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Int Arch Allergy Immunol ; 180(1): 28-36, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31189157


BACKGROUND: Clinically meaningful specific IgE determination is an important step in the diagnosis of allergic diseases. While patient's history and skin prick tests are available during the medical visit, most IgE immunoassays require hours to several days to be available. Recent developments in the field of nanofluidic technology open new horizons for point-of-care management of this unmet medical need. OBJECTIVE: This study aimed to compare IgE diagnostic agreement between a nanofluidic assay (abioSCOPE®) and a laboratory reference method (Phadia Laboratory System®) in a real-world clinical setting. METHODS: Sera from 105 patients whose routine allergy diagnostic workup required a blood sampling were used to compare the novel nanofluidic IgE assay to a reference method in a blind manner for a panel of five respiratory allergens. To assess the agreement between methods, patient records were reviewed by four independent experts to establish the final diagnosis. Experts were blinded to the IgE serological method used, but had access to patient history, skin prick tests, and blood test results. RESULTS: Analytic agreement between the two methods was 81% for the tested panel of allergens (ranging from 77 to 89%). The overall agreement in clinical diagnosis decision taken by the expert panel was 94.6% with the nanofluidic IgE assay when compared to the reference method. CONCLUSION: The nanofluidic IgE assay, as determined through an evaluation based on clinical history, skin prick tests, and IgE measurement, is a valuable tool for allergy experts to identify patients' sensitization patterns at the point of care, and for routine IgE diagnostic workup.

Imunoensaio/métodos , Imunoensaio/normas , Imunoglobulina E/imunologia , Dispositivos Lab-On-A-Chip , Nanotecnologia/métodos , Adolescente , Adulto , Idoso , Alérgenos/imunologia , Feminino , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Padrões de Referência , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Testes Cutâneos , Adulto Jovem
J Dermatol ; 46(7): 622-625, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31106887


Severe dermatitis, multiple allergies and metabolic wasting (SAM) syndrome is a recently recognized syndrome caused by mutations in the desmoglein 1 (DSG1) and desmoplakin (DSP) genes. Only two cases of SAM-DSP have been reported. We report on a 2-year-old girl presenting with pustular lakes within areas of erythema and large accumulations of intraepidermal neutrophils, which initially led to our misdiagnosis of generalized pustular psoriasis. No mutation was found in either the IL36RN or CARD14 genes by Sanger sequencing. The distinctive manifestations of erythroderma with severe itching, hypotrichosis, enamel defects, onychodystrophy, palmoplantar keratoderma and the crucial result of de novo missense mutation in exon 14 of the DSP gene (c.1828T>C, p.S610P) discovered by next-generation sequencing finally confirmed the diagnosis of SAM syndrome. The eruptions significantly improved after a 4-week treatment with oral acitretin and topical pimecrolimus. Oral gabapentin was prescribed simultaneously for 4 months, relieving her skin pruritus and suggesting that early treatment with pimecrolimus, acitretin and gabapentin for SAM-DSP syndrome is effective. It may even inhibit multiple allergies induced by skin barrier injury. In this work we also review the clinical features, differential diagnoses and pathological manifestations of SAM-DSP syndrome.

Acitretina/administração & dosagem , Dermatite Esfoliativa/diagnóstico , Desmoplaquinas/genética , Gabapentina/administração & dosagem , Hipersensibilidade/diagnóstico , Síndrome de Emaciação/diagnóstico , Administração Cutânea , Administração Oral , Pré-Escolar , Análise Mutacional de DNA , Dermatite Esfoliativa/tratamento farmacológico , Dermatite Esfoliativa/genética , Dermatite Esfoliativa/patologia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Hipersensibilidade/tratamento farmacológico , Hipersensibilidade/genética , Hipersensibilidade/patologia , Mutação de Sentido Incorreto , Psoríase/diagnóstico , Índice de Gravidade de Doença , Pele/efeitos dos fármacos , Pele/patologia , Síndrome , Tacrolimo/administração & dosagem , Tacrolimo/análogos & derivados , Resultado do Tratamento , Síndrome de Emaciação/tratamento farmacológico , Síndrome de Emaciação/genética , Síndrome de Emaciação/patologia
Health Psychol ; 38(7): 613-622, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31021124


