Cómo proceder ante personal sanitario alérgico a la vacuna de ARNm contra el COVID-19 / How to deal with healthcare workers allergic to COVID-19 mRNA vaccine

Notifican al Servicio de Prevención y Riesgos Laborales el caso de una enfermera de 37 años que refiere rinorrea acuosa y prurito generalizado 10-15 minutos tras la administración de la primera dosis vacunal generada por BioNTech/Pfizer. Presenta: eritema facial, habón maxilar y constantes normales. ¿Cómo debe actuar el Servicio de Prevención y Riesgos Laborales (SPRL) frente a una trabajadora sanitaria que sufre una reacción alérgica a la vacuna de ARNm contra el COVID-19?Este caso clínico llama la atención sobre medidas preventivas habituales como la vacunación pero también sobre otras como la colaboración entre diferentes servicios hospitalarios, el manejo y diagnóstico por Alergología, seguimiento del Servicio de Prevención y notificación de efectos vacunales adversos por Farmacología Clínica.La coordinación entre estos servicios resulta fundamental para el correcto manejo de trabajadores afectados por reacciones adversas frente a la primera dosis vacunal contra el COVID-19 pudiendo quedar vacunados y protegidos. (AU)

The Occupational Risk and Prevention Service is notified the case of a 37-year-old nurse who reported watery rhinorrhea and generalized itching 10-15 minutes after first dose of the vaccine produced by BioNTech/Pfizer’s administration. She presents: facial erythema, maxillary wheal and normal constants. How should the Occupational Risk and Prevention Service should deal with a health worker who suffers an allergic reaction to the mRNA vaccine against COVID-19?This clinical case draws attention to common preventive measures such as vaccination, but also to others such as collaboration between different hospital services, management and diagnosis by Allergology, follow-up by the Occupational Risk and Prevention Service and notification of adverse vaccine effects by Clinical Pharmacology.Coordination between these services is essential for the correct management of workers affected by adverse reactions to the first vaccine dose against COVID-19, being the workers able to be vaccinated and protected. (AU)

Effect of chronic lithium on mechanical sensitivity and trabecular bone loss induced by type-1 diabetes mellitus in mice.

Type-1 diabetes mellitus (T1DM) is a chronic condition characterized by long-term hyperglycemia that results in several complications such as painful peripheral neuropathy, bone deterioration, and increased risk of bone fractures. Lithium, a first-line therapy for bipolar disorder, has become an attractive agent for attenuating peripheral neuropathy and menopause-induced bone loss. Therefore, our aim was to determine the effect of chronic lithium treatment on mechanical hypersensitivity and trabecular bone loss induced by T1DM in mice. T1DM was induced in male C57BL/6J mice by intraperitoneal injection of streptozotocin (STZ, 50 mg/kg/day, for 5 consecutive days). 12 weeks after T1DM-induction, mice received a daily intraperitoneal injection of vehicle, 30 or 60 mg/kg lithium (as LiCl) for 6 weeks. Throughout the treatment period, blood glucose levels and mechanical sensitivity were evaluated every 2 weeks. After lithium treatment, the femur and L5 vertebra were harvested for microcomputed tomography (microCT) analysis. T1DM mice showed significant hyperglycemia, mechanical hypersensitivity, and significant trabecular bone loss as compared with the control group. Chronic lithium treatment did not revert the hindpaw mechanical hypersensitivity nor hyperglycemia associated to T1DM induced by STZ. In contrast, microCT analysis revealed that lithium reverted, in a dose-dependent manner, the loss of trabecular bone associated to T1DM induced by STZ at both the distal femur and L5 vertebra. Lithium treatment by itself did not affect any trabecular bone parameter in non-diabetic mice.

Colitis eosinofílica asociada a enfermedad inflamatoria intestinal / Eosinophilic colitis associated with inflammatory bowel disease

INTRODUCCIÓN: La colitis eosinofílica y la colitis de la enfermedad inflamatoria intestinal, son dos entidades que pueden compartir similares características clínicas, endoscópicas y terapéuticas pero diferentes criterios diagnósticos. OBJETIVOS: Describir el caso clínico de un niño preescolar con antecedente de alergia alimentaria, de hospitalizaciones y uso de antibióticos por varias ocasiones, que evoluciona con diarrea crónica intermitente. CASO CLÍNICO: Se trata de un paciente masculino, de 3 años 5 meses, con antecedente de alergia alimentaria con cuadro crónico de dolor abdominal, diarrea y retraso en el crecimiento. Se realiza abordaje de diarrea crónica. RESULTADOS: Con hallazgos clínicos de enfermedad inflamatoria intestinal y descripción histopatológica de colitis eosinofílica, se considera la asociación entre estas dos patologías sin dejar la posibilidad de que esta última se trate de una fase inicial de enfermedad inflamatoria intestinal. CONCLUSIONES: El tratamiento de pacientes con colitis eosinofílica complicada es similar a la enfermedad inflamatoria intestinal, se requiere seguimiento clínico, endoscópico e histopatológico de pacientes con colitis eosinofílica a largo plazo.

