RESUMO
Sublingual immunotherapy (SLIT) is used worldwide to treat house dust mites (HDM) allergy. Epitope specific immunotherapy with peptide vaccines is used far less, but it is of great interest in the treatment of allergic reactions, as it precludes the drawbacks of allergen extracts. The ideal peptide candidates would bind to IgG, blocking IgE-binding. To better elucidate IgE and IgG4 epitope profiles during SLIT, sequences of main allergens, Der p 1, 2, 5, 7, 10, 23 and Blo t 5, 6, 12, 13, were included in a 15-mer peptide microarray and tested against pooled sera from 10 patients pre- and post-1-year SLIT. All allergens were recognized to some extent by at least one antibody isotype and peptide diversity was higher post-1-year SLIT for both antibodies. IgE recognition diversity varied among allergens and timepoints without a clear tendency. Der p 10, a minor allergen in temperate regions, was the molecule with more IgE-peptides and might be a major allergen in populations highly exposed to helminths and cockroaches, such as Brazil. SLIT-induced IgG4 epitopes were directed against several, but not all, IgE-binding regions. We selected a set of peptides that recognized only IgG4 or were able to induce increased ratios of IgG4:IgE after one year of treatment and might be potential targets for vaccines.
Assuntos
Alergia a Ácaros , Imunoterapia Sublingual , Humanos , Animais , Alérgenos , Epitopos , Imunoglobulina G , Imunoglobulina E , Peptídeos , Antígenos de Dermatophagoides , PyroglyphidaeRESUMO
BACKGROUND: Cleaning workers represent a significant proportion of the active population worldwide, with poor remuneration, particularly in developing countries. Despite this, they remain a relatively poorly studied occupational group. They are constantly exposed to agents that can cause symptoms and respiratory problems. This study aimed to evaluate upper airway inflammation in professional cleaning workers in three different occupational settings by comparing nasal cytology inflammation and clinical profiles. METHODS: We performed a cross-sectional study on the prevalence of upper airway inflammation and symptoms of asthma/rhinitis related to cleaning work, according to workplace. A total of 167 participants were divided into four groups: hospital, university, housekeeper and control. A nasal swab was collected for upper airway inflammation evaluation. Clinical profiles and respiratory symptom employee evaluations were performed using specific questionnaires (European Community Respiratory Health Survey-ECRS and the International Study of Asthma and Allergies in Childhood-ISAAC). RESULTS: Cleaning workers showed increased neutrophils and lymphocytes; the hospital and university groups showed increased macrophages compared to the housekeeper and control groups. The hospital and housekeeper groups showed increased eosinophils when they performed cleaning services for up to one year and reported having more asthma symptoms than the control group. Cleaning workers showed increased rhinitis symptoms. The university group showed increased rhinitis symptoms aggravated by the workplace compared with the hospital and housekeeper groups. Cleaning workers showed an increased affirmative response when directly asked about rhinitis symptoms compared to the control group. CONCLUSIONS: Cleaning workers showed airway inflammation, asthma symptoms and rhinitis, regardless of the occupational environment to which they were exposed, as well as showed increased rhinitis and asthma symptoms. Hospital cleaning workers showed increased macrophages, lymphocytes and eosinophils compared to the others. The length of time spent performing cleaning work was not related to nasal inflammation or respiratory symptoms in this population. However, there were differences in workplaces. Registered on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER: NCT03311048. Registration date: 10.16.2017. Retrospectively registered.
Assuntos
Asma , Doenças Profissionais , Rinite , Asma/complicações , Estudos Transversais , Humanos , Inflamação/epidemiologia , Doenças Profissionais/induzido quimicamente , Doenças Profissionais/epidemiologia , Rinite/complicações , Rinite/epidemiologia , Local de TrabalhoRESUMO
Post-orgasmic illness syndrome (POIS) is a rare condition characterized by post-ejaculatory symptoms. Here is reported the first Brazilian POIS patient. Immunological investigation did not confirm the previous hypothesis of a hypersensitivity reaction. Cell immunophenotyping comparing healthy individuals produced evidence of abnormalities not associated to clinical manifestations. The patient was submitted to specific immunotherapy with transient clinical response and was referred to a psychologist but did not demonstrate clinical improvement of symptoms. Therefore, etiology of POIS remains unclear.
Assuntos
Ejaculação , Imunofenotipagem , Orgasmo , Transtornos Somatoformes/imunologia , Adulto , Ansiedade/etiologia , Calafrios/etiologia , Depressão/etiologia , Fadiga/etiologia , Febre/etiologia , Humanos , Masculino , Náusea/etiologia , SíndromeRESUMO
PURPOSE: The pathogenesis of persistent allergic rhinitis with chronic and refractory nasal obstruction is still unknown. Inflammation and tissue remodeling are known to play a role, but this has not been studied thoroughly. The purpose of this study is to identify the profile of gene expression of inflammatory and remodeling markers in nasal mucosa of patients with PAR and chronic obstruction. METHODS: After informed consent, we obtained nasal mucosa tissue from five aeroallergen-sensitized PAR patients undergoing anterior turbinectomy, and control non-sensitized individuals undergoing cerebrospinal fluid fistula repair or rhinoplasty. We assessed the expression of 34 genes related to inflammation and tissue remodeling using the real-time polymerase chain reaction (qPCR) to quantify each mRNA. RESULTS: IL-4 mRNA was upregulated in nasal mucosa of all five patients; CCR3, CCR8 and Eotaxin-2 were upregulated in four out of five patient samples; while IL-5 and IL-13 were upregulated in two of them. TGF-ß1 was not upregulated in PAR samples. mRNA from metalloproteinases MMP-7, MMP13 and MMP15 were upregulated in three out of five samples. Our results indicate a typical mRNA expression profile of the infiltrating inflammatory Th2 cells and eosinophils, combined with altered gene expression of remodeling-related proteins in stromal cells from the mucosa. CONCLUSION: Prolonged allergen challenge can lead to persistent upregulation of genes for inflammatory mediators such as IL-4 Th2/eosinophil cytokines, chemokines and receptors, which may play an important role in maintaining PAR with chronic nasal obstruction. Our findings may have therapeutic implications, including the use of anti-IL4, -CCR3 or -MMP therapy to ameliorate the condition.
