Anaphylaxis triggered by prick test with latex extract: a case report

ABSTRACT CONTEXT: Adverse reactions associated with prick tests are rare but may be present as serious systemic reactions. CASE REPORT: A 38-year-old female nursing technician complained of three episodes of anaphylaxis in one year, all in the workplace. To investigate latex allergy, the patient underwent the prick test with latex, and immediately developed a rash, itchy skin, hoarseness, dyspnea and dry cough. Her condition improved promptly after appropriate measures were established for controlling her anaphylaxis. CONCLUSION: The skin test must be performed under medical supervision, since complications that can lead to life-threatening reactions, if support measures are not readily implemented, have been attributed to this test.

Evaluation of atopy in patients with COPD / Avaliação de atopia em portadores de DPOC

OBJECTIVE: To determine the prevalence of atopy and to evaluate clinical, laboratory, and radiological profiles in patients with COPD. METHODS: This was a cross-sectional study involving outpatients with stable COPD (defined by the clinical history and a post-bronchodilator FEV1/FVC < 70% of the predicted value). The patients completed a questionnaire regarding clinical characteristics and atopy, after which they underwent nasal lavage cytology, skin prick testing, chest X-rays, arterial blood gas analyses, and determination of total serum IgE. RESULTS: Of the 149 subjects studied, 53 (35.6%), 49 (32.8%), and 88 (59.1%) presented with nasal eosinophilia, a positive skin prick test result, and symptoms of allergic rhinitis, respectively. Correspondence analysis confirmed these findings, showing two distinct patterns of disease expression: atopy in patients with COPD that was less severe; and no evidence of atopy in those with COPD that was more severe (reduced FEV1 and hyperinflation). There was a statistically significant association between nasal eosinophilia and a positive bronchodilator response. CONCLUSIONS: Using simple and reproducible methods, we were able to show that there is a high frequency of atopy in patients with COPD. Monitoring inflammation in the upper airways can be a useful tool for evaluating respiratory diseases in the elderly and in those with concomitant asthma and COPD, a clinical entity not yet fully understood. .

OBJETIVO: Determinar a prevalência de atopia e avaliar o perfil clínico, laboratorial e radiológico de pacientes com DPOC. MÉTODOS: Estudo de corte transversal com pacientes ambulatoriais portadores de DPOC estável (definida pela história clínica e relação VEF1/CVF < 70% do previsto após broncodilatador). Os pacientes responderam um questionário clínico e de atopia e foram submetidos a citologia de lavado nasal, teste cutâneo de alergia, radiografia de tórax, hemogasometria arterial e dosagem de IgE total. RESULTADOS: Dos 149 indivíduos avaliados, 53 (35,6%), 49 (32,8%) e 88 (59,1%), respectivamente, apresentavam eosinofilia no lavado nasal, teste cutâneo positivo e sintomas de rinite alérgica. A análise de correspondência confirmou esses achados, evidenciando dois perfis distintos de doença: a presença de atopia em pacientes com estágios mais leves de DPOC, e a ausência de características de atopia em pacientes com aspectos de doença mais grave (VEF1 reduzido e hiperinsuflação). Houve uma associação estatisticamente significante entre eosinofilia no lavado nasal e prova farmacodinâmica positiva. CONCLUSÕES: Este estudo identificou uma alta frequência de atopia em pacientes com DPOC, utilizando ferramentas simples e reprodutíveis. A monitorização inflamatória de vias aéreas parece ser uma ferramenta útil para avaliar as doenças respiratórias em idosos, assim como em pacientes com sobreposição de asma e DPOC, entidade clínica ainda pouco compreendida. .

Perfil de sensibilização a alérgenos domiciliares em pacientes ambulatoriais / Indoor allergen sensitization profile in allergic patients of the allergy clinic in the University Hospital in Uberlândia, Brazil

OBJETIVO: Conhecer o perfil de sensibilização dos pacientes com diagnóstico de doenças alérgicas atendidos no Ambulatório de Alergia do Hospital de Clínicas da Universidade Federal de Uberlândia. MÉTODOS: Foi realizado um estudo retrospectivo por meio da análise de prontuários de pacientes atendidos no serviço, que foram submetidos ao teste cutâneo de puntura (TCP) para os alérgenos de Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), Blomia tropicalis (Blo t), Canis familiaris (Can f), Felis domesticus (Fel d), Blattella germanica (Bla g) e Alternaria alternata, e respondido corretamente ao questionário ISAAC. RESULTADOS: Foram analisados 212 prontuários de pacientes que preenchiam os critérios de inclusão. A rinite alérgica isoladamente foi a maior causa de atendimento (32 por cento), seguida das associações asma e rinite (29,7 por cento) e asma, rinite e eczema (9,4 por cento). Pacientes com asma isoladamente perfizeram apenas 1,9 por cento dos atendimentos. A sensibilização dos pacientes observada foi de 73,5 por cento, sendo de 61,7 por cento para Der p, 59,9 por cento para Der f, 54,7 por cento para Blo t, 45,7 por cento para Bla g, 38,2 por cento para Can f, 33,3 por cento para Fel d e 9,9 por cento para Alternaria. Não houve diferenças significantes entre as patologias encontradas e os perfis de sensibilização. CONCLUSÃO: Os principais alérgenos sensibilizantes determinados pelo TCP foram os ácaros, com predomínio de Der p e Der f, chamando a atenção a elevada prevalência de sensibilização ao último. Ainda foi observada elevada sensibilização aos alérgenos de B. germanica, superior aos estudos anteriores realizados no País.