INTRODUCTION: Eosinophilic colitis and inflammatory bowel disease colitis are two entities that may share similar clinical, endoscopic and therapeutic features but different diagnostic criteria. OBJECTIVES: To describe the clinical case of a preschool child with a history of food allergy, hospitalizations and use of antibiotics for several occasions, who evolves with chronic intermittent diarrhea. CLINICAL CASE: This is a male patient, 3 years 5 months old, with a history of food allergy with chronic abdominal pain, diarrhea and growth retardation. Chronic diarrhea was approached. RESULTS: With clinical findings of inflammatory bowel disease and histopathological description of eosinophilic colitis, the association between these two pathologies is considered without leaving the possibility that the latter is an initial phase of inflammatory bowel disease. CONCLUSIONS: The treatment of patients with complicated eosinophilic colitis is similar to inflammatory bowel disease, clinical, endoscopic and histopathological follow-up of patients with eosinophilic colitis is required in the long term.

Actualización en el manejo perioperatorio del paciente ambulatorio alérgico al látex / Update on the perioperative management of the latex allergic out patient

Introducción: Actualmente la alergia al látex es un problema de salud que no tiene cura, y presenta alta prevalencia entre los trabajadores sanitarios, grupos de riesgo y población general. La evitación del látex es actualmente el tratamiento más eficaz y la clave para la prevención de las reacciones alérgicas en los individuos sensibilizados. El diagnóstico correcto precisa de la combinación de tres criterios: historial del paciente, prueba cutánea y análisis de IgE específica. El manejo de protocolos permitirá evitar la manifestación clínica de una reacción eventualmente mortal. Objetivos: Nuestros objetivos son evaluar la seguridad del paciente alérgico al látex en el periodo perioperatorio mediante la utilización de un protocolo sin premedicación, e identificar las pruebas diagnósticas para el látex realizadas a los pacientes. Pacientes y métodos: Se diseña estudio descriptivo, observacional y transversal, no aleatorizado. Resultados: Es una muestra de 90 pacientes; el 16 % varones y el 84 % mujeres. De ellos, el 28 % eran sanitarios y al 41 % de los pacientes se les practicó el Prick test. El 30 % no realizó prueba alguna, pero consideran alérgicos por tener problemas con guantes y preservativos. Conclusiones: Aunque la administración preoperatoria de fármacos sigue siendo motivo de controversia, nuestro protocolo perioperatorio sin premedicación aporta seguridad al paciente alérgico al látex ante una intervención quirúrgica. Las personas que presentan signos y síntomas relacionados con la alergia al látex deben ser diagnosticados por un especialista (AU)

Introduction: Currently, latex allergy is a health problem that has no cure; it has a high prevalence among health workers, risk groups, and the general population. Avoidance of latex is currently the most effective treatment and the key to the prevention of allergic reactions in sensitized individuals. Correct diagnosis requires the combination of three criteria: patient history, skin test, and specific IgE analysis.Management of protocols may allow to avoid the clinical manifestation of a potentially fatal reaction. Objectives: Our objectives are to evaluate the safety of patients with latex allergies in the perioperative period using a protocol without premedication, and to identify the diagnostic tests for latex performed on patients. Patients and methods: A descriptive, observational and not randomized cross-sectional study was designed. Results: A sample of 90 patients, 16 % men and 84 % women, was used. Of these, 28 % were healthcare professionals and 41 % patients underwent the Prick test. 30 % did not perform any tests but they were considered to be allergic due to having problems with gloves and condoms. Conclusions: Although preoperative administration of drugs continues to be controversial, our perioperative protocol with no premedication provides safety for patients with latex allergy in the face of a surgical intervention. People who ha vesigns and symtoms related to latex allergy should be diagnosed by a specialist (AU)

Penicillin desensitization in allergic pregnant women with syphilis. Report of two cases / Desensibilización a penicilina en mujeres embarazadas alérgicas. Informe de dos casos