Assuntos
Mediadores da Inflamação , Interleucina-4/análise , Metaloproteases/análise , Mucosa Nasal/imunologia , Obstrução Nasal , Receptores CCR3/análise , Rinite Alérgica/imunologia , Adulto , Biomarcadores/análise , Feminino , Perfilação da Expressão Gênica , Humanos , Mediadores da Inflamação/análise , Mediadores da Inflamação/classificação , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/etiologia , Obstrução Nasal/imunologia , Rinite Alérgica/complicações , Rinite Alérgica/patologia , Tempo , Regulação para CimaRESUMO
BACKGROUND: Sensitization to house dust mites (HDMs) is frequent in patients with atopic dermatitis. OBJECTIVE: To investigate the efficacy of sublingual immunotherapy (SLIT) with Dermatophagoides pteronyssinus extract in patients with atopic dermatitis sensitized to HDM. METHODS: In this randomized, double-blind, placebo-controlled trial, we enrolled 91 patients 3 years or older, with SCORing Atopic Dermatitis (SCORAD) score greater than or equal to 15 and positive skin test result and/or IgE to D pteronyssinus. Patients were stratified according to age (<12 and ≥12 years) to receive HDM SLIT or placebo for 18 months. Primary outcome was a greater than or equal to 15-point decrease in SCORAD score. Secondary outcomes were decreases in SCORAD and objective SCORAD, Eczema Area and Severity Index, visual analog scale for symptoms, and pruritus scale scores; Investigator's Global Assessment 0/1; and decrease greater than or equal to 4 points in Dermatology Life Quality Index. Background therapy was maintained. RESULTS: A total of 66 patients completed the study (35 HDM SLIT, 31 placebo). After 18 months, 74.2% and 58% of patients in the HDM SLIT group and the placebo group, respectively, showed greater than or equal to 15-point decrease in SCORAD score (relative risk, 1.28; 95% CI, 0.89-1.83). Significant SCORAD score decreases from baseline of 55.6% and 34.5% in HDM SLIT and placebo groups (mean difference, 20.4; 95% CI, 3.89-37.3), significant objective SCORAD score decreases of 56.8% and 34.9% in HDM SLIT and placebo groups (mean difference, 21.3; 95% CI, 0.66-41.81), and more patients with Investigator's Global Assessment 0/1 in the HDM SLIT group as compared with the placebo group (14 of 35 vs 5 of 31; relative risk, 2.63; 95% CI, 1.09-6.39) were observed at 18 months. CONCLUSIONS: Our results suggest that HDM SLIT may be effective in HDM-sensitized patients as an add-on treatment for atopic dermatitis.
Assuntos
Dermatite Atópica , Eczema , Imunoterapia Sublingual , Animais , Antígenos de Dermatophagoides/uso terapêutico , Criança , Dermatite Atópica/tratamento farmacológico , Dermatophagoides pteronyssinus , Método Duplo-Cego , Eczema/tratamento farmacológico , Humanos , Pyroglyphidae , Imunoterapia Sublingual/métodos , Resultado do TratamentoRESUMO
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.
Assuntos
Anafilaxia/etiologia , Hipersensibilidade ao Látex/diagnóstico , Doenças Profissionais/etiologia , Testes Cutâneos/métodos , Adulto , Anafilaxia/diagnóstico , Feminino , Humanos , Hipersensibilidade ao Látex/complicações , Doenças Profissionais/diagnósticoRESUMO
Os distúrbios do olfato (DO) impactam de forma significativa na qualidade de vida dos indivíduos, e o conhecimento teórico a respeito do assunto deve ser de domínio dos alergologistas e imunologistas clínicos, possibilitando, assim, o seu diagnóstico e implementação de intervenções. Suas causas podem ser variadas, entre elas estão: rinite alérgica, rinossinusite crônica com ou sem pólipos, infecções de vias aéreas superiores, exposição a substâncias químicas, doenças neurológicas, drogas, traumas e o próprio envelhecimento. O olfato pode ser avaliado e mensurado através de testes com metodologias diferentes, cujo objetivo é avaliar parâmetros como a identificação de odores, limiar e discriminação olfativa. Esses testes são de fundamental importância para caracterizar objetivamente a queixa do paciente, como também avaliar o olfato antes e após determinada aplicação terapêutica. O tratamento das desordens olfativas é baseado em sua etiologia, portanto determinar a sua causa é indispensável para uma melhor eficácia no manejo. Entre as principais opções estão os corticoides tópicos, com impacto significativo nos pacientes com doença sinusal associada, treinamento olfatório e outras intervenções como ômega 3, vitamina A intranasal, e terapias que ainda requerem mais estudos.