OBJECTIVE: Recent research on open-label placebos, or placebos administered without deception or concealment, suggests that they can be effective in a variety of conditions. The current research sought to unpack the mechanisms underlying the treatment efficacy of open-label placebos. METHOD: A health care provider induced an allergic reaction in 148 participants via a histamine skin prick test. Participants were then exposed to 1 of 4 conditions additively leveraging various mechanisms of open-label placebo treatments: a supportive patient-provider relationship, a medical ritual, positive expectations, and a rationale about the power of placebos. RESULTS: There were no main effects of condition on allergic responses. However, participant beliefs about placebos moderated the effect of open-label placebo treatment condition on physiological allergic reactions: the condition including all 4 components of open-label placebos (a supportive patient-provider relationship, a medical ritual, positive expectations, and a rationale about the power of placebos) significantly reduced physiological allergic reaction among participants with a strong belief in placebos compared with participants in the control group. CONCLUSION: Participants' beliefs about placebos interact with information from the provider to reduce physiological allergic reactions in response to an open-label placebo treatment. This study underscores the importance of measuring and understanding how participants' beliefs influence outcomes of treatment, and furthers our understanding of when and how open-label placebo treatments work. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cultura , Decepção , Hipersensibilidade/psicologia , Motivação , Participação do Paciente/psicologia , Efeito Placebo , Adulto , Feminino , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Masculino , Motivação/fisiologia , Projetos de Pesquisa , Resultado do Tratamento
Int Arch Allergy Immunol ; 179(2): 108-113, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970353


INTRODUCTION: Although the skin prick test (SPT) is a reliable diagnostic tool in perennial allergic rhinitis (PER) for patients allergic to cats, the minimum necessary SPT wheal size required to distinguish cat sensitization from true allergy remains controversial. The cat nasal challenge test (cNCT) could be considered the gold standard for detecting true cat allergy. AIMS: To assess the difference in the frequency of cNCT positivity between cat owners and non-owners and to determine an appropriate cut-off level for SPT wheal size in detecting positive cNCT in PER patients who are candidates for allergen immunotherapy (AIT) with cat allergen extracts. SUBJECTS AND METHODS: cNCT in the form of a nasal spray was administered to 60 adult patients with PER, i.e., cat owners (n = 19) and cat non-owners (n = 41) with positive SPT to cat fur allergen (Diater, Spain). Subjective (total nasal symptom score [TNSS]) and objective measurements (peak nasal inspiratory flow [PNIF]) for assessment of nasal patency and nasal eosinophil count [NEo]) were used to assess the nasal response. Peak expiratory flow (PEF) was used as a safety parameter during cNCT. RESULTS: No differences were obtained in SPT wheal size and cNCT positivity between cat owners and non-owners. Positive cNCT detecting true cat allergy could be predicted by a cat SPT wheal size > 6.5 mm with 71.11% sensitivity and 100% specificity. CONCLUSIONS: In adult patients with PER, the frequency of cat allergy was similar among cat owners and non-owners. A cat SPT wheal size ≥6.5 mm could be helpful in detecting true cat allergy by avoiding the demanding, time-consuming, and often unavailable cNCT when cat AIT is needed.

Alérgenos/imunologia , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Imunização , Adulto , Animais , Gatos , Feminino , Humanos , Imunoglobulina E/imunologia , Masculino , Pessoa de Meia-Idade , Testes de Provocação Nasal , Curva ROC , Testes Cutâneos , Adulto Jovem
Mol Med Rep ; 19(5): 3497-3504, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30896856


The detection of allergen­specific immunoglobulin (Ig)E is an important method for the diagnosis of IgE­mediated allergic diseases. The sensitivity of the indirect IgE­ELISA method against allergen extracts is limited by interference from high IgG titers and low quantities of effectual allergen components in extracts. To overcome these limitations, a novel capture IgE­ELISA based on a recombinant Der f 1/Der f 2 fusion protein (rDer f 1/2) was developed to enhance the sensitivity to IgEs that bind allergens from the house dust mite (HDM) species Dermatophagoides farina. pET28­Der f 1/2 was constructed and expressed in Escherichia coli BL21 (DE3) pLysS. The purified fusion protein was evaluated by IgE western blotting, IgE dot blotting and indirect IgE­ELISA. Capture­ELISA was performed by coating wells with omalizumab and incubating in series with sera, biotinylated Der f 1/2, horseradish peroxidase­conjugated streptavidin and 3,3,5,5­tetramethylbenzidine. The relative sensitivities of indirect­ELISA and capture­ELISA for HDM allergen­specific IgE binding were determined; sera from non­allergic individuals were used as the control group. rDer f 1/2 was expressed in the form of inclusion bodies comprising refolded protein, which were then purified. It exhibited increased IgE­specific binding (24/28, 85.8%) than rDer f 1 (21/28, 75.0%) or rDer f 2 (22/28, 78.6%) with HDM­allergic sera. Furthermore, in a random sample of HDM­allergic sera (n=71), capture­ELISA (71/71, 100%) was more sensitive than indirect­ELISA (68/71, 95.8%) for the detection of HDM­specific IgEs (P<0.01), indicating that this novel method may be useful for the diagnosis of HDM allergy.