ABSTRACT Syphilis during pregnancy has a high risk of congenital transmission with disastrous fetal consequences. Penicillin (PNC) is the only effective antimicrobial for the treatment of pregnant women with syphilis. Chilean guidelines do not consider desensitization to PNC in these women. We report two cases of pregnant women aged 32 and 23 years, with immediate allergy to PNC and syphilis who were safely and successfully desensitized using a four-hour intravenous protocol in the critical care unit and who subsequently received benzathine G PNC. An electronic survey was conducted among approximately 100 Clinical Pharmacists (CP) in the country. Of these, 16 answered and 13 reported having experience in drug desensitization, in at least five cases with PNC and none reported deaths or cardiorespiratory arrest. Desensitization to PNC can be carried out safely and in Chile, this alternative should be incorporated to the management of pregnant women with syphilis and immediate allergy to PNC, instead of using erythromycin.

La sífilis durante el embarazo tiene un alto riesgo de transmisión congénita con consecuencias desastrosas para el feto. La penicilina (PNC) es el único compuesto efectivo para el tratamiento de sífilis en una mujer embarazada.. En Chile, ante alergias de tipo inmediata, no se considera la desensibilización a la PNC en mujeres embarazadas por norma ministerial. Se comunican dos casos de mujeres embarazadas con alergia tipo inmediata y sífilis durante la gestación que fueron desensibilizadas a este compuesto con un protocolo endovenoso de 4 horas en la unidad de pacientes críticos, sin observar complicaciones, recibiendo posteriormente PNC G Benzatina. Se efectuó una encuesta electrónica a farmacéuticos clínicos del país que incluyó más de 100 profesionales. De ellos, 16 contestaron y 13 declararon poseer experiencia en desensibilización de fármacos, en al menos cinco casos con PNC y ninguno reportó muertes o paro cardiorrespiratorio. La desensibilización a PNC puede ser efectuada en forma segura en embarazadas con alergia de tipo inmediata a PNC que cursan con sífilis. En Chile se debería incorporar esta alternativa en el manejo de mujeres embarazadas con sífilis y alergia inmediata a PNC en lugar de solo considerar por norma el uso de eritromicina.

Sensibilización a aeroalérgenos en una población pediátrica peruana con enfermedades alérgicas / Sensitization to aeroallergens in a peruvian pediatric population with allergic diseases

RESUMEN Con el objetivo de determinar el perfil de sensibilización a aeroalérgenos en pacientes pediátricos con asma y/o rinitis alérgica se realizó un estudio transversal en 411 pacientes usando una prueba cutánea de alergia. Se analizó la edad, sexo, nivel de IgE total y eosinófilos. La edad media fue de 8,1 ± 3,7 años y el 60,6% fueron varones. La media de los eosinófilos y el nivel de IgE total fue de 450,1 ± 377,3 células/mm3 y 861,7 ± 757,6 IU/mL, respectivamente. Los ácaros fueron los alérgenos sensibilizantes más frecuentes (79,8%) y el Dermatophagoides farinae (65,2%) fue el más común. La polisensibilización estuvo presente en el 76,2% de los pacientes. La sensibilización se evidenció en la mayoría de los pacientes con asma y/o rinitis alérgica y estuvo asociada con la edad, grupos etarios y nivel de IgE total.

ABSTRACT In order to determine the profile of sensitization to aeroallergens in pediatric patients with asthma and / or allergic rhinitis, a cross-sectional study was carried out in 411 patients using an allergy skin test. Age, sex, total IgE level and eosinophils were analyzed. The mean age was 8.1 ± 3.7 years and 60.6% were male. The average of the eosinophils and the level of total IgE was 450.1 ± 377.3 cells / mm3 and 861.7 ± 757.6 IU / mL, respectively. Mites were the most frequent sensitizing allergens (79.8%) and Dermatophagoides farinae (65.2%) was the most common. Polysensitization was present in 76.2% of patients. Sensitization was evident in the majority of patients with asthma and / or allergic rhinitis and was associated with age, age groups and total IgE level.