Olfactory dysfunction significantly impacts quality of life, and allergists and clinical immunologists must be informed about it for diagnostic and interventional purposes. The causes are varied: allergic rhinitis, chronic rhinosinusitis with or without polyps, upper airway infections, exposure to chemicals, neurological diseases, drugs, trauma, and aging itself. Olfactory function can be evaluated and measured by several tests that use different methodologies to evaluate and identify odors, olfactory threshold, and olfactory discrimination. These tests are fundamental for objectively characterizing patient complaints and evaluating olfactory function before and after therapeutic interventions. Olfactory disorders are treated according to their etiology, so determining their cause is a major factor in treatment efficacy. The main options include topical corticosteroids, which have a significant impact on patients with sinus disease, olfactory training, other therapies (such as omega 3 and intranasal vitamin A), in addition to therapies that require further research.
Assuntos
Humanos , Ácidos Graxos Ômega-3 , COVID-19RESUMO
Cats are a significant source of allergens that contribute towards worsening of allergic diseases. The aim of this study was to investigate the association between sensitization to cat allergens and allergic respiratory diseases.This was an observational retrospective study based on the skin pricktests results of patients at a tertiary-level hospital in São Paulo. A total of 1,985 test results were assessed. The prevalence of sensitization to cat allergen was 20% (399 patients). Our data indicated that in this population of atopic patients, a positive skin prick test result for cat allergen was not associated significantly with a diagnosis of respiratory allergy.
Assuntos
Alérgenos/efeitos adversos , Gatos/imunologia , Hipersensibilidade Respiratória/diagnóstico , Testes Cutâneos , Alérgenos/análise , Animais , Estudos Transversais , Feminino , Humanos , Masculino , Hipersensibilidade Respiratória/epidemiologia , Hipersensibilidade Respiratória/etiologia , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Occupational diseases involving the immune system are considered to be occupational allergic diseases (OAD); 15% of occupational diseases are allergic. The social consequences of OAD are significant for both workers and employers. OBJECTIVES: To describe demographic and clinical characteristics of patients with OAD and their social outcomes. METHODS: Descriptive and retrospective study of the medical records of patients diagnosed with OAD cared at the occupational allergy clinic of a university hospital in São Paulo, Brazil. RESULTS: A total of 72 patients exhibited OAD, with age 21 to 89 years old; 52% were male. Atopic antecedents were described for 35% of patients. Most patients worked in the chemical industry (17%), cleaning (15%), construction (11%) and health care (8%). Occupational rhinitis was found in 26% of the patients, work-related asthma in 18%, asthma and rhinitis in 25%, and allergic contact dermatitis in 13%. In regard to the social outcomes, 36 (50%) workers remained in their jobs, 19 (26%) changed function, 7 (10%) changed occupation, 7 (10%) were fired and 3 (4%) retired. CONCLUSIONS: In the present study, OAD prevailed among males and within the economically active age; cases of occupational rhinitis were the most frequent. Half of the employees remained in the same job position even after diagnosis.
INTRODUÇÃO: Doença ocupacional envolvendo o sistema imunológico é considerada doença alérgica ocupacional (DAO). Das doenças ocupacionais, 15% são alérgicas. As consequências sociais do diagnóstico de DAO são importantes para o trabalhador e empregador. OBJETIVOS: Descrever características demográficas e clínicas dos pacientes estudados com DAO e seus desfechos sociais. MÉTODOS: Estudo descritivo, retrospectivo dos prontuários de pacientes do ambulatório de alergia ocupacional de hospital universitário em São Paulo, com diagnóstico de DAO. RESULTADOS: 72 pacientes apresentaram DAO, com idades entre 21 e 89 anos; 52% do sexo masculino. Antecedentes atópicos foram descritos em 35% dos pacientes. A maioria dos pacientes trabalhava nas áreas de indústria química (17%), limpeza (15%), construção civil (11%) e saúde (8%). Rinite ocupacional foi vista em 26% dos pacientes; asma relacionada ao trabalho, em 18%; asma e rinite, em 25%; dermatite de contato alérgica, em 13%. Sobre o desfecho social, 36 (50%) mantiveram-se em seus cargos, 19 (26%) mudaram de função, 7 (10%) mudaram de área, 7 (10%) foram afastados e 3 (4%) se aposentaram. CONCLUSÕES: Na casuística estudada, a DAO prevaleceu no sexo masculino, em faixa etária condizente com faixa trabalhadora; com maior número de casos de rinite ocupacional. Metade dos pacientes continuou exercendo a mesma função mesmo após o diagnóstico.
RESUMO
A pandemia de COVID-19 representa um grande desafio para todas as especialidades médicas. A imunoterapia com alérgenos (ITA) é considerada o único procedimento terapêutico capaz de modificar a história natural das doenças alérgicas, e caracteriza o estado da arte na área de Alergia e Imunologia. Esta estratégia terapêutica de imunomodulação é capaz de promover a remissão e controle das doenças alérgicas por períodos prolongados, mesmo após o seu término. Existem poucos dados em relação ao emprego da ITA em pacientes vacinados contra COVID-19, e até o momento não há um posicionamento oficial das sociedades internacionais da área de Alergia e Imunologia Clínica. Este documento tem como objetivo estabelecer recomendações práticas para o manejo da ITA em pacientes que receberam a vacina contra COVID-19. Os fenômenos imunológicos envolvidos na imunoprofilaxia vacinal e no mecanismo de ação da ITA foram comparados, proporcionando o estabelecimento de recomendações precisas.
