Urticária crônica exacerbada por anti-inflamatórios não esteroidais e resposta aos antileucotrienos / Nonsteroidal anti-inflammatory drug-exacerbated chronic urticaria and response to antileukotrienes

Introdução: Pacientes com urticária crônica espontânea (UCE) frequentemente exacerbam com o uso de anti-inflamatórios não esteroidais (AINEs), que são medicamentos que inibem a ciclooxigenase 1 (COX-1) e levam a um desvio para produção de leucotrienos. Os antileucotrienos seriam uma opção terapêutica para aqueles que não respondam aos anti-histamínicos (AH1). Objetivo: O objetivo deste estudo foi avaliar a eficácia dos antileucotrienos nos pacientes com UCE exacerbada ou não pelos AINEs que não responderam apenas aos AH1. Método: Estudo retrospectivo com análise de prontuários eletrônicos de pacientes com UCE em seguimento ambulatorial. Todos os pacientes foram interrogados sobre a história de exacerbação ou não da UCE por AINEs. Além dos AH1, o montelucaste foi introduzido para todos os pacientes, em algum momento do acompanhamento. Foram avaliadas a resposta ao antileucotrieno e a presença da associação desta resposta à história de exacerbação com AINE. Resultados: Sessenta e dois pacientes participaram do estudo. A média de idade foi de 48,4 anos, sendo 82,3% do sexo feminino. Destes, 35 pacientes (56,5%) referiam piora da urticária com uso de AINEs, e, destes, 77,1% responderam ao antileucotrieno associado ao AH1. Dentre os 27 pacientes que não apresentavam UCE exacerbada por AINE, 48,1% obtiveram boa resposta ao uso de antileucotrieno associado ao AH1. Conclusão: A resposta ao antileucotrieno foi superior e estatisticamente significante (p = 0,031) no grupo de pacientes com UCE exacerbada por AINE. Portanto, a associação dos antileucotrienos aos AH1 seria uma opção eficaz e segura, sendo que essa associação se torna ainda mais relevante em pacientes que UC exacerbada por AINEs.

Introduction: Patients with chronic spontaneous urticaria (CSU) frequently show symptom exacerbation after the use of nonsteroidal anti-inflammatory drugs (NSAIDs) ­ drugs that inhibit cyclooxygenase-1 (COX-1) and affect leukotriene production. Antileukotrienes are considered a therapeutic option for patients who do not respond to antihistamines (AH1). Objective: The aim of this study was to assess the effectiveness of antileukotrienes in patients with CSU exacerbated or not by NSAIDs. Methods: In this retrospective study, the electronic charts of CSU outpatients were analyzed. All patients were inquired about history of CSU exacerbation or not by NSAIDs. In addition to AH1, treatment with montelukast was introduced to all patients at some point during follow-up. Response to antileukotriene treatment and association between treatment response and history of NSAID exacerbation were evaluated. Results: A total of 62 patients participated in the study. Mean age was 48.4 years, and 82.3% were female. Thirtyfive patients (56.5%) reported worsening of urticaria with the use of NSAIDs; 77.1% of these patients responded to antileukotriene combined with AH1. Of the 27 patients with no history of CSU exacerbation with NSAIDs, 48.1% showed a favorable response to antileukotrienes associated with AH1. Conclusion: Response to antileukotriene treatment was higher and statistically significant (p=0.031) in patients with NSAID-exacerbated CSU. Therefore, the association of antileukotrienes with AH1 could be a safe and effective treatment option, especially for patients with NSAIDexacerbated CSU.

Chagas disease: Present status of pathogenic mechanisms and chemotherapy

There are approximately 7.8 million people in Latin America, including Chile, who suffer from Chagas disease and another 28 million who are at risk of contracting it. Chagas is caused by the flagellate protozoan Trypanosoma cruzi. It is a chronic disease, where 20 percent-30 percent of infected individuals develop severe cardiopathy, with heart failure and potentially fatal arrhythmias. Currently, Chagas disease treatment is more effective in the acute phase, but does not always produce complete parasite eradication during indeterminate and chronic phases. At present, only nifurtimox or benznidazole have been proven to be superior to new drugs being tested. Therefore, it is necessary to find alternative approaches to treatment of chronic Chagas. The current treatment may be rendered more effective by increasing the activity of anti-Chagasic drugs or by modifying the host's immune response. We have previously shown that glutathione synthesis inhibition increases nifurtimox and benznidazole activity. In addition, there is increasing evidence that cyclooxygenase inhibitors present an important effect on T. cruzi infection. Therefore, we found that aspirin reduced the intracellular infection in RAW 264.7 cells and, decreased myocarditis extension and mortality rates in mice. However, the long-term benefit of prostaglandin inhibition for Chagasic patients is still unknown.