Tos crónica por hipersensibilidad refleja: un nuevo paradigma con implicancias diagnósticas y terapéuticas / Cough hypersensitivity syndrome: a new paradigm with diagnostic and therapeutic implications

La tos es un reflejo protector del aparato respiratorio que si se prolonga en el tiempo puede afectar seriamente la calidad de vida. Recientemente un nuevo paradigma califica a la tos por hipersensibilidad refleja consecuente a una exagerada sensibilidad de las terminaciones nerviosas periféricas a diversos estímulos y a alteraciones en los núcleos centrales integradores del reflejo. Este nuevo paradigma tiene implicancias terapéuticas, más allá del tratamiento de la causa de la tos. En este artículo se revisarán los nuevos mecanismos implicados en la tos por hipersensibilidad refleja y las nuevas drogas en investigación que modulan el reflejo tusígeno. A pesar de las nuevas investigaciones farmacológicas se necesitan evidencias más seguras para aconsejar un tratamiento "sintomático" de estos pacientes que contribuya al control de la hipersensibilidad central y periférica del reflejo de la tos.

Cough is a protective reflex of the respiratory system that if persist over time can seriously affect the quality of life. Recently, a new paradigm qualifies cough as a consequence of a reflex hypersensitivity resulting from an exaggerated sensitivity of the peripheral nerve endings to various stimuli and central neural alterations in cough processing. This new paradigm has therapeutic implications, beyond the causal treatment of cough. In this article we will review the new mechanisms involved in cough due to reflex hypersensitivity and new therapeutic strategies under development that modulate the cough reflex. Despite the new pharmacological investigations, safer evidence is needed to advise a "symptomatic" treatment of these patients that contributes to the control of central and peripheral hypersensitivity of the cough reflex

Prevalencia e impacto clínico de la sensibilización a látex y frutas en estudiantes de odontología de la Universidad de Antioquia y su relación con alergia a frutas / Prevalence and clinical impact of sensitization to latex and fruits in dentistry students at the University of Antioquia, and its relationship with allergy to fruits / Prevalência e impacto clínico da sensibilização a látex e frutas em estudantes de Odontologia da Universidade de Antioquia e sua relação com alergia a frutas

Objetivo: determinar la prevalencia y el impacto clínico de la sensibilización al látex y a cinco frutas tropicales (banano, aguacate, kiwi, piña y maracuyá) en estudiantes de odontología. Métodos: estudio transversal analítico de 128 estudiantes de odontología de la Universidad de Antioquia; se recolectó la información mediante un cuestionario y se hicieron pruebas intraepidérmicas con látex y frutas. Resultados: todos los estudiantes habían tenido contacto con látex; nueve refirieron al menos un episodio de reacción adversa al contacto con látex sin sensibilización probada al mismo. Cinco informaron al menos una reacción con una de las frutas, pero los resultados fueron negativos en las pruebas cutáneas. Cuatro de los 14 que informaron síntomas gastrointestinales estaban sensibilizados al látex o a alguna de las frutas. La tasa global de sensibilización al látex fue del 3,1%. Conclusión: el porcentaje de sensibilización al látex hallado en nuestro estudio está por debajo del publicado lo que puede ser debido a la expresión de mecanismos inmunológicos diferentes a la mediación IgE. No se logró demostrar más sensibilización al látex en función del mayor número de semestres cursados. Se debe destacar la asociación entre síntomas gastrointestinales y la sensibilización tanto a frutas como al látex.

Objective: To determine the prevalence and clinical impact of sensitization to latex and to five tropical fruits (banana, avocado, kiwi, pineapple and passion fruit) in dentistry students. Methods: Analytical cross-sectional study of 128 dentistry students at University of Antioquia in Medellín, Colombia. Information was collected by means of a questionnaire and skin prick tests with latex and fruits were done. Results: All students reported having had contact with latex. Nine of them informed at least one episode of adverse reaction to contact with latex without proof of sensitization to it. Five reported at least one reaction with one of the fruits, but skin prick tests were negative. Four of the 14 students who reported gastrointestinal symptoms were sensitized to latex or to one of the tested fruits. Overall, latex sensitization rate was 3.1%. Conclusion: This percentage of sensitization to latex is lower than that in other studies; this may be due to the expression of immune mechanisms other than IgE mediation. We failed to demonstrate a higher sensitization rate to latex as students advanced in their career. The association between gastrointestinal symptoms and sensitization to both fruit and latex is to be emphasized.