The COVID-19 pandemic represents a serious challenge for all medical specialties. Allergen-specific immunotherapy (AIT) is considered the only therapeutic procedure capable of modifying the natural history of allergic diseases and characterizes the state of the art in the field of allergy and immunology. This therapeutic strategy of immunomodulation is able to promote remission and control of allergic diseases for prolonged periods, even after cessation. There are few data regarding use of AIT in patients vaccinated against COVID-19 and, to date, there is no official position statement published by international allergy and clinical immunology societies. This document aims to establish practical recommendations for the management of AIT in patients who have received the COVID-19 vaccine. The immunological mechanisms involved in immunoprophylaxis with vaccines and the mechanism of action of AIT have been compared to provide a solid basis for establishing precise recommendations.
Assuntos
Humanos , Sociedades Médicas , Dessensibilização Imunológica , Vacinas contra COVID-19 , COVID-19 , Vacinas de mRNA , Imunoterapia , Terapêutica , Alérgenos , Alergia e Imunologia , Imunomodulação , Hipersensibilidade , MétodosRESUMO
CONTEXT: Some studies have shown that inflammatory processes in the nasal air passages may reflect or affect those in the lower airways. We decided to indirectly assess the inflammatory status of the nasal airways in two groups of children with different sensitization rates to aeroallergens. OBJECTIVE: To compare the inflammatory activity in the nasal airways, through the determination of mediators in nasal lavage fluid in two distinct populations. TYPE OF STUDY: Cross-sectional study. SETTING: Two public elementary schools, one in an urban setting and the other in a rural setting of the State of São Paulo, Brazil. METHODS: Two groups of 40 elementary school children with different sensitization rates to aeroallergens were formed. Samples of nasal lavage fluid were assessed for eosinophil cationic protein (ECP) and tryptase. Non-parametric tests were used for statistical analysis. RESULTS: Significantly higher levels of ECP were observed among students living in the urban area than those in the rural area (p < 0.05). No significant difference in the tryptase levels was observed. Also, the urban children who were sensitized to aeroallergens presented higher levels of ECP in nasal mucosa than the non-sensitized children, while this difference was not observed among the rural children. DISCUSSION: The lack of mast cell activity and increased eosinophil degranulation revealed a chronic inflammatory state in the nasal air passages. The higher eosinophil activity in the urban area, coinciding with higher sensitization to aeroallergens, suggests that there must be some factors in the urban area that can modulate airway inflammation by influencing the activation of inflammatory cells. CONCLUSION: Our findings showed that there was no difference in the concentrations of tryptase in nasal lavage fluids between the two studied groups. However, the children from the urban area presented with higher concentrations of eosinophil cationic protein than did those from the rural area. Also, the urban children who were sensitized to aeroallergens presented with greater concentrations of eosinophil cationic protein in nasal mucosa than the non-sensitized children, while this difference was not observed among the rural children.
Assuntos
Alérgenos/análise , Proteína Catiônica de Eosinófilo/análise , Mediadores da Inflamação/análise , Líquido da Lavagem Nasal/química , Serina Endopeptidases/análise , Adolescente , Alérgenos/imunologia , Brasil , Criança , Estudos Transversais , Proteína Catiônica de Eosinófilo/imunologia , Eosinófilos/química , Feminino , Humanos , Mediadores da Inflamação/imunologia , Masculino , Mastócitos/química , Rinite/imunologia , População Rural , Serina Endopeptidases/imunologia , Triptases , População UrbanaRESUMO
ABSTRACT Cats are a significant source of allergens that contribute towards worsening of allergic diseases. The aim of this study was to investigate the association between sensitization to cat allergens and allergic respiratory diseases.This was an observational retrospective study based on the skin pricktests results of patients at a tertiary-level hospital in São Paulo. A total of 1,985 test results were assessed. The prevalence of sensitization to cat allergen was 20% (399 patients). Our data indicated that in this population of atopic patients, a positive skin prick test result for cat allergen was not associated significantly with a diagnosis of respiratory allergy.
Assuntos
Humanos , Animais , Masculino , Feminino , Hipersensibilidade Respiratória/diagnóstico , Testes Cutâneos , Alérgenos/efeitos adversos , Gatos/imunologia , Hipersensibilidade Respiratória/etiologia , Hipersensibilidade Respiratória/epidemiologia , Alérgenos/análise , Estudos Transversais , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND AND OBJECTIVES: The number of patients allergic to latex has increased significantly. It is crucial to recognize the cases in order to prevent and apply adequate treatment. The objective of this study was to evaluate the prevalence of allergy to latex in meningomyelocele patients. MATERIALS AND METHODS: A retrospective evaluation of medical records of patients with meningomyelocele diagnosis from January 2002 to December 2007 was conducted. Patients were grouped into allergics and non-allergics. The comparison of groups for gender was made by the Chi-Squared test, the Student's t test was used to compare age, and Mann-Whitney test was used to compare groups for clinical manifestations of allergy, number of procedures under anesthesia, hospital admissions and vesical catheterizations. RESULTS: The mean number of procedures under anesthesia was 7 in the group with allergy and 4 in the group without allergy; this difference was statistically significant (p=0.028). The mean number of hospital admissions was 4.5 in the group with allergy and 3.4 in group without allergy and mean vesical catheterization was 24.5 in allergic patients and 21.7 in non allergic ones. CONCLUSIONS: Meningomyelocele patients undergoing multiple procedures under anesthesia have high risk of developing clinical signals of allergy to latex. It is necessary that patients with meningomyelocele diagnosis should undergo exclusively latex-free procedures, avoiding high risk of sensitization and its complications. Specific tests to evaluate sensitization, genetic markers and latex-fruit relationship may contribute to a better understanding of risk factors related to allergy to latex and ways to prevent it.
