Allergic sensitization to Storage Dust Mites: a prospective study of patients with respiratory allergy

Summary: Objectives. To describe the prevalence of allergic sensitization to Storage Dust Mites (SDM), access whether the place of living and occupational exposure were determinants for SDM sensitization and study association between Lepidoglyphus destructor and other SDM sensitization. Methods. Prospective analysis of patients evaluated for suspected allergic rhinitis and/or asthma that performed Skin Prick Tests (SPT) to SDM between January and December 2018 in our Department. Results. Two hundred consecutive patients were evaluated for rhinitis and/or asthma in our outpatient consultation: 123 (61.5%) presented positivity for at least one SDM, 68.3% were female and the mean age was 33.1 ± 12.12. Lepidoglyphus destructor (69.9%) was the most prevalent, followed by Tyrophagus putrescentiae (50.4%), Blomia tropicalis and Glycyphagus domesticus (48.8%) and Acarus siro (24.4%). Living in a rural place was not associated with a higher prevalence of sensitization to SDM, except for Acarus siro (p = 0.032), and working in a place with storage areas was not associated with sensitization to any of SDM. Sensitization to Lepidoglyphus destructor was associated with sensitization to Blomia tropicalis, Glycyphagus domesticus and Tyrophagus putrescentiae (p less than 0.005), but not with Acarus siro.Conclusions. Our study suggests that our population, independently of their occupational exposure and place of residency, are sensitized to SDM and that evaluation of sensitization to SDM should be considered as standard practice.

Molecular Profile of Sensitization to Dermatophagoides pteronyssinus Dust Mite in Portugal.

BACKGROUND AND OBJECTIVES: To analyze component-resolved diagnosis of sensitization to Dermatophagoides pteronyssinus (Der p) in patients with respiratory allergy and the association between diagnostic findings and clinical severity in different geographical areas. METHODS: The study population comprised 217 patients (mean age, 25.85 [12.7] years; 51.16% female) selected from 13 centers in Portugal (5 from the North, n=65). All had allergic rhinitis with or without asthma and positive skin prick test results to at least 1 dust mite. Specific IgE (sIgE) to Der p, Dermatophagoides farinae, Lepidoglyphus destructor, Der p 1, Der p 2, Der p 10, and Der p 23 was determined using ImmunoCAP. The Mann-Whitney test was applied for the following comparisons: rhinitis vs rhinitis and asthma; mild vs moderate-to-severe rhinitis; North vs South. RESULTS: The prevalence of sensitization was 98.2% for Der p, and 72.4%, 89.4%, 9.7%, and 77% for Der p 1, Der p 2, Der p 10, and Der p 23, respectively. The corresponding median sIgE levels were 8.56, 17.7, 0.01, and 3.95 kUA/L. sIgE to all allergens was higher in patients with moderate-to-severe rhinitis and rhinitis with asthma (nonsignficant). Concentrations of sIgE to Der p 2 were significantly higher in the South than in the North (P=.0496). CONCLUSION: The most common sensitization in Portugal was to Der p. The highest prevalence and median sIgE level were observed for Der p 2. All sIgE values for molecular components were higher in more symptomatic patients (nonsignificant). Concentrations of sIgE to Der p 2 were higher in the South, probably because of the warmer temperature and/or the larger sample size.

Galactose-α-1,3-galactose allergy: a rare syndrome and an atypical presentation.

Summary: Allergies to red meat associated with galactose-α-1,3-galactose, commonly known as α-gal, are rare and have only recently been described. At this time, the literature reports only one case documented in Portugal. In this study, we report the case of a 76-year-old male with an immediate reaction following the ingestion of red meat. Rigorous diagnostic exams, including prick test, prick-to-prick tests, serum specific IgE and SDS-PAGE IgE-immunoblotting, were performed. The α-gal epitope IgE re-turned a value of 35.3 kUA/L, leading the authors to believe that this is an atypical case of α-gal allergy.

Diagnostic usefulness of component-resolved diagnosis by skin prick tests and specific IgE to single allergen components in children with allergy to fruits and vegetables.

