Perioperative Kounis syndrome in an older adult

Introduction: Kounis syndrome (KS) is myocardial ischemia secondary to the release of inflam matory mediators (mastocyte degranulation) during an allergic reaction. Adult anaphylaxis is often triggered by medications, of which antibiotics are the most frequently reported. Objective: to study the presentation of and clinical approach to a patient with Kounis syndrome and increase the diagnostic suspicion of a disease which does not have a standardized treatment and is not supported by clinical practice guidelines. Case presentation: we present the case of a 62-year-old adult patient with chest pain and anginal equivalents following perioperative anaphylactic shock during a scheduled open cholecystectomy for gallstones, with subsequent acute myocardial infarction without ST elevation, and coronary artery lesions or atheromatous disease ruled out by arteriography. Conclusions: Kounis syndrome is an underdiagnosed entity with a variable clinical presenta tion and no concrete or standardized treatment. This therefore encourages the development of a greater case history and the structuring of widely disseminated guidelines for its treatment. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2289).

Introducción: el síndrome de Kounis (SDK) corresponde a una isquemia miocárdica secundaria a la liberación de mediadores inflamatorios (degranulación de mastocitos) durante una reacción alérgica. La anafilaxia en adultos comúnmente es desencadenada por medicamentos, de los cuales los antibióticos son los más frecuentemente informados. Objetivo: estudiar la forma de presentación y abordaje clínico de un paciente con síndrome de Kounis y aumentar la sospecha diagnóstica de una patología que no tiene un tratamiento estanda rizado o respaldado por guías de práctica clínica. Presentación de caso: se presenta el caso de una paciente adulta de 62 años con dolor pre cordial y equivalentes anginosos posterior a un choque anafiláctico perioperatorio durante una colecistectomía abierta realizada de forma programada por colelitiasis, con posterior infarto agudo de miocardio sin elevación del ST, con arteriografía que descartó lesiones en arterias coronarias o enfermedad ateromatosa. Conclusiones: el síndrome de Kounis es una entidad subdiagnosticada, con presentación clínica variable y sin un tratamiento concreto o estandarizado, lo que motiva a realizar una mayor casuística y estructurar recomendaciones de amplia difusión respecto a su tratamiento. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2289).

Intoxicación escombroide secundaria al consumo de atún: presentación de un caso / Scombroid poisoning secondary to tuna ingestion: a case report

Resumen: La intoxicación escombroide es ocasionada por el consumo de ciertos tipos de pescado (de la familia Scombridae), comúnmente el atún, los cuales acumulan grandes concentraciones de histamina cuando los procedimientos de refrigeración son inadecuados, ocasionando en quienes los consumen síntomas muy similares a los de una alergia alimentaria, por lo que es frecuente que no se diagnostique correctamente. Generalmente, los síntomas desaparecen en pocas horas y no suelen ser graves, excepto algunos casos descritos en la literatura especializada, de hipotensión, broncoespasmo, dificultad respiratoria, taquicardia supraventricular e, incluso, infarto agudo de miocardio. Este fue, precisamente, el caso de una mujer que ingresó al servicio de urgencias de un hospital de tercer nivel de Medellín a los pocos minutos de haber ingerido atún con una sintomatología típica de la intoxicación, pero con taquicardia supraventricular, una de sus manifestaciones graves y atípicas.

Abstract: Scombroid poisoning is caused by the consumption of certain types of fish (from the Scombridae family), especially tuna. Due to inadequate refrigeration procedures, these fish have high levels of histamine which generate symptoms similar to those of a food allergy in their consumers, so it is frequently underdiagnosed. It is self-limited in a few hours and the symptoms are usually not serious, except for specific cases reported in the literature of hypotension, bronchospasm, respiratory distress, tachyarrhythmias, and even acute myocardial infarction. We report here the case of a woman admitted to the emergency department of a third level hospital in Medellín a few minutes after eating tuna with the typical symptoms of intoxication, as well as tachyarrhythmias, a serious and atypical manifestation.

Individualized treatment for allergic rhinitis based on key nasal clinical manifestations combined with histamine and leukotriene D4 levels / Tratamento individualizado para a rinite alérgica baseado nas principais manifestações clínicas nasais e dos níveis de histamina e leucotrieno D4

Abstract Introduction The types of allergic rhinitis are roughly classified based on the causative antigens, disease types, predilection time, and symptom severity. Objective To examine the clinical typing and individualized treatment approach for allergic rhinitis and to determine the optimal treatment method for this disease using various drug combination therapies. Methods A total of 108 participants with allergic rhinitis were divided into three groups based on symptoms. Subsequently, each group was further categorized into four subgroups based on the medications received. The efficacy of the treatments was evaluated using the visual analog scale VAS scores of the total and individual nasal symptoms, decline index of the symptom score, histamine and leukotriene levels, and mRNA and protein expression levels of histamine 1 and cysteinyl leukotriene 1 receptors. Results Loratadine + mometasone furoate and loratadine + mometasone furoate + montelukast significantly improved the sneezing symptom and reduced the histamine