Alérgenos/imunologia , Antígenos de Dermatophagoides/imunologia , Proteínas de Artrópodes/imunologia , Cisteína Endopeptidases/imunologia , Ensaio de Imunoadsorção Enzimática , Imunoglobulina E/imunologia , Proteínas Recombinantes de Fusão , Adolescente , Adulto , Animais , Antígenos de Dermatophagoides/química , Antígenos de Dermatophagoides/genética , Proteínas de Artrópodes/química , Proteínas de Artrópodes/genética , Cisteína Endopeptidases/química , Cisteína Endopeptidases/genética , Epitopos/química , Epitopos/imunologia , Feminino , Humanos , Hipersensibilidade/sangue , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Ligação Proteica/imunologia , Pyroglyphidae/imunologia , Sensibilidade e Especificidade , Adulto Jovem
Ital J Pediatr ; 45(1): 35, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30857564


BACKGROUND: The benefit of probiotics in newborn children in relation to allergy and general morbidity later in life appears to be controversial. Allergic diseases represent an increasingly important health problem worldwide in recent years. This is evident in all age groups. The occurrence of allergic illnesses also continues to rise exponentially, and thus the use of preventive and prognostic methods, particularly in children with an inherently higher risk of allergy, is gaining increased importance. Since the advent of probiotics the effect of probiosis on immunity through alterations of composition and function of the human gut microbiome has been increasingly studied. The exact mechanisms have not yet been clearly defined. The Academy of Sciences of the Czech Republic (The Czech Academy of Sciences has suggested that the expression of TH1 and TH2 cytokines in umbilical blood is associated with an increased risk of allergies. The counter -balance of Th1 and Th2 affect Immunoglobulin E (IgE) production and maturation of the gastrointestinal tract epithelium. CASE PRESENTATION: We examined IgE levels in 3000 samples of umbilical blood taken from children born into families with a positive history of allergy in one or both parents from 2007 to 2017. At the age of ten days, those with high IgE were given Colinfant Newborn (a lyophilized non-pathogenic strain of Escherichia.coli) for one month, three times weekly. At 15 months and three years we investigated the levels of Immunoglobulins E,A and G, and the incidence of illness and allergy. The results revealed that allergy and high umbilical IgE is strongly linked with family history (p ≤ 0.001). We also detected differences in seasonality, especially with regards to pollen allergies. Eighty percent of children treated with Colinfant Newborn had significantly reduced IgE and morbidity at 13-15 months and 3 years, and furthermore without any clinical signs of allergy. Normalization of Immunoglobulins A and G was seen in 90% of treated subjects (p ≤ 0.001). These levels significantly correlated with an almost negligible morbidity up to 4 years of life. Colinfant Newborn, a lyophilized strain of Esherichia coli (E. coli), and a normal component of intestinal flora, readily colonizes the intestinal tract. It's long term presence significantly stimulates the production of specific and non-specific intestinal antibodies. and optimalizes immune development through tolerance. In our study Colinfant Newborn reduced the incidence of infections later in life by safely and effectively normalizing immunoglobulin levels in the majority of treated patients. CONCLUSION: Our study strongly suggests as positive effect of physiological Escherichia coli on the microbiome of newborn children as evidenced by a significantly reduced incidence of allergy and morbidity when applied early in life. These benefits appear to be strongly strain specific.