Objetivo: determinar a prevalência e o impacto clínico da sensibilização ao látex e a cinco frutas tropicais (banana, abacate, kiwi, pinha e maracujá) em estudantes de odontologia. Métodos: estudo transversal analítico de 128 estudantes de odontologia da Universidade de Antioquia; coletou-se a informação mediante um questionário e se fizeram provas intraepidérmicas com látex e frutas. Resultados: todos os estudantes tinham tido contato com látex; nove referiram ao menos um episódio de reação adversa ao contato com látex sem sensibilização provada ao mesmo. Cinco informaram ao menos uma reação com uma das frutas, mas os resultados foram negativos nas provas cutâneas. Quatro dos 14 que informaram sintomas gastrointestinais estavam sensibilizados ao látex ou a alguma das frutas. A taxa global de sensibilização ao látex foi de 3,1%. Conclusão: a porcentagem de sensibilização ao látex achado em nosso estudo está por embaixo do publicado, que pode ser devido à expressão de mecanismos imunológicos diferentes à mediação IgE. Não se conseguiu demonstrar mais sensibilização ao látex em função do maior número de semestres cursados. Deve-se destacar a associação entre sintomas gastrointestinais e a sensibilização tanto a frutas como ao látex.

Tratamento da hipersensibilidade dentinária cervical com laser de baixa potência: revisão de literatura / Low-level laser therapy for treating cervical dentinal hipersensitivity: literature review

A Hipersensibilidade Dentinária Cervical (HSDC) é uma patologia bastante prevalente, sendo, na maioria dos casos, de difícil diagnóstico e tratamento. Existem várias formas de tratamento, porém seus resultados são parciais e não duradouros. Nos últimos anos, os lasers têm merecido especial atenção, tanto os de alta como os de baixa intensidade. Tendo em vista uma grande variação nas formas de utilização desses lasers, constitui propósito deste estudo avaliar os trabalhos encontrados na literatura quanto às metodologias empregadas e os seus resultados. Diante dos poucos trabalhos encontrados, podemos concluir que a terapia a laser tem-se demonstrado promissora para o tratamento da HSDC, porém mais estudos devem ser realizados, visando ao estabelecimento de uma metodologia reprodutível e confiável para pesquisas na área, o que levará a resultados mais confiáveis.

The dentinal hipersensibility (HSDC) is a very prevalent pathology that, in most of the cases presents a hard diagnostic and difficulty of treatment. There are many forms of treatment, however with parcial results. In these past few years laser therapy have been in focus, as much as low and high power. The purpose of this study is to inquire into the methodology and results found in suitable literature. In front of a little amount of articles avaliable in literature we have to conclude that laser therapy have been shown a promising way to treat dentinal hipersensibility. Therefore, we should go deeper into the studies to establish a reproducible methodolgy in aid of research, providing reliable results.

Hipersensibilidade a inalantes em adultos jovens que responderam o questionário do International Study of Asthma and Allergies in Childhood / Hypersensitivity to inhalants in young adults who answered to the International Study of Asthma and Allergies in Childhood questionnaire

Objetivo: A prevalência de doenças alérgicas, como asma, rinite e eczema, aumentou significativamente, tendo etiologia multifatorial como a exposição à alérgenos. Este estudo teve como objetivo determinar a prevalência de sensibilização à aeroalérgenos através de testes cutâneos em adultos jovens da Faculdade de Medicina do ABC, que responderam ao questionário padrão ISAAC (International Study of Asthma and Allergies in Childhood) em 2006 e 2007. Métodos: Estudo transversal realizado em 600 jovens que responderam ao questionário ISAAC. Desses, 100 foram randomizados para realizar testes cutâneos de hipersensibilidade imediata para os alérgenos: D. pteronyssinus e D. farinae, Blomia tropicalis, Blatella, epitélio de cão e gato. Os resultados foram correlacionados com as respostas dos questionários. Resultados: Nos questionários, 28 (28%) alunos apresentaram-se assintomáticos, 14 (14%) com asma ativa, 63 (63%) com rinite ativa e 12 (12%) com eczema. Entre os submetidos aos testes cutâneos, 37 (74,0%) apresentavam sintomas de rinite (p < 0,05), 9 (64,3%) de asma e 6 (50,0%) de eczema. Observou-se que 50 (50%) alunos apresentaram reações positivas para pelo menos um alérgeno, dos quais 39 (78%) apresentavam sintomas alérgicos e 11 (22,0%) eram assintomáticos (p = 0,18 e OR = 1,82). Entre os que mostraram positividade para mais de um alérgeno, 11 (73,3%) tinha asma, 13 (92,9%) tinham rinite e 7 (58,3%) eczema. (p < 0,05). Conclusões: Observou-se relação direta entre a prevalência de doenças alérgicas e positividade aos testes cutâneos. Rinite foi a doença mais frequente, seguida pela asma e eczema, nos quais os ácaros apresentaram maior prevalência, principalmente o D. farinae.