Assuntos
Hipersensibilidade ao Látex/epidemiologia , Meningomielocele/imunologia , Meningomielocele/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/imunologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Adulto JovemRESUMO
Introdução: Doença ocupacional envolvendo o sistema imunológico é considerada doença alérgica ocupacional (DAO). Das doenças ocupacionais, 15% são alérgicas. As consequências sociais do diagnóstico de DAO são importantes para o trabalhador e empregador. Objetivos: Descrever características demográficas e clínicas dos pacientes estudados com DAO e seus desfechos sociais. Métodos: Estudo descritivo, retrospectivo dos prontuários de pacientes do ambulatório de alergia ocupacional de hospital universitário em São Paulo, com diagnóstico de DAO. Resultados: 72 pacientes apresentaram DAO, com idades entre 21 e 89 anos; 52% do sexo masculino. Antecedentes atópicos foram descritos em 35% dos pacientes. A maioria dos pacientes trabalhava nas áreas de indústria química (17%), limpeza (15%), construção civil (11%) e saúde (8%). Rinite ocupacional foi vista em 26% dos pacientes; asma relacionada ao trabalho, em 18%; asma e rinite, em 25%; dermatite de contato alérgica, em 13%. Sobre o desfecho social, 36 (50%) mantiveram-se em seus cargos, 19 (26%) mudaram de função, 7 (10%) mudaram de área, 7 (10%) foram afastados e 3 (4%) se aposentaram. Conclusões: Na casuística estudada, a DAO prevaleceu no sexo masculino, em faixa etária condizente com faixa trabalhadora; com maior número de casos de rinite ocupacional. Metade dos pacientes continuou exercendo a mesma função mesmo após o diagnóstico.
Background: Occupational diseases involving the immune system are considered as occupational allergic diseases (OAD); 15% of occupational diseases are allergic. The social consequences of OAD are significant for both workers and employers. Objectives: To describe demographic and clinical characteristics of patients with OAD and their social outcomes. Methods: Descriptive and retrospective study of the medical records of patients diagnosed with OAD and cared at the occupational allergy clinic of a university hospital in São Paulo, Brazil. Results: A total of 72 patients exhibited OAD, with age from 21 to 89 years old; 52% were male. Atopic antecedents were described for 35% of patients. Most patients worked in the chemical industry (17%), cleaning (15%), construction (11%) and health (8%). Occupational rhinitis was found in 26% of the patients, work-related asthma in 18%, asthma and rhinitis in 25%, and allergic contact dermatitis in 13%. In regard to the social outcomes, 36 (50%) remained in their job, 19 (26%) changed function, 7 (10%) changed work area, 7 (10%) were fired and 3 (4%) retired. Conclusions: In the present study, OAD prevailed in males and the economically active age; cases of occupational rhinitis were the most frequent. Half of the employees remained in the same function even after diagnosis.
Assuntos
Humanos , Dermatite Ocupacional/epidemiologia , Asma Ocupacional/imunologia , Asma Ocupacional/epidemiologia , Brasil , Epidemiologia Descritiva , Estudos RetrospectivosRESUMO
Introdução: A rinite alérgica é uma doença de grande prevalência em todo o mundo, acometendo 15 a 42% da população geral, e 3 a 12% dos idosos. Acredita-se ser uma doença subdiagnosticada nesta população, porque algumas doenças frequentes nos idosos podem confundir o diagnóstico de doenças alérgicas. Objetivo: Avaliar o perfil clínico dos idosos com rinite alérgica atendidos no serviço de imunologia clínica e alergia de um hospital terciário de São Paulo. Avaliar também a sensibilização a aeroalérgenos, presença de asma alérgica e outras comorbidades. Métodos: Foram selecionados 104 pacientes maiores de 60 anos, diagnosticados com rinite alérgica e não alérgica. Esses pacientes foram comparados quanto à presença de asma e outras doenças concomitantes, sensibilização a aeroalérgenos e uso de medicamentos. Resultados: Dentre os pacientes com rinite alérgica, identificamos predomínio de rinite persistente moderada, sendo a asma o principal diagnóstico associado à rinite. Dentre as demais comorbidades observadas, os idosos tinham doença pulmonar obstrutiva crônica (DPOC), hipertensão arterial sistêmica e diabetes, mas não foram encontradas associações significativas entre a presença destas comorbidades e a rinite. Detectamos 71,9% de sensibilidade entre os idosos com rinite alérgica, e verificamos associação significativa com relação a IgE específica in vitro e ocorrência de sintomas. Conclusão: Estudos com a população idosa são necessários para melhor conhecimento da rinite nesta população, suas necessidades e possíveis ações preventivas.