Terapia Biológica/métodos , Sangue Fetal/imunologia , Hipersensibilidade/tratamento farmacológico , Imunoglobulina E/sangue , Estudos de Coortes , República Tcheca , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Hipersensibilidade/diagnóstico , Recém-Nascido , Masculino , Microbiota , Triagem Neonatal/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
Medicine (Baltimore) ; 98(10): e14702, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855461


RATIONALE: In the recent years, growing interest is focused on the use of platelet-rich plasma (PRP) in wound healing and tissue regeneration. There are a number of papers regarding the usefulness of PRP in the healing of ulcerations, skin injures, bone loss or distraction osteogenesis. Most authors emphasize the safety of PRP usage due to its authogenic nature. PATIENT CONCERNS: We present a case of a 14 -year-old boy admitted to our department due to simple bone cyst of the distal tibia, qualified for injection of PRP into the cyst. PRP was separated with the use of Magellan Autologous Platelet Separator System (Arteriocyte Medical Systems Hopkington, MA) according to the manufacturers' manual. Immediately after separation during short-term IV anaesthesia, 3 mL of PRP was installed to the bone cyst under image intensifier control. DIAGNOSES: Within the first 24 hours after exposure to PRP, the skin rash appeared. Physical examination revealed the small red papular, regionally purpuric eruptions, mainly concentrated on the upper extremities and on more warmed regions of skin, in association with pharyngitis, tonsillar enlargement, mucopurulent discharge in the posterior pharynx and swelling of the eyelids. INTERVENTIONS: As the patient received calcium citrate with the PRP injection additional calcium citrate test were performed. Skin prick testing (negative) was and an intradermal test was positive (10×13 mm). Treatment included Claritine (Loratidinum) and Clemastin (Clemastinum)-both antihistaminic drugs. OUTCOMES: All symptoms withdrew and the patient was released home after 4 days. The patient is in 6 years follow-up without any symptoms of allergic disease. LESSONS: Our case shows that safety of use of PRP is not absolutely sure. The pure autologous tissue is safe, but preparation for its use can substantially decrease this safety. In our patient, only limited skin reaction to calcium citrate was observed, but general reaction leading to anaphylactic shock cannot be excluded. In order to reduce the risk of side effects skin test should be performed but as there were no records of allergic diseases on family and patients medical history this should apply to all patients.

Antialérgicos/administração & dosagem , Cistos Ósseos , Edema , Exantema , Pálpebras , Tíbia , Adolescente , Cistos Ósseos/diagnóstico , Cistos Ósseos/terapia , Regeneração Óssea/fisiologia , Edema/diagnóstico , Edema/tratamento farmacológico , Edema/etiologia , Exantema/diagnóstico , Exantema/tratamento farmacológico , Exantema/etiologia , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/tratamento farmacológico , Hipersensibilidade/etiologia , Injeções Intralesionais/efeitos adversos , Injeções Intralesionais/métodos , Masculino , Plasma Rico em Plaquetas , Testes Cutâneos/métodos , Tíbia/diagnóstico por imagem , Tíbia/patologia , Resultado do Tratamento
Allergol. immunopatol ; 47(1): 12-15, ene.-feb. 2019. graf
Artigo em Inglês | IBECS | ID: ibc-180765


Introduction and objectives: Profilin is a panallergen contained in pollen, plant foods and latex. Although cross-reactivity is expected while performing skin prick tests (SPT) with allergens that contain profilin, this is not always noticed. The purpose of this study was to detect if profilin is contained in the commercial SPT extracts of pollen and plant foods which, in their fresh form, contain determined epitopes of profilin. Material and methods: Commercial SPT extracts of different pharmaceuticals were analyzed using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The study included purified palm date profilin, peach (whole, pulp and peel extracts), hazelnut, Olea europea, Parietaria judaica and Phleum pratense. Results: Profilin was detected in all, but peach extracts; it was neither contained in the whole peach extract nor in the ones of peel or pulp. Conclusion: The only accurate way to detect sensitization to profilin, while performing SPT, is the use of purified profilin extract. Even if a plant food or pollen contain an identified molecule of profilin, the relevant SPT commercial extract may not

No disponible

Humanos , Alérgenos/metabolismo , Antígenos de Plantas/metabolismo , Hipersensibilidade/diagnóstico , Extratos Vegetais/metabolismo , Erros de Diagnóstico/prevenção & controle , Profilinas/metabolismo , Testes Cutâneos/métodos , Alérgenos/imunologia , Antígenos de Plantas/imunologia , Reações Cruzadas , Frutas/imunologia , Olea/imunologia , Parietaria/imunologia , Extratos Vegetais/imunologia , Pólen/imunologia , Profilinas/imunologia , Prunus persica/imunologia
Ann Lab Med ; 39(3): 284-290, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30623620