Objective: The prevalence of allergy diseases, such as asthma, rhinitis and eczema, increased significantly having the multifactorial etiology as the allergens exposure. The study objective was to appoint the prevalence of sensitization to the aeroallergens through the skin allergy test (prick test) in young adults from the Faculdade de Medicina do ABC, who filled the ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire in 2006 and 2007. Methods: Cross-sectional study of 600 young adults who answered the ISAAC questionnaire. From those, 100 were randomly picked to do the skin allergy test for immediate hypersensitivity to the allergens: D. pteronyssinus, D. farinae, Blomia tropicalis, Blatella, dog and cat epithelial. The results and the questionnaires answers were correlated. Results: In the questionnaires, 28 (28%) students presented themselves as asymptomatic, 14 (14%) with active asthma, 63 (63%) with active rhinitis and 12 (12%) with eczema. In the allergy skin tests, 37 (74.0%) had rhinitis symptoms (p < 0.05), 9 (64.3%) had asthma and 6 (50.0%) had eczema. It was proven that 50 (50%) students who had been tested positive for at least one allergen, from them 39 (78%) had allergic symptoms and 11 (22.0%) was asymptomatic (p = 0.18 and OR = 1.82). From those who has more than one allergen, 11 (73.3%) students had asthma, 13 (92.9%) had rhinitis and 7 (58.3%) had eczema (p < 0.05).Conclusions: It was noted a direct relationship to the prevalence of allergy diseases and a positivity in the skin allergy tests. The rhinitis was the main diseases founded followed by the asthma and eczema, which the mites had higher prevalence, specially the D. farinae.

Evaluation of palatal arches made from low-nickel stainless steel wire

Aim: To test the hypothesis that there is no difference between stainless steel wires and low-nickel stainless steel ones regarding their mechanical behavior. Force, resilience and elasticity modulus produced by Coffin, “W” arch, and Quad-helix appliances made of 0.032-inch and 0.036-inch wires were evaluated. Methods: Fifteen appliances of each type (Coffin, “W” arch, and Quad-helix) were made according to metal alloy and wire thickness. All arches (12 groups of 15 appliances each) were submitted to mechanical compression test by using an EMIC DL-10000 machine simulating activations of 5, 8, 10, and 12 mm. Analysis of variance with multiple comparisons and Tukey’s test were used (P < 0.05) for analyzing statistically force and resilience data. Results: The results showed that mechanical properties depended on shape of the appliance, diameter of the wire, amount of activation, and metal alloy. Conclusions: Appliances made from lownickel stainless steel alloy had higher release of force, resilience and elasticity modulus compared to those made of stainless steel alloy.

Utilização do ácido gamalinolênico em pacientes portadores de dermatite atópica / Determination of serum concentration of specific IgE to cow's milk and its fractions for the cow's milk allergy diagnosis

As proteínas do leite de vaca são os principais alérgenos relacionados à alergia alimentar em crianças e o diagnóstico inclui a realização do teste de provocação oral duplo cego placebo controlado (TPODCPC). Apesar da acurácia, este teste envolve riscos, necessita condições especiais para sua realização e apresenta limitações em crianças de baixa idade e em pacientes anafiláticos. Assim, há necessidade de métodos diagnósticos alternativos, entre eles o estabelecimento de pontos de corte de concentrações de IgE sérica específica para leite de vaca, que permitam o diagnóstico mesmo sem a realização do TPODCPC. O objetivo deste estudo foi estabelecer uma concentração discriminante de IgE sérica específica para leite de vaca e suas frações protéicas para o diagnóstico de alergia à proteína do leite de vaca (APLV) e avaliar se há diferentes concentrações discriminantes de IgE específica para este alérgeno no grupo de pacientes com anafilaxia. Realizou-se um estudo de coorte histórica incluindo pacientes com APLV e grupo controle composto por pacientes com suspeita não confirmada de APLV. Para estes objetivos, foram construídas curvas ROC para os seguintes alérgenos: leite de vaca, caseína, a-lactoalbumina e b-lactoglobulina. Os níveis de IgE específica foram avaliados posteriormente, em separado, nos pacientes com anafilaxia. Foram incluídos 123 pacientes (1,3M:1F mediana = 1,91 anos, com idade de 3,5 meses a 13,21 anos) com diagnóstico confirmado de APLV através de TPODCPC (n=26), presença de anafilaxia à proteína do leite de vaca (n=46) ou história clínica fortemente sugestiva de APLV associada à pesquisa positiva de IgE específica através de teste cutâneo (n=51). Entre os 65 pacientes com anafilaxia, 19 confirmaram o diagnóstico posteriormente, através de testes de provocação. O grupo controle foi composto por 61 pacientes (1M:1,1F) com idade variando entre 0,66 e 16,7 anos (mediana= 6,83 anos). A metodologia adotada para estabelecimento dos pontos de corte...