Introduction: Allergic rhinitis is a highly prevalent disease worldwide, affecting 15 to 42% of the general population and 3 to 12% of the elderly. The condition is believed to be underdiagnosed in the elderly population, because other pathologies commonly present in this population may mask the diagnosis of allergic diseases. Objective: To evaluate the clinical profile of elderly patients with allergic rhinitis treated at the immunology and allergy service of a tertiary hospital of São Paulo. Sensitization to aeroallergens, presence of allergic asthma, and other comorbidities were also assessed. Methods: We selected 104 patients older than 60 years diagnosed with allergic and nonallergic rhinitis. These patients were compared for the presence of asthma and other concomitant diseases, sensitization to aeroallergens and use of medications. Results: Among the patients with allergic rhinitis, we identified a predominance of moderate persistent rhinitis; asthma was the main diagnosis associated with rhinitis. Other comorbidities included chronic obstructive pulmonary disease (COPD), systemic arterial hypertension and diabetes, but no significant associations were found between these comorbidities and rhinitis. We detected 71.9% of sensitivity among the elderly with allergic rhinitis, and a significant association was found between in vitro assays for specific IgE and the occurrence of symptoms. Conclusion: Studies with the elderly are necessary to improve our understanding of the occurrence of rhinitis in this population, patient needs and possible preventive actions.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Asma , Alergia e Imunologia , Rinite Alérgica , Sinais e Sintomas , Imunoglobulina E , Prevalência , Doença Pulmonar Obstrutiva Crônica , Diabetes Mellitus , Uso de Medicamentos , HipertensãoRESUMO
CONTEXT AND OBJECTIVE: The only effective treatment for patients who have severe reactions after Hymenoptera stings is venom immunotherapy. The aim of this study was to review the literature to assess the effects of venom immunotherapy among patients presenting severe reactions after Hymenoptera stings. DESIGN AND SETTING: Randomized controlled trials in the worldwide literature were reviewed. The manuscript was produced in the Discipline of Allergy and Clinical Immunology, Universidade de São Paulo (USP). METHODS: Randomized controlled trials involving venom immunotherapy versus placebo or only patient follow-up were evaluated. The risk of systemic reactions after specific immunotherapy was evaluated by calculating odds ratios (OR) and their 95% confidence intervals. RESULTS: 2,273 abstracts were identified by the keywords search. Only four studies were included in this review. The chi-square test for heterogeneity showed that two studies were homogeneous and could be included in a meta-analysis. By combining the two studies, the odds ratio became significant: 0.29 (0.10-0.87). However, analysis on the severity of the reactions after immunotherapy showed that the benefits may not be so significant because the reactions were mostly similar to or milder than the original reaction. CONCLUSIONS: Specific immunotherapy should be recommended for adults and children with moderate to severe reactions, but there is no need to prescribe it for children with skin reactions alone, especially if the exposure is very sporadic. On the other hand, the risk-benefit relation should always be assessed in each case.
Assuntos
Venenos de Artrópodes/uso terapêutico , Himenópteros/imunologia , Hipersensibilidade/terapia , Imunoterapia/métodos , Animais , Venenos de Artrópodes/imunologia , Venenos de Abelha/imunologia , Venenos de Abelha/uso terapêutico , Distribuição de Qui-Quadrado , Humanos , Hipersensibilidade/imunologia , Mordeduras e Picadas de Insetos/imunologia , Mordeduras e Picadas de Insetos/terapia , Razão de Chances , Resultado do Tratamento , Venenos de Vespas/imunologia , Venenos de Vespas/uso terapêuticoRESUMO
OBJETIVO: Comparar os níveis séricos de anticorpos IgE veneno-específicos e a reatividade em testes cutâneos antes e após 3 anos de imunoterapia específica com veneno de himenópteros. MÉTODO: Pacientes foram selecionados para imunoterapia de acordo com a história clínica e pesquisa de anticorpos IgE veneno-específicos (ImmunoCap, Phadia, Brasil) e testes cutâneos (prick test e intradérmico). Após 3 anos de imunoterapia, os pacientes foram avaliados sobre ferroadas acidentais e foram repetidos a IgE sérica e o teste cutâneo. RESULTADOS: Trinta e cinco pacientes foram avaliados. Dos que fizeram imunoterapia com veneno de abelha, 56% tiveram diminuição dos níveis de IgE por ImmunoCap, 71% permaneceram com teste cutâneo positivo, e 5% apresentaram sensibilização ao veneno de vespa, que não havia sido detectada na avaliação inicial. Para os que fizeram imunoterapia com veneno de vespa, 80% tiveram diminuição no nível de IgE sérica, 88% apresentaram teste cutâneo negativo, e 5% apresentaram sensibilização ao veneno de abelha. Dos que fizeram imunoterapia com veneno de formiga, 92% tiveram diminuição dos níveis de IgE sérica específica, 78% permaneceram com teste cutâneo positivo, e 10%, apresentaram sensibilização para abelha e vespa. Não houve reação sistêmica dos pacientes que apresentaram ferroadas acidentais (86% dos pacientes alérgicos a abelha, 75% a vespa e 82% a formiga). CONCLUSÃO: A imunoterapia por pelo menos 3 anos foi efetiva, pois todos os pacientes que foram ferroados acidentalmente não apresentaram reações sistêmicas. Nossos resultados também demonstraram que tanto a IgE sérica específica assim como os testes cutâneos não servem como parâmetros de sucesso no tratamento, pois a maioria permanece com positividade, no entanto sem reatividade clínica.