BACKGROUND: Although Th2 immune activation is predominant in allergic diseases, neopterinlevels and indoleamine 2,3-dioxygenase (IDO)-1 activity (kynurenine:tryptophan ratio), which reflect Th1 immune activity, increase with interferon-gamma (IFN-γ) stimulation. We investigated neopterin, tryptophan, and kynurenine levels as biomarkersof the Th1 immune system activation and changes in IDO-1 activityin children with asthma, allergic rhinitis, and atopic dermatitis, as well as the relationship between these biomarkers and the total IgE level, age, and disease severity. METHODS: We divided 205 children (80 girls and 125 boys, four months to 17 years old) into four groups: controls, patients with asthma, patients with allergic rhinitis, and patients with atopic dermatitis. Peripheral venous blood samples were collected. Neopterin levels were determined by an enzyme immunoassay. Tryptophan and kynurenine levels were analyzed using HPLC. IDO-1 enzyme activity was calculated using tryptophan and kynurenine levels. IgE levels were measured. The Mann-Whitney U test, Kruskal-Wallis test, and Conover post-hoc method were used for statistical analysis. RESULTS: Neopterin, tryptophan, and kynurenine levels were higher and IgE levels and IDO-1 enzyme activity were lower in patients with asthma and allergic rhinitis than in controls (P<0.05). Patients with atopic dermatitis showed higher neopterin, tryptophan, and kynurenine levels, higher IDO-1 activity, and lower IgE levels thancontrols (P<0.05). CONCLUSIONS: The Th1/Th2 balance is disrupted in children with allergic diseases, concomitant with increased Th1-mediated immune response activation and reduced IgEproduction, which is promoted by Th2-type cytokines.

Biomarcadores/análise , Hipersensibilidade/diagnóstico , Indolamina-Pirrol 2,3,-Dioxigenase/sangue , Neopterina/sangue , Adolescente , Asma/diagnóstico , Asma/imunologia , Criança , Pré-Escolar , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Hipersensibilidade/imunologia , Sistema Imunitário/metabolismo , Imunoglobulina E/sangue , Lactente , Cinurenina/sangue , Masculino , Estudos Prospectivos , Rinite Alérgica/diagnóstico , Rinite Alérgica/imunologia , Triptofano/sangue
Pediatr Allergy Immunol ; 30(3): 315-324, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30681195


BACKGROUND: Natural course and co-occurrence of asthma, eczema, and allergic rhinitis through childhood are still not fully documented. We aim to identify and characterize profiles based on the time course, severity, and apparent triggers of respiratory/allergy symptoms in school-aged children. METHODS: Data on occurrence, severity, and triggers of asthma, rhinitis, and dermatitis symptoms were collected annually during the follow-up of the PARIS birth cohort. Children with similar symptom trajectories until 8-9 years were grouped into profiles using multidimensional (all symptoms considered simultaneously) cluster analysis. Associations between profiles and different health outcomes were analyzed using logistic or linear regression models. RESULTS: Six distinct symptomatic profiles were identified. A profile was defined by persistent dermatitis symptoms, associated with sensitization to food and aeroallergens. Two profiles were characterized by wheezing: one with early transient wheezing and the other with persistent wheezing related to doctor-diagnosed asthma, airway obstruction, and perennial aeroallergen sensitization. Three profiles were characterized by rhinitis symptoms: one non-allergic and two allergic, either with persistent rhinitis symptoms related to allergic multimorbidity and sensitization to perennial aeroallergens, or with late-onset symptoms, related to both pollen and perennial aeroallergens sensitization as well as low lung function. CONCLUSION: This study brings further insights into the developmental profiles of respiratory/allergic outcomes from birth to school age. The identified profiles clearly differed regarding objective features such as diagnosed morbidity, sensitization, or lung function measurements, thus highlighting their biologic and clinical relevance. Allergic rhinitis profiles deserve particular attention, since they were likely to be involved in multimorbidity patterns.