INTRODUCTION: The accurate identification of sensitizing proteins in patients allergic to plant-derived foods is extremely important, allowing a correct dietary advice. We aimed to evaluate the diagnostic usefulness of skin prick tests (SPT) and specific IgE (sIgE) with single molecular allergen components in children with allergy to fruits and vegetables. METHODS: Twenty children underwent SPT with a palm profilin (Pho d 2, 50 µg/mL); a Mal d 1-enriched apple extract (2 µg/mL) (PR-10 allergen); and a peach Lipid Transfer Protein (LTP) (Pru p 3, 30 µg/mL). Detection of sIgE to rBet v 1, rBet v 2, Phl p 12 and Pru p 3 was also measured. RESULTS: Allergy to multiple fruits and vegetables was observed in 11 (55%) children. Sensitization by SPT to Pho d 2, Mal d 1, and Pru p 3 occurred in 5, 7, and 8 cases, respectively. LTP sensitization appeared to be associated with peach allergy but not with severe reactions, and profilins sensitization to melon and tomato allergy. Kiwi sensitization (12 cases), the plant-derived food that caused more allergic reactions, seemed mostly species-specific. The concordance of SPT extracts and sIgE to the corresponding pan-allergens was high for profilins (k=0.857) and LTP (k=0.706), while for PR-10 allergens it was absent (k=0.079). CONCLUSIONS: Pan-allergen sensitization in children with allergy to fruits and vegetables was common and often multiple. There was no association of severe reactions to LTP sensitization. The introduction of routine SPT to pan-allergens can be a simple and feasible way of improving diagnostic and therapeutic efficacy.

Anaphylaxis in children: a nine years retrospective study (2001-2009).

BACKGROUND: Anaphylaxis is an acute multisystemic and potentially fatal reaction, resulting from the rapid release of inflammatory mediators. Its exact prevalence is unknown. In children, foods are the most significant triggers for IgE-mediated anaphylaxis. OBJECTIVES: To characterise the cases of anaphylaxis evaluated in an Allergy Division of a Central Paediatric Hospital. MATERIAL AND METHODS: A review of all cases of anaphylaxis evaluated from 2001 to 2009. Anaphylaxis was defined according to Sampson's 2006 criteria. RESULTS: Seventy-three children had anaphylactic reactions (47 male), of which 64% had history of atopy. Age at time of reaction ranged between 17 days and 15 years old (median: four years). Food was the most frequently identified cause (n=57), followed by drugs (n=8), hymenoptera venom (n=2), and cold (n=1). In five cases there was no identifiable cause. Among foods, cow's milk was the culprit agent in 27 children. The most severe reaction was a cardiorespiratory arrest. The most frequent symptoms were respiratory and cutaneous in 51 cases. Hypotension was present in nine cases. There were no fatalities. Most acute reactions were treated with corticosteroids and/or antihistamines. Adrenaline was used in only about one quarter of children. CONCLUSIONS: The most important causes of anaphylaxis in our study were foods, and the most common symptoms were respiratory and cutaneous. The prevalence of anaphylaxis was higher in males and, in two thirds of patients there was a history of atopy. Despite being the primary and most important treatment for anaphylaxis, adrenaline is still used in only a minority of these cases.

Fas ligand triggers pulmonary silicosis.

We investigated the role of Fas ligand in murine silicosis. Wild-type mice instilled with silica developed severe pulmonary inflammation, with local production of tumor necrosis factor (TNF)-alpha, and interstitial neutrophil and macrophage infiltration in the lungs. Strikingly, Fas ligand-deficient generalized lymphoproliferative disease mutant (gld) mice did not develop silicosis. The gld mice had markedly reduced neutrophil extravasation into bronchoalveolar space, and did not show increased TNF-alpha production, nor pulmonary inflammation. Bone marrow chimeras and local adoptive transfer demonstrated that wild-type, but not Fas ligand-deficient lung macrophages recruit neutrophils and initiate silicosis. Silica induced Fas ligand expression in lung macrophages in vitro and in vivo, and promoted Fas ligand-dependent macrophage apoptosis. Administration of neutralizing anti-Fas ligand antibody in vivo blocked induction of silicosis. Thus, Fas ligand plays a central role in induction of pulmonary silicosis.

