitis was the most frequent oral lesion in both groups, while geographic tongue was present in 2 cases (2%) in the test group and 2 (2%) in the control group. Atopic patients with fungiform papillary glossitis presented high serum IgE levels. In atopic patients with geographic tongue, the prick test positively identified extracts of Dermatophagoides pteronyssinus (100%) and Dermatophagoides farinae (100%). CONCLUSION: Due to the low frequency of geographic tongue lesions found in the study, it is no possible to conclude if that could be an oral manifestation of atopy. However fungiform papillary glossitis is a common alteration in atopic and non-atopic patients and has a relationship with high IgE serum levels. However, the consolidation of this result requires a larger sample size.

Controle ambiental: prevenção e manejo das doenças atópicas / Environmental control: prevention and management of atopic diseases

A asma é uma das doenças crônicas mais prevalentes no mundo, sendo que 50% a 80% dos pacientes apresentam o fenótipo alérgico. A asma resulta da interação entre predisposição genética e exposição ambiental. Os aeroalérgenos perenes, especialmente os ácaros da poeira doméstica, são considerados um dos responsáveis pelo aumento da prevalência da asma em todo mundo. O controle ambiental é uma das medidas necessárias para o tratamento e controle da asma.

Asthma is one of the most prevalent chronic diseases worldwide, and 50 to 80% of affected patients have the allergic phenotype. Asthma results from the interaction between genetic predisposition and environmental exposure. Perennial aeroallergens, especially household dust mites, are considered one of the reasons for the increase in the prevalence of asthma worldwide. Environmental control is a necessary measure to treat and control asthma.

Incidence of Childhood Eosinophilic Esophagitis in Central Brazil: How Many Are We Missing?

BACKGROUND: Few studies have assessed the incidence of eosinophilic esophagitis (EoE) in childhood. Our study aimed to determine the incidence of EoE in pediatric patients undergoing upper gastrointestinal endoscopy (UGE), with analysis of epidemiological data including sex, age, symptoms, frequency of atopy, and endoscopic and histological findings. METHODS: We performed a retrospective, observational, analytical study of the medical records of patients aged 0 to 14 years who underwent UGE in a tertiary hospital from January 2004 to January 2014. RESULTS: A total of 4071 upper digestive endoscopies were performed in 2651 patients. Esophageal eosinophilia was found in 405 biopsy reports, and 127 patients had ≥15/HPF. The clinical histories of 70 patients were analyzed. Sixty-three fulfilled the diagnostic criteria for EoE, 3 fulfilled the criteria for eosinophilic gastroenteritis, and 4 cases were secondary to caustic ingestion. The mean annual incidence was 2.48/100 000 individuals/year and the cumulative incidence over 10 years was 24.8/100 000. No statistical differences were found between responders to proton pump inhibitors and nonresponders for age, gender, atopic diseases, symptoms, and endoscopy findings. CONCLUSIONS: The incidence of EoE in the present study was similar to that reported in the literature. However, these data may be underestimated owing to difficulties accessing UGE. Increased knowledge of esophageal eosinophilic diseases in childhood requires associated improvements in health infrastructure.

La sensibilización a hongos ambientales y su relación con enfermedades atópicas en escolares / The sensitivity to environmental fungus and its relation to atopic diseases present in school children

Las enfermedades alérgicas y el asma, sobre todo en la población infantil, son afecciones muy frecuentes en todo el mundo y en Cuba. Con el objetivo de determinar la frecuencia de sensibilización a hongos ambientales y su relación con enfermedades atópicas, se realizó un estudio analítico transversal en 100 escolares de 6 a 7 años de una escuela primaria de San Antonio de los Baños, provincia La Habana, en el período comprendido entre septiembre de 2006 y marzo de 2007. El 27 por ciento de la muestra seleccionada padecía de asma, el 40 por ciento de rinitis alérgica y el 26 por ciento de dermatitis atópica. La sensibilización micótica más frecuente resultó Penicillium, para un 50 por ciento de la muestra. No hubo una asociación estadísticamente significativa entre reactividad cutánea a hongos ambientales y la presencia de enfermedades atópicas; tampoco fue significativa su asociación con la enfermedad alérgica respiratoria ni dermatitis atópica. Se concluye que la mayor sensibilización a hongos anemófilos se apreció al Penicillium, aunque sin asociación con la presencia de enfermedades atópicas(AU)