Cow's milk proteins are the main allergens related to food allergy in children and the diagnosis include the double blind placebo controlled food challenge (DBPCFC). Although this test presents accuracy, it involves risks, it is necessary special conditions and it presents limitations in infants and anaphylactic patients. It is necessary other diagnostic methods, among them the cut off values for IgE specific for milk to allow the cow's milk allergy (CMA) diagnosis without the need to perform the DBPCFC. The objective of this study was to establish a discriminating concentration of specific IgE to cow's milk and its proteins fractions for the diagnosis of allergy to CMA and to assess if there are different discriminating concentrations of specific IgE to this allergen in the group of patients with anaphylaxis. It was carried out a historical cohort study including patients with CMA and the control group was composed by patients with excluded CMA suspicion. To obtain the cutoff points for diagnosis of CMA , ROC curves were constructed for the following allergens: cow's milk, casein, a-lactalbumin and a b-lactoglobulin. The levels of specific IgE were later evaluated, separately, in patients with anaphylaxis. The study included 123 patients (1.3 M: 1F median = 1.91 years, ranging from 3.5 months to 13.21 years) with confirmed diagnosis of CMPA through DBPCFC (n = 26), the presence of anaphylaxis triggered by cow's milk protein (n = 46) or strongly suggestive clinical history associated with positive specific IgE through skin test (n = 51). Among the 65 patients with anaphylaxis, 19 confirmed the diagnosis through challenge tests. The control group was consisted of 61 patients (1M: 1.1 F) with ages ranging between 0.66 and 16.7 years (mean 6.86, median = 6.83 years). The methodology to stablish the cutoff was the construction of a ROC curve and subsequent calculation of positive and negative predictive value. The cutoff points obtained considering a 98%...

Alterações orofaciais em doenças alérgicas de vias aéreas: [revisão] / Orofacial alterations in allergic diseases of the airways: [review]

OBJETIVO: Apontar as possíveis alterações orofaciais decorrentes do sintoma "obstrução nasal" em pacientes portadores de doenças alérgicas de vias aéreas superiores, por meio de revisão de literatura. FONTES DE DADOS: Levantamento bibliográfico utilizando bancos de dados eletrônicos, como Medline, Ovid, SciELO e Lilacs, com as palavras-chave "asthma", "rhinitis" e "mouth breathing", abrangendo os 30 últimos anos. Foram incluídos artigos de revisão, estudos observacionais e ensaios clínicos. SÍNTESE DOS DADOS: A obstrução nasal é encontrada freqüentemente em doenças alérgicas de vias aéreas, como rinite e asma. A respiração bucal decorrente da obstrução nasal pode interferir de maneira direta no desenvolvimento infantil, com alterações no crescimento do crânio e orofacial, na fala, na alimentação, na postura corporal, na qualidade do sono e no desempenho escolar. CONCLUSÕES: Devido à variedade de alterações orofaciais encontradas na criança respiradora bucal decorrente de obstrução nasal por doenças alérgicas de vias aéreas, é necessário realizar diagnóstico e tratamento precoces por uma equipe multidisciplinar, composta por médico, ortodontista e fonoaudiólogo, contemplando a visão de uma via respiratória única, que traz conseqüências ao crescimento e desenvolvimento do sistema motor oral.

OBJECTIVE: To study possible orofacial alterations originated from nasal obstruction symptoms in patients with allergic diseases of the superior airways, through search of scientific literature about the theme. DATA SOURCES: Bibliographic survey of the last 30 years using electronic data such as Medline, Ovid, SciELO and Lilacs, and the keywords "asthma", "rhinitis" and "mouth breathing". Revision articles, observational and clinical studies were included. DATA SYNTHESIS: Nasal obstruction is often found in patients with allergic diseases of airways, such as rhinitis and asthma. The mouth breathing originated from nasal obstruction can interfere directly in the child development with alterations in the craniofacial growth, body posture, sleep quality and performance at school. CONCLUSIONS: Due to the variety of orofacial alterations found in children who have nasal obstruction because of allergic diseases of airways and, therefore, are mouth breathers, it is necessary to start the treatment as soon as possible by a multidisciplinary team, formed by doctors, orthodontists and speech therapists, considering a unique airway that brings consequences to growth and development of the oral motor system of these children.