Asthma control and exacerbations in patients with severe asthma treated with omalizumab in Portugal.

The analysis of outcomes from patients with severe asthma treated with omalizumab, using real-life prospective data, should contribute to future informed decisions about this treatment in Portugal. The aim of this study was to assess the clinical effect of omalizumab in Portuguese patients with severe persistent allergic asthma, considering specifically asthma control and exacerbations. This was an observational, prospective, multicentre study. Data were collected at routine care over a 12-month period. Disease control was defined by Control of Allergic Rhinitis and Asthma Test (CARAT) global score >24. All asthma patients already under treatment with omalizumab in 7 departments from 6 Portuguese hospitals were included (n=48). Most (77%) patients were female and the mean (SD) age was 51.9 (10.2) years old. During the study period, asthma was controlled in 34% of the visits and the 12-month exacerbation rate was 1.7 per patient (0.6 with unscheduled medical care). One-third of the patients needed unscheduled medical care because of asthma and 29% had to start or increase oral corticosteroid. There was still a 41% reduction in the total sum of oral corticosteroids usage from the first to the last trimester of the study. During routine treatment with omalizumab, Portuguese patients with severe asthma achieved asthma control in 1/3 of the visits and only 1/3 needed unscheduled or Emergency Room care because of asthma exacerbations. These outcomes support the maintenance of the clinical effect during treatment with omalizumab in routine care in Portugal.

Respiratory mechanics and lung histology in normal rats anesthetized with sevoflurane.

Respiratory system, lung, and chest wall mechanical properties were subdivided into their resistive, elastic, and viscoelastic/inhomogeneous components in normal rats, to define the sites of action of sevoflurane. In addition, we aimed to determine the extent to which pretreatment with atropine modified these parameters. Twenty-four rats were divided into four groups of six animals each: in the P group, rats were sedated (diazepam) and anesthetized with pentobarbital sodium; in the S group, sevoflurane was administered; in the AP and AS groups, atropine was injected 20 min before sedation/anesthesia with pentobarbital and sevoflurane, respectively. Sevoflurane increased lung viscoelastic/inhomogeneous pressures and static elastance compared with rats belonging to the P group. In AS rats, lung static elastance increased in relation to the AP group. In conclusion, sevoflurane anesthesia acted not at the airway level but at the lung periphery, stiffening lung tissues and increasing mechanical inhomogeneities. These findings were supported by the histological demonstration of increased areas of alveolar collapse and hyperinflation. The pretreatment with atropine reduced central and peripheral airway secretion, thus lessening lung inhomogeneities.

Gastrin and gastric acid secretion in renal failure.

In 10 anephric patients awaiting transplantation, 15 patients with chronic renal failure and 30 patients with acute renal failure, daily basal plasma gastrin levels and basal and stimulated gastric acid secretion were measured. Significant elevated plasma gastrin levels were found in all of the anephric patients and in 50 percent of the patients with acute and 55 percent of those with chronic renal failure. Elevated plasma gastrin levels decreased to normal after kidney transplantation or when kidney function returned to normal in the patients with acute renal failure. Gastric acid secretion studies showed a consistent pattern in all three groups of patients with a low basal acid output, a high basal intragastric pH and a very significant peak acid output, perhaps secondary to elevated plasma gastrin levels due to inadequate renal inactivation of gastrin. This may partly explain the increased incidence of gastrointestinal bleeding and gastritis seen in patients with different degrees of renal failure.

Food hypersensitivity in Portuguese adults.

OBJECTIVE: To describe the frequency and epidemiological features of self-reported food hypersensitivity in Portuguese adults. DESIGN: Cross-sectional. SETTING: Participants were selected by random digit dialing among residents of Porto. SUBJECTS: In total, 659 individuals over 39 y were asked to recall the occurrence of food hypersensitivity, and to describe the most serious episode. The adoption of eviction diets and previous medical diagnosis of food allergy were recorded, and recent dietary intake was evaluated using a validated food frequency questionnaire. RESULTS: Self-reported food allergy was more frequent in women than men (7.3 vs 1.9%, P<0.01) and decreased with age. Age- and sex-standardized (European population > or =40 y) prevalence of food hypersensitivity was 4.8% (95% CI 3.4-6.9%). Most subjects (67.6%) referred allergy to a single food, fresh fruits being the more frequently incriminated (25%). Approximately 90% that reported food allergy declared the adoption of eviction diets, although 53% in fact ingested the incriminated foods during the previous year. CONCLUSIONS: The adult prevalence of food hypersensitivity in Porto is one of the lowest observed worldwide, probably reflecting specificities of the genetic make-up and dietary patterns of our population.