Hipersensibilidade/epidemiologia , Criança , Pré-Escolar , Análise por Conglomerados , Feminino , Humanos , Hipersensibilidade/diagnóstico , Imunoglobulina E/sangue , Lactente , Masculino , Prevalência , Testes de Função Respiratória/métodos , Testes Cutâneos/métodos
Pediatr Allergy Immunol ; 30(3): 289-295, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30681199


BACKGROUND: Schoolchildren screening for allergic diseases may improve early identification and management of atopic children. The aim of this study was to perform a schoolchildren screening program for identification of children with allergic diseases. METHODS: All parents of children attending to 13 primary schools in the city of Rome were requested to fill in a demographic data form and the ChAt questionnaire. Allergological evaluation was performed in the children with suspect of allergy (ChAt score > 2). Ocular examination was performed to identify signs of allergic conjunctivitis. The presence of allergic symptoms was related to demographic and environmental variables. RESULTS: A total of 2667 children (mean age: 7.1 ± 1 years) were included, and 2489 (93.3%) parents completed the ChAt questionnaire. Results of ChAt questionnaire showed a previous diagnosis of allergic disease in 637 (25.6%) children and the potential presence of an allergic disease (ChAt score > 2) in 35.1%. Multivariate analysis showed that older age, male gender, and having less than two siblings were associated with higher risk of allergic disease. Visual screening showed the presence of clinical signs of allergic conjunctivitis in 2% of children. Allergologic evaluation in 334 children confirmed the diagnosis of allergic disease in 324 (97%) cases. Among them, 97 (29.9%) did not refer to a previous formal diagnosis of allergic condition. CONCLUSIONS: This study confirmed that schoolchildren screening using ChAt questionnaire could represent a useful tool for early identification of yet undiagnosed atopic children.

Hipersensibilidade/epidemiologia , Programas de Rastreamento/métodos , Criança , Pré-Escolar , Feminino , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/etiologia , Masculino , Prevalência , Fatores de Risco , Roma/epidemiologia , Instituições Acadêmicas , Inquéritos e Questionários
Occup Environ Med ; 76(2): 78-82, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30554157


OBJECTIVES: Cannabis allergy has mainly been described following recreational use but some cases also point to cannabis sensitisation as a result of occupational exposure. As a consequence, little is known on the prevalence and clinical phenotype of occupational cannabis allergy. Therefore, this study aims to explore the allergy-associated health risks of occupational cannabis exposure in Belgian police force personnel. METHODS: 81 participants, active in the police force, reporting regular occupational cannabis exposure during the past 12 months, were included. History was combined with a standardised questionnaire on allergies and cannabis exposure.Basophil activation tests (BATs) with a crude cannabis extract and rCan s 3 were performed. In addition, specific (s)IgE rCan s 3 as well as sIgE to house dust mite, six pollen and three mould allergens were quantified. RESULTS: Although 42% of the participants reported respiratory and/or cutaneous symptoms on occupational cannabis exposure, all cannabis diagnostics were entirely negative, except one symptomatic case demonstrating a borderline result. Furthermore, there is no significant difference between the groups with and without symptoms on cannabis exposure in terms of allergenic sensitisations. CONCLUSIONS: The origins of the reported respiratory and cutaneous symptoms during cannabis exposure remain elusive but are probably due to non-immune reactions. It should be noted that the study was volunteer-based possibly reflecting an excessive number of symptomatic individuals. Nevertheless, as only one participant reported using fully protective gear, much improvement is needed for reducing the number of symptoms reported on duty, independent of their origin.

Cannabis/imunologia , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Exposição Ocupacional/efeitos adversos , Polícia , Adulto , Alérgenos/análise , Teste de Degranulação Basófila , Bélgica , Feminino , Humanos , Hipersensibilidade/prevenção & controle , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Testes Cutâneos
J. investig. allergol. clin. immunol ; 29(2): 94-102, 2019. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-184051


The emergence of new technology enables allergists and patients to compile data and receive feedback regarding key symptoms, risk behavior, and/or management. The term "eHealth" refers to a diverse group of tools that use computerized technologies to improve both the efficacy and the efficiency of the health care industry. eHealth comprises a variety of technologies, as follows: mobile devices (mHealth) in medical care, including electronic diaries, wearable sensors, and adherence monitoring; health informatics (eg, electronic health records, computerized physician order entry, clinical decision support); telemedicine, which is the use of information and communication technologies for the management of diseases and medical education; social media platforms, and the analysis of information acquired through these platforms using "big data" technologies.In this review, we summarize the latest findings on the use of eHealth technology and the relevance of eHealth to allergic conditions