OBJECTIVE: To evaluate allergens among patients with allergic respiratory disease attended at the Allergy Clinic of the University Hospital - Federal University of Uberlândia. METHODS: A retrospective study was performed using medical records. Patients were included if their ISAAC questionnaires were correctly filled out and their skin prick tests were positive to at least one of the allergens from Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), Blomia tropicalis (Blo t), Canis familiaris (Can f), Felis domesticus (Fel d), Blattella germanica (Bla g) and Alternaria alternata. RESULTS: Two-hundred and twelve medical records fulfilled the inclusion criteria. Allergic rhinitis was the main clinical diagnosis (32 percent), followed by concomitant manifestation of asthma and rhinitis (29.7 percent), and asthma, rhinitis and atopic dermatitis (9.4 percent). Asthma alone was found only in 1.9 percent of patients. The total sensitization observed was 73.5 percent, of which 61.7 percent, 59.9 percent, 54.7 percent, 45.7 percent, 38.2 percent, 33.3 percent, 9.9 percent were sensitized to Der p, Der f, Blo t, Bla g, Can f, Fel d and Alternaria, respectively. No significant difference was found between allergic disease types and source of allergen sensitization. CONCLUSION: The highest sensitization in allergic patients under study was to dust mites, especially Der p and Der f. It is noteworthy that the number of patients sensitized to cockroach extract was uncommonly high when compared to previous studies.

Sinusitis: relación entre signos y síntomas clínicos y hallazgos endoscópicos nasales y en estudio por imágenes / Sinusitis: relation between signs and clinical symptoms and nasal endoscopic findings and in study though images

La Academia Americana de Otorrinolaringología y Cirugía de Cabeza y Cuello (AAO), en 1996 definió la sinusitis del adulto en base a signos y síntomas del paciente. La comisión que trabajó en esta definición propuso que este diagnóstico debería estar basado en la presencia de dos factores mayores, o bien, en uno mayor y dos menores. Lo anterior, para ser aplicado en todas las formas de la enfermedad, incluyendo rinosinusitis aguda, subaguda, crónica y recurrente. No se incluyó endoscopía nasal ni imagen radiológica, de manera tal que pudiese ser utilizado por el médico general, pediatra, etc. Así el diagnóstico de sinusitis podría realizarse con un examen físico mínimo y sin comprobación radiográfica, ni menos endoscópica. El otorrinolaringólogo, por lo general, es más acucioso en su anamnesis y cuando sospecha una sinusitis, además de guiarse por las recomendaciones de la AAO solicita frecuentemente un estudio imagenológico. Rara vez utiliza simultáneamente endoscopia nasal y estudio por imagen. La literatura señala que no siempre existe una coincidencia entre la sintomatología de paciente y los hallazgos de los exámenes radiográficos y endoscópicos. El presente estudio pretende aclarar este punto. Se realizo un estudio prospectivo en 25 pacientes que cumplían con el criterio diagnóstico para sinusitis según la AAO. Se establecieron criterios de exclusión y de inclusión. Se examinaron los enfermos que cumplían con los requisitos, se graduaron sus síntomas y signos y se les sometió a endoscopía nasal y a tomografía computarizada (TC). Ambos exámenes habían sido previamente graduados: la endoscopía en escala convencional, y la TC de senos paranasales de acuerdo a los criterios de Metson/Glicklich. Se analizan los resultados y se discute las conclusiones alcanzadas.

Evaluación serológica del tratamiento de la enfermedad de Chagas crónica con alopurinol e itraconazol / Serologic evaluation of treatment of chronic Chagas disease with allopurinol and itraconazole

Background: Chagas disease is endemic in Chile. Allopurinol and itraconazole have activity against Trypanosoma cruzi and are recommended for the treatment of chronic disease in adults. Aim: To evaluate the chemotherapeutic effects of allopurinol and itraconazole using conventional and non conventional serologic test. Patients and methods: Sera of 90 patients with chonic Chagas disease were studied before and after 9 to 11 months of treatment with allopurinol or itraconazole and after two month of treatment with placebo. Indirect immunofluorescence, ELISA and Western Blot analysis were the conventional serologic tests used and antibody dependent complement mediated lysis (CoML) the non conventional test. Results: There were no differences in ELISA and indirect immunofluorescence tests before and after therapy. Antigenic recognition profiles by Western Blot showed qualitative and quantitative differences in a small number of cases. CoML showed that the greater negativity was achieved in the Chagasic group treated with allopurinol or itraconazole that had a negative xenodiagnosis before drugs treatment (35.8 and 61.6 percent, respectively). Conclusions: There is a reversion of lytic activity in sera of patients with negative xenodiagnosis before treatment, suggesting the parasitemia could be an important parameter to be considered in the chemotherapy of Chagas disease

Asma y medio laboral / Asthma and occupational environment

El reconocimiento de los factores agravantes o desencadenantes de las crisis asmáticas, posee un valor innegable como herramienta terapéutica. Se enfatiza la importancia anamnéstica del reconocimiento de los factores laborales capaces de producir asma bronquial, y las características clíncias de esta condición. El fluojómetro de wright ha venido a objetivar las fluctuaciones respiratorias circadianas previas del asma y ha permitido establecer la relación entre sintomatología y medio laboral logrando evitar la ejecución laboriosa de los test de provaocación bronquial. Se plantea un estrategia de estudo de estos pacientes y las limitantes de la metodología existente