[Technical modification of total cavo-pulmonary connection]. / Modificação técnica da conexão cavo-pulmonar total.

A variation of total cavopulmonary connection without anastomosing the superior vena cava to the right pulmonary artery branch is presented. Both vena cava flow go through an intra atrial tunnel to the right atrial appendage, which is anastomosed to the right pulmonary artery, in anatomical eligible cases.

[Subaortic stenosis associated with atrioventricular septal defect. A rarely mentioned condition]. / Estenose subaórtica associada a defeito do septo atrioventricular. Uma condição pouco referida.

White male patient, 14 years old, who developed a severe subaortic stenosis in the late postoperative period of a total correction of atrioventricular septal defect. Clinical diagnosis was confirmed by echocardiography and cardiac catheterization. The patient underwent reoperation for treatment of the new condition, with resection of subaortic stenosis. Atrioventricular septal defects show a narrow and deformed left ventricle outflow tract, susceptible to obstruction before or after operation. It is, therefore, advisable to investigate a possible obstruction before the operation at the operation room and in the late postoperative period.

Hyptis suaveolens (L.) Poit (Lamiaceae), a medicinal plant protects the stomach against several gastric ulcer models.

ETHNOPHARMACOLOGICAL RELEVANCE: Hyptis suaveolens is used by the traditional population in several parts of the world to treat inflammation, gastric ulcer and infection and is used as a crude drug to relieve symptoms related with gastric ulcer or gastritis in northeaster and central region of Brazil. MATERIALS AND METHODS: the standardized ethanolic extract (Hs-EtOHE) and hexanic fraction (Hs-HexF) of Hyptis suaveolens (62,5, 125, 250 and 500 mg/kg) was evaluated in several models of acute gastric ulcers. The participation of NO was evaluated by pretreatment with L-NAME and non-protein sulfyhydryls by NEM in the gastroprotective effect. RESULTS: Hs-EtOHE and Hs-HexF markedly reduced the gastric lesions induced by all ulcerogenic agents (HCl/ethanol, ethanol, NSAIDs and hypothermic restraint-stress). Gastric ulcerations were exacerbated by administration of NEM suggesting that the gastroprotective mechanism of action of Hs-EtOHE and Hs-HexF involves sulfhydryl groups. CONCLUSION: Ours results show that an extract of Hyptis suaveolens, administered orally to rodents, present gastro protective activity in different models of acute of gastric ulcer and give some support to the reported claims on the use of this plant as a gastro protective agent.

Anisakis simplex as a risk factor for relapsing acute urticaria: a case-control study.

BACKGROUND: IgE-mediated hypersensitivity reactions to Anisakis simplex have been described after ingestion of fish, suggesting that sensitisation to this parasite may induce acute urticaria and anaphylaxis. Anisakis simplex allergens are highly resistant to heat and freezing, and sensitisation may occur even in populations with low consumption of raw/undercooked fish. This study aimed to quantify the association between sensitisation to A. simplex and relapsing acute urticaria. METHODS: This is the first case-control study on this topic. Cases (n = 200) were patients with a clinical diagnosis of relapsing acute urticaria, consecutively approached at the immunoallergology unit of Porto's largest paediatric hospital. Controls (n = 200) were consecutively selected at the surgery department of the same hospital, from subjects undergoing programmed orthopaedic, maxillofacial or general surgical procedures. Specific IgE measurements (Anisakis and Ascaris) were taken, and skin-prick tests (A simplex, common aeroallergens, fish, and Ascaris) were done. RESULTS: Sensitisation to A simplex (OR 3.86, 95% CI 2.04% to 7.29%), Ascaris (OR 3.37, 95% CI 1.89% to 6.02%), fish (OR 4.62, 95% CI 1.85% to 11.52%), and at least one aeroallergen (OR 4.59, 95% CI 2.99% to 7.05%) were associated with increased risk of acute urticaria. Regarding the sensitisation to A simplex, the aeroallergen sensitisation-adjusted OR was 2.61 (95% CI 1.33% to 5.12%) for the whole sample, and 2.72 (95% CI 0.99% to 7.47%) for those not sensitised to Ascaris or fish. CONCLUSION: Sensitisation to A simplex increases the risk of relapsing acute urticaria in subjects not sensitised to Ascaris or fish, and this is independent of aeroallergen sensitisation.