La aparición de nuevas tecnologías conlleva para los alergólogos y los pacientes la posibilidad de recopilar datos y recibir información directa sobre los síntomas clave de las enfermedades, los comportamientos de riesgo y/o su manejo. El término "eHealth", o salud electrónica, se refiere a un grupo diverso de herramientas que utilizan tecnologías informáticas para mejorar la eficacia y la eficiencia de la industria de la salud. La "eHealth" comprende varias tecnologías, como el uso de dispositivos móviles aplicados a la salud ("mHealth"), incluyendo diarios electrónicos, sensores ponibles o monitorización de la adherencia terapéutica; la informática biomédica (por ejemplo, la historia clínica electrónica, la prescripción electrónica o los sistemas de ayuda a las decisiones clínicas); la telemedicina, que es el uso de las tecnologías de la información y la comunicación para el manejo de enfermedades y de educación sanitaria; las plataformas de redes sociales, y el análisis de la información adquirida a través de estas plataformas, usando técnicas de "big data" o inteligencia de datos. En esta revisión, resumimos la evidencia que rodea al uso de tecnologías "eHealth" y su relevancia para las enfermedades alérgicas

Humanos , Telemedicina/tendências , Asma/tratamento farmacológico , Consulta Remota/tendências , Hipersensibilidade/tratamento farmacológico , Asma/diagnóstico , Aplicativos Móveis/tendências , Big Data/provisão & distribução , Políticas de eSaúde , Rede Social , Hipersensibilidade/diagnóstico
J. investig. allergol. clin. immunol ; 29(3): 213-221, 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-ET1-3265


Background: Alcohol consumption is associated with enhanced TH2 immune responses. Objective: To investigate the frequency of false-positive results in serological tests for allergy in alcoholic patients. Methods: A total of 138 alcoholic patients consecutively admitted to hospital underwent a panel of allergy tests that included serum total IgE, a multiallergen IgE test (UniCAP Phadiatop), and skin prick tests to relevant aeroallergens in the area, which were considered the standard reference for atopy. In selected cases with positive specific IgE (sIgE) to cross-reactive carbohydrate determinants (CCDs) on ImmunoCAP, we determined sIgE to hymenoptera venom components (ADVIA Centaur) and a microarray of 103 allergen components (ISAC).Results: Increased serum total IgE (>170 IU/mL) was observed in 59/110 (54%) of nonatopic (skin prick test-negative) patients. The result of the multiallergen IgE test was positive in 46 nonatopic patients (42%). This finding was closely associated with high serum concentrations of total IgE and sIgE to CCDs. The vast majority of patients with positive CCD-sIgE showed positivity to glycosylated plant and hymenoptera allergen components on ISAC and ADVIA Centaur. Only 1 out of 26 patients with positive sIgE to CCD and hymenoptera venom developed honeybee venom allergy after a median follow-up of 166 months. Correlations between measurements of sIgE to CCD markers on ImmunoCAP, ADVIA Centaur, and ISAC were imperfect. Conclusions: Serological tests for allergy should be interpreted with caution in alcoholic patients, who frequently have increased levels of total IgE and CCD-sIgE and subsequent positivity of sIgE to glycosylated allergen components, irrespective of the method used

Antecedentes: El consumo de alcohol se asocia con respuestas inmunes aumentadas de tipo Th2.Objetivo: Investigar la frecuencia de falsos positivos en los tests serológicos de alergia en alcohólicos. Métodos: En un total de 138 pacientes alcohólicos ingresados en el hospital de forma consecutiva se realizó un panel de pruebas de alergia que incluyó la determinación de IgE sérica total, un test de IgE específica multialergeno (UniCAP Phadiatop) y pruebas cutáneas en prick a una batería de aeroalérgenos relevantes en el área, cuya positividad se consideró la referencia para clasificar a los pacientes como atópicos. En casos seleccionados con positividad de IgE específica (sIgE) frente a carbohidratos con reactividad (CCDs) en el ImmunoCAP, se determinó la sIgE a componentes del veneno de hymenópteros (ADVIA Centaur) y a un microarray de 103 componentes alergénicos (ISAC).Resultados: Se observó un aumento de las concentraciones de IgE sérica total (>170 IU/mL) en 59/110 (54%) de los alcohólicos no atópicos (prick test-negativos). Cuarenta y seis alcohólicos no atópicos (42%) presentaban un test de IgE específica multialérgeno positivo. Este hallazgo estuvo estrechamente asociado con la presencia de concentraciones elevadas de IgE total y de sIgE a CCDs. La gran mayoría de los alcohólicos con positividad de sIgE a CCDs mostraron positividad con componentes moleculares glicosilados de plantas e himenópteros en el ISAC y el ADVIA Centaur. Sólo uno de los 26 pacientes con positividad de sIgE a CCDs e himenópteros desarrolló alergia clínica a picadura de abeja tras un seguimiento mediano de 166 meses. La correlación de las determinaciones de sIgE a marcadores de CCD en ImmunoCAP, ADVIA Centaur e ISAC fue imperfecta. Conclusiones: Los tests serológicos de alergia se deben interpretar con precaución en pacientes alcohólicos, que frecuentemente muestran elevación de IgE total, positividad de sIgE a CCDs y, consecuentemente, positividad de sIgE a componentes alergénicos glicosilados, independientemente del método utilizado