Hipersensibilidade a metais utilizados durante o tratamento ortodôntico / Hypersensitivity to metals during orthodontic treatment

Na prática ortodôntica podem ocorrer reações adversas em pacientes devido aos materiais utilizados durante o tratamento, tanto de natureza irritativa como reações de hipersensibilidade. A hipersensibilidade a metais utilizados durante o tratamento ortodôntico consiste em uma resposta inflamatória induzida pela corrosão das estruturas dos dispositivos ortodônticos e subseqüente liberação de íons metálicos. Algumas manifestações clínicas dessa condição compreendem: estomatite, sensação de queimação, presença de gengivite severa com ausência de placa bacteriana, urticária, eczema e dermatite alérgica. Assim, inúmeros estudos foram realizados com o intuito de avaliar a inter-relação entre os metais dos dispositivos ortodônticos e possíveis reações adversas. Em face ao exposto, o presente artigo tem como objetivo realizar uma revisão de literatura, com descrição de um caso clínico sobre a hipersensibilidade a metais utilizados durante o tratamento ortodôntico, contribuindo para um maior conhecimento sobre essa condição.

In orthodontical practice, adverse reactions can occur due to the materials used during the treatment, either irritation or hypersensitivity reactions. The hypersensitivity to metals used during the orthodontic treatment consists in an induced inflammatory response by the corrosion of the structures of the orthodontic devices and subsequent release of metallicions. Some clinical manifestations of this condition are: stomatitis, burning sensation, severe gingivitis in the absence of plaque, generalized urticaria, eczema and allergic dermatitis. Thus, several studies have been carried through with intention of evaluating the interrelation among metals of the orthodontic devices and possible adverse reactions. Therefore, the purpose of this article is to review the literature and discuss a case report about the hypersensitivity to metals used during the orthodontic treatment, contributing to the knowledge of this condition.

Reação reversa nodular tardia simulando recidiva: a importância da história clínica e dos exames laboratoriais / Late nodular reversal reaction mimicking relapse: the importance of clinical history and laboratory findings

Um homem de 51 anos recebe o diagnóstico de hanseníase dimorfa em 2005. Na ocasião apresentou 3 lesões em placas foveolares e algumas pequenas pápulas no tronco posterior. A histopatologia mostrou quadro ativo de Hanseníase dimorfa-virchoviana com baciloscopia de 5+ (presença de bacilos típicos). A reação de Mitsuda foi negativa, a dosagem de IgM anti-PGL-1 (glicolipídeo fenólico 1) por ELISA foi de 0,003 e o teste ML-Flow (teste de fluxo lateral para o M. leprae) foi negativo. Submeteu-se a poliquimioterapia (PQT) para multibacilar (24 doses). Nove meses após a alta medicamentosa, inicia episódio reacional caracterizado por tumefação e eritema das placas pré-existentes, e múltiplos nódulos eritematosos generalizados em face, tronco e extremidades. A histopatologia demonstrou padrão granulomatoso dimorfo-tuberculóide reacional com 1+ de bacilos granulosos. Discute-se o diagnóstico diferencial entre recidiva e reação reversa, a reativação com múltiplos nódulos semelhantes a hansenomas e os valores de IgM anti PGL-1 e o teste de ML-Flow negativo por ocasião do diagnóstico da doença.

A 51 years old man has the diagnosis of borderline leprosy in 2005. On this time he presented 3 honeycombed plaques and some little papules on the back. The histopathology showed active borderline-lepromatous leprosy, bacilloscopy 5+, with viable bacilli. Mitsuda reaction was negative, the dosage of IgM anti-PGL-1 (phenolic glicolipid 1) by ELISA was 0,003 and ML-Flow test (lateral flux test to M. leprae) was negative. Multidrugtherapy (MDT) for multibacillary leprosy was started for 24 months. Nine months after finished treatment, reversal reaction characterized by exacerbation of previous lesions and appearance of multiple erythematous nodules on face, trunk and extremities. The histopathology showed reactional borderline-tuberculoid pattern, with bacilloscopy 1+, granular bacilli. It is discussed the differential diagnosis between relapse and reversal reaction, the reactivation of the disease with multiple nodules mimicking lepromas and the low values of IgM anti-PGL-1 and the negative ML-flow test on the diagnosis.