Objective: To compare serum levels of venom-specific IgE antibodies and skin test reactivity before and after 3 years of specific immunotherapy with Hymenoptera venom. Method: Patients were selected for immunotherapy according to clinical history, presence of venom-specific IgE (ImmunoCAP, Phadia, Brazil), and positive skin tests (prick test and intradermal test). After 3 years of immunotherapy, patients were inquired about accidental stings, and both serum IgE and skin tests were repeated. Results: Thirty-five patients were evaluated. Among those who had received bee venom immunotherapy, 56% showed lower levels of specific IgE on ImmunoCAP, 71% had positive skin tests, and 5% showed sensitization to wasp venom that was not detected at baseline. Of those who had received immunotherapy with wasp venom extract, 80% showed lower levels of serum IgE, 88% had negative skin tests, and 5% showed sensitization to bee venom. Finally, among patients treated with fire ant immunotherapy, 92% showed lower specific IgE levels; 78% had positive skin tests, and 10% presented sensitization to bee and wasp venoms. There were no systemic reactions in patients who had been accidentally stung (86% of patients allergic to bee, 75% to wasp, and 82% to fire ant). Conclusion: Immunotherapy for at least 3 years was effective, as none of the patients accidentally stung showed systemic reactions. Our results also showed that neither serum specific IgE nor skin tests are reliable parameters for the evaluation of treatment success, as the majority of patients remained positive, however without clinical reactivity.
Assuntos
Humanos , Masculino , Feminino , Anafilaxia , Himenópteros , Imunoglobulina E , Imunoterapia , Mordeduras e Picadas de Insetos , Venenos , Técnicas e Procedimentos Diagnósticos , Métodos , Padrões de Referência , Pacientes , Testes CutâneosRESUMO
JUSTIFICATIVA E OBJETIVOS: O número de pacientes alérgicos ao látex vem aumentando significativamente. É essencial reconhecê-los para preve nir e aplicar o tratamento adequado. O objetivo do estudo foi avaliar a prevalência de alergia ao látex em pacientes com mielomeningocele. MATERIAIS E MÉTODOS: Foram avaliados, retrospectivamente, os prontuários médicos de pacientes com diagnóstico de mielomeningocele no período de janeiro de 2002 a dezembro de 2007. Os pacientes foram agrupados em alérgicos e não alérgicos. A comparação dos grupos em relação ao gênero foi feita pelo teste do Qui-quadrado, pelo teste t de Student em relação à idade, e o teste de Mann-Whitney para comparação entre os grupos em relação as manifestações clínicas de alergia, número de procedimentos sob anestesia, de internações hospitalares e de cateterizações vesicais. RESULTADOS: O número médio de procedimentos sob anestesia foi de 7 no grupo com alergia e 4 no grupo sem alergia, sendo esta diferença estatisticamente significante (p = 0,028). O número médio de internações hospitalares foi de 4,5 no grupo com alergia e 3,4 no grupo sem alergia e a média de cateterização vesical foi 24,5 nos alérgicos e 21,7 nos não alérgicos. CONCLUSÕES: Os pacientes portadores de mielomeningocele submetidos a múltiplos procedimentos sob anestesia apresentam alto risco de desenvolvimento de sinais clínicos de alergia ao látex. Há necessidade de que pacientes com diagnóstico de mielomeningocele sejam submetidos exclusivamente a procedimentos latex-free, evitando o alto risco de sensibilização e suas complicações. Testes específicos para avaliação da sensibilização, marcadores genéticos e relação látex-fruta poderão contribuir para melhor entendimento dos fatores de risco relacionados à alergia ao látex e formas de prevenção.
BACKGROUND AND OBJECTIVES: The number of patients allergic to latex has increased significantly. It is crucial to recognize the cases in order to prevent and apply adequate treatment. The objective of this study was to evaluate the prevalence of allergy to latex in meningomyelocele patients. MATERIALS AND METHODS: A retrospective evaluation of medical records of patients with meningomyelocele diagnosis from January 2002 to December 2007 was conducted. Patients were grouped into allergics and non-allergics. The comparison of groups for gender was made by the Chi-Squared test, the Student's t test was used to compare age, and Mann-Whitney test was used to compare groups for clinical manifestations of allergy, number of procedures under anesthesia, hospital admissions and vesical catheterizations. RESULTS: The mean number of procedures under anesthesia was 7 in the group with allergy and 4 in the group without allergy; this difference was statistically significant (p = 0.028). The mean number of hospital admissions was 4.5 in the group with allergy and 3.4 in group without allergy and mean vesical catheterization was 24.5 in allergic patients and 21.7 in non allergic ones. CONCLUSIONS: Meningomyelocele patients undergoing multiple procedures under anesthesia have high risk of developing clinical signals of allergy to latex. It is necessary that patients with meningomyelocele diagnosis should undergo exclusively latex-free procedures, avoiding high risk of sensitization and its complications. Specific tests to evaluate sensitization, genetic markers and latex-fruit relationship may contribute to a better understanding of risk factors related to allergy to latex and ways to prevent it.