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Hipersensibilidade/diagnóstico , Alcoolismo/complicações , Apresentação Cruzada/imunologia , Imunoglobulina E/análise , Reações Falso-Positivas , Testes Sorológicos/estatística & dados numéricos , Erros de Diagnóstico/estatística & dados numéricos
J. investig. allergol. clin. immunol ; 29(3): 222-230, 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-ET1-3266


Background: Suspicion of an acute allergic reaction is a common reason for attending the emergency department (ED). However, there are few comparisons between the initial diagnosis of suspected allergic reaction made in the ED with the definitive diagnosis made subsequently in the allergy department (AD).Objective: To compare details of the initial diagnosis made in the ED relating to allergy with the final diagnosis made in the AD. Methods: Patients attending the ED of 2 hospitals with suspected allergic reactions were prospectively enrolled based on key words. A certified allergy specialist reviewed the ED records of these patients and, if these were suggestive of an allergic reaction, the patients were scheduled for further evaluation at the allergy clinic. Results: In total, 2000 patients were enrolled between April 2013 and October 2015. Of these, 1333 passed the initial assessment and underwent further evaluation. Of the 1333 patients, 528 underwent an allergological study, and 206 were confirmed as being allergic. With respect to drug allergy, nonsteroidal anti-inflammatory drugs were the most common triggers, followed by ß-lactams; in food allergy, plant-based foods were the most common. Only 16.4% of patients confirmed as having anaphylaxis in the AD were initially diagnosed with the condition in the ED. Conclusion: Of the 528 patients who finally underwent the full allergological study, fewer than half were confirmed as allergic. Moreover, anaphylaxis appears to be underdiagnosed in the ED. Better communication between the ED and the AD is necessary to improve the diagnosis and management of these patients

Antecedentes: La sospecha de una reacción alérgica aguda es un motivo frecuente de consulta en urgencias. Sin embargo, hay pocos trabajos que comparen el diagnóstico inicial realizado en las unidades de urgencias con el diagnóstico definitivo realizado en las unidades de alergia. Objetivo: Analizar en detalle la sospecha diagnóstica inicial dada en urgencias con el diagnóstico definitivo en las consultas de alergia. Métodos: Estudio prospectivo, que consistió en la selección, en base a palabras claves, de pacientes con sospecha de reacción alérgica. En la fase de screening, se seleccionaron los pacientes en base a las palabras claves, finalmente aquellos pacientes que presentan reacción sugestiva de alergia se seleccionaron para evaluación final. Resultados: Se revisaron 2.000 pacientes entre abril de 2013 y octubre de 2015, de los cuales 1.333 se seleccionaron para la evaluación. Finalmente, 528 se sometieron a un estudio alergológico y 206 se confirmaron como alérgicos. Con respecto a las reacciones por fármacos, los AINE y ß-lactámicos fueron los mayormente implicados; en relación con los alimentos, los de origen vegetal fueron los más frecuentes. Sólo el 16,4% de los pacientes con anafilaxia confirmada tras el estudio de alergia, fueron diagnosticados inicialmente en urgencias. Conclusión: Sólo la mitad de los pacientes que finalizaron en estudio fueron confirmados como alérgicos. Un dato importante es el infradiagnóstico de la anafilaxia en las urgencias. Por ello pensamos que es necesaria una mejor comunicación entre las unidades de urgencias y alergia para mejorar el manejo clínico y terapéutico de estos pacientes

Humanos , Masculino , Feminino , Adulto , Hipersensibilidade/diagnóstico , Anafilaxia/diagnóstico , Testes Diagnósticos de Rotina/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Estudos Prospectivos , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Erros de Diagnóstico/prevenção & controle