The allergic diseases and the asthma, mainly in children, are very frequent affections at world level and in Cuba. The objective of present paper was to determine the sensitization frequency to environmental fungi and its relation to atopic diseases, thus, a cross-sectional and analytical study was conducted in 100 school children aged 6 to 7 from a primary school of San Antonio de los Ba±os, La Habana province, from September 2006 to March, 2007. The 27 percent of the selected sample suffered from asthma, the 40 percent of allergic rhinitis, and the 26 percent had Penicillium for the 50 percent of sample. There was not a significant statistic association between the cutaneous reactivity to environmental fungi and the presence of atopic diseases and its association with the respiratory allergic disease as well as the atopic dermatitis was not significant. We conclude that the greater sensitization to anemophilic fungi was to Penicillium, although without an association with the presence of atopic diseases(AU)

La sensibilización a hongos ambientales y su relación con enfermedades atópicas en escolares / The sensitivity to environmental fungus and its relation to atopic diseases present in school children

Las enfermedades alérgicas y el asma, sobre todo en la población infantil, son afecciones muy frecuentes en todo el mundo y en Cuba. Con el objetivo de determinar la frecuencia de sensibilización a hongos ambientales y su relación con enfermedades atópicas, se realizó un estudio analítico transversal en 100 escolares de 6 a 7 años de una escuela primaria de San Antonio de los Baños, provincia La Habana, en el período comprendido entre septiembre de 2006 y marzo de 2007. El 27 por ciento de la muestra seleccionada padecía de asma, el 40 por ciento de rinitis alérgica y el 26 por ciento de dermatitis atópica. La sensibilización micótica más frecuente resultó Penicillium, para un 50 por ciento de la muestra. No hubo una asociación estadísticamente significativa entre reactividad cutánea a hongos ambientales y la presencia de enfermedades atópicas; tampoco fue significativa su asociación con la enfermedad alérgica respiratoria ni dermatitis atópica. Se concluye que la mayor sensibilización a hongos anemófilos se apreció al Penicillium, aunque sin asociación con la presencia de enfermedades atópicas

The allergic diseases and the asthma, mainly in children, are very frequent affections at world level and in Cuba. The objective of present paper was to determine the sensitization frequency to environmental fungi and its relation to atopic diseases, thus, a cross-sectional and analytical study was conducted in 100 school children aged 6 to 7 from a primary school of San Antonio de los Ba±os, La Habana province, from September 2006 to March, 2007. The 27 percent of the selected sample suffered from asthma, the 40 percent of allergic rhinitis, and the 26 percent had Penicillium for the 50 percent of sample. There was not a significant statistic association between the cutaneous reactivity to environmental fungi and the presence of atopic diseases and its association with the respiratory allergic disease as well as the atopic dermatitis was not significant. We conclude that the greater sensitization to anemophilic fungi was to Penicillium, although without an association with the presence of atopic diseases

Marcha atópica / Atopic march

Objetivo: Rever a literatura a respeito do conceito de marcha atópica, suas bases teóricas e evidências clínicas. Tal conhecimento é importante no entendimento e aplicação dos princípios de prevenção primária e secundária das doenças atópicas. Fontes dos dados: Pesquisa bibliográfica em base eletrônica de dados, limitando a busca a artigos publicados nos últimos 15 anos, referentes a pesquisas ou estudos clínicos em seres humanos e estudos experimentais, escritos em português ou inglês. Referências a livros pertinentes ao tema também foram incluídas. Foram selecionados os artigos mais citados e com metodologia e discussão melhor estruturados dentro do tema dermatite atópica / marcha atópica. Síntese dos dados: O conceito de marcha atópica é uma tentativa de se explicar a inter-relação entre as doenças atópicas, assim como as características da história natural de cada uma delas. Tal conceito baseia-se em estudos clínicos que demonstraram que, em cerca de 50% dos indivíduos predispostos, as doenças atópicas ocorrem de forma seqüencial, sendo a dermatite atópica considerada como o primeiro passo desta marcha. Conclusões: A partir de dados coletados em estudos sobre prevalência de doenças atópicas e os possíveis fatores determinantes envolvidos no desenvolvimento das mesmas, princípios de prevenção primária e secundária podem ser recomendados e implementados.

Objective: To review the literature on atopic march concept, its theoretical basis and clinicai evidences. This knowledge is important to understand and to apply the principies of primary and secondary atopic diseases prevention. Data sources: A bibliographic search was done in electronic database, limited to articles published in the last 15 years, related to human research or experimental research, written in Portuguese or English. Some book relevant references were also included. The articles about atopic dermatitis and atopic march were selected according to the number of citation and the better methodology and discussion. Data synthesis: The atopic march concept is a trial to explain the relationship between the atopic diseases and the natural evolution of each one. Clinicai researches have demons¬trated that in something about 50% of predisposed individual, the atopic diseases occurred in a sequence way, being the atopic dermatitis the first step in this marcho Conclusions: Principies of primary e secondary prevention can be recommended and implemented after review the data collected in studies about prevalence of atopic diseases and the factors involved in the development of such diseases.