JUSTIFICATIVA Y OBJETIVOS: El número de pacientes alérgicos al látex ha venido aumentando significativamente. Es esencial reconocer los casos para prevenir y aplicar el tratamiento adecuado. El objetivo del estudio, fue evaluar la prevalencia de alergia al látex en pacientes con mielomeningocele. MATERIAL Y MÉTODOS: Fueron evaluadas retrospectivamente, las historias clínicas de pacientes con diagnóstico de mielomeningocele en el período de enero de 2002 a diciembre de 2007. Los pacientes fueron agrupados en alérgicos y no alérgicos. La comparación de los grupos con relación al sexo se hizo por medio del test del Xi-Cuadrado (Xi²), por el test t de Student con relación a la edad, y el test de Mann-Whitney para la comparación entre los grupos, con relación a las manifestaciones clínicas de alergia, número de procedimientos bajo anestesia, de ingresos hospitalarios y de cateterizaciones vesicales. RESULTADOS: El número promedio de procedimientos bajo anestesia fue de 7 en el grupo con alergia y 4 en el grupo sin alergia, siendo que esa diferencia es estadísticamente significativa (p = 0,028). El número promedio de ingresos fue de 4,5 en el grupo con alergia y de 3,4 en el grupo sin alergia, y el promedio de cateterización vesical fue 24,5 en los alérgicos y de 21,7 en los no alérgicos. CONCLUSIONES: Los pacientes portadores de mielomeningocele sometidos a múltiples procedimientos bajo anestesia, presentan un alto riesgo de desarrollar signos clínicos de alergia al látex. Existe la necesidad de que pacientes con diagnóstico de mielomeningocele se sometan exclusivamente a procedimientos latex-free, evitando así el alto riesgo de sensibilización y sus complicaciones. Test específicos para la evaluación de la sensibilización, marcadores genéticos y relación látex-fruta, podrán contribuir para un mejor entendimiento de los factores de riesgo relacionados con la alergia al látex y con las formas de prevención.
Assuntos
Humanos , Hipersensibilidade ao Látex/epidemiologia , Meningomielocele/complicaçõesRESUMO
CONTEXT AND OBJECTIVE: The only effective treatment for patients who have severe reactions after Hymenoptera stings is venom immunotherapy. The aim of this study was to review the literature to assess the effects of venom immunotherapy among patients presenting severe reactions after Hymenoptera stings. DESIGN AND SETTING: Randomized controlled trials in the worldwide literature were reviewed. The manuscript was produced in the Discipline of Allergy and Clinical Immunology, Universidade de São Paulo (USP). METHODS: Randomized controlled trials involving venom immunotherapy versus placebo or only patient follow-up were evaluated. The risk of systemic reactions after specific immunotherapy was evaluated by calculating odds ratios (OR) and their 95 percent confidence intervals. RESULTS: 2,273 abstracts were identified by the keywords search. Only four studies were included in this review. The chi-square test for heterogeneity showed that two studies were homogeneous and could be included in a meta-analysis. By combining the two studies, the odds ratio became significant: 0.29 (0.10-0.87). However, analysis on the severity of the reactions after immunotherapy showed that the benefits may not be so significant because the reactions were mostly similar to or milder than the original reaction. CONCLUSIONS: Specific immunotherapy should be recommended for adults and children with moderate to severe reactions, but there is no need to prescribe it for children with skin reactions alone, especially if the exposure is very sporadic. On the other hand, the risk-benefit relation should always be assessed in each case.
CONTEXTO E OBJETIVO: O único tratamento eficaz para pacientes que têm reações graves após ferroada de Hymenoptera é a imunoterapia com veneno. O objetivo deste estudo foi rever a literatura para avaliar os efeitos da imunoterapia com veneno em pacientes com reações graves após ferroada de Hymenoptera. TIPO DE ESTUDO E LOCAL: Foram revisados na literatura mundial ensaios clínicos controlados e aleatórios. O manuscrito foi realizado na Disciplina de Alergia e Imunologia Clínica, Universidade de São Paulo (USP). MÉTODOS: Ensaios clínicos controlados e aleatórios envolvendo imunoterapia com veneno de Hymenoptera versus placebo ou apenas acompanhamento dos pacientes foram avaliados. Realizada imunoterapia específica, o risco de reações sistêmicas foi avaliado através de cálculo do "odds ratio" e intervalo de confiança de 95 por cento. RESULTADOS: 2.273 resumos foram identificados na busca pelas palavras chave. Apenas quatro estudos foram incluídos nesta revisão. O teste qui-quadrado de heterogeneidade mostrou que dois estudos foram homogêneos e puderam ser incluídos na metanálise. Ao combinar os dois estudos, o "odds ratio" passou a ser significativo: 0.29 (0.10-0.87). Entretanto, ao analisar a gravidade das reações ocorridas após a imunoterapia, observou-se que os benefícios podem não ser tão relevantes, pois as reações foram, na grande maioria, ou mais leves ou semelhantes à reação original. CONCLUSÕES: A imunoterapia específica deve ser recomendada para adultos e crianças com reações moderadas a graves, porém não há necessidade de prescrevê-la para as crianças apenas com reações cutâneas, especialmente se a exposição é muito esporádica. No outro lado, a relação risco-benefício deve ser sempre avaliada em cada caso.