Plants of the American continent with antiulcer activity.

Peptic ulcer is a chronic and appalling disease. Today, it is dominant among the diseases that affect the world's population. The principal factors causing this disease are inadequate dietetic habits, prolonged use of non-steroidal anti-inflammatory drugs, stress and infection by Helicobacter pylori, in addition to other factors of genetic origin. The present work is a literature survey of plant extracts from the American continent that have been reported to show antiulcer activity. This review refers to 58 plants with their families, parts used, type of extract used, model bioassays and their activity. This work intends to aid the researchers in the study of natural products appropriate to the treatment of stomach and intestinal diseases, in general, and peptic ulcer in particular.

Atividade anti-helmíntica de plantas nativas do continente americano: uma revisão / Anthelmintic activity of native American plants: a review

O presente trabalho faz uma revisão de plantas nativas do continente americano com atividade anti-helmíntica com a finalidade de subsidiar pesquisas e o desenvolvimento de novos medicamentos na área de produtos naturais. Na literatura, foram citadas 22 famílias de plantas, tais como: Moraceae, Asteraceae e Cucurbitaceae, e estudadas cerca de 35 espécies, como a Ficus sp, Cucurbita máxima, e Ruta graveolens, usadas por sua alegada atividade anti-helmíntica. Destas espécies, 26 foram ativas contra alguns helmintos: Strongyloides stercolaris, Ancylostomidae, Trichostrongylus sp, Capillaria sp, Ascaris lumbricoides, Taenia saginata, Haemonchus contortus, e Hymenolepsis diminuta. Foi verificado maior número de estudos com parasitas de animais, possivelmente devido ao desenvolvimento de resistência dos helmintos aos tratamentos convencionais disponíveis.

This paper is a review of native American plants showing anthelmintic activity in order to give support to research and development of new drugs in the field of natural products. In the literature, 22 plant families were cited, such as: Moraceae, Asteraceae and Cucurbitaceae, and around 35 species were studied, including Ficus sp, Cucurbita maxima and Ruta graveolens, used for their putative anthelmintic activity. From these species, 26 were active against some helminthes: Strongyloides stercolaris, Ancylostomidae, Trichostrongylus sp, Capillaria sp, Ascaris lumbricoides, Taenia saginata, Haemonchus contortus and Hymenolepsis diminuta. Data indicated a larger number of studies with animal parasites, probably due to the resistance of these helminthes to the conventional treatments available.

Immune complex nephropathy i schistosomiasis.

In a patient with chronic hepatosplenic schistosomiasis a segmental sclerosing nephropathy led to terminal renal failure. The demonstration of glomerular capillary deposition of immunoglobulin and complement with electron dense deposits and lucent deformities of the glomerular basement membrane and the presence of antischistosome adult worm antibody in serum suggested that this was an example of immune complex nephropathy. Successful renal transplantation followed by niridazole treatment of the schistosomiasis induced a transient relapse of renal dysfunction with proteinuria and a fall in serum complement. The pathogenic schistosomal adult worm antigen was identified by immunofluorescence in the mesangium of the transplant; complement and immunoglobulin were present also in that site.

Unilateral adrenal hyperplasia.

A case of unilateral primary adrenal hyperplasia, without concomitant hypokalemia, is presented. After surgical removal of the gland, a complete remission occurred. This rare condition may, in fact, be more frequent than thought as it can coexist with normokalemia. We postulate that it is probably a new phase of the transformation between hyperplasia and adenomas that can also occur in the adrenal cortex similar to such transformations in other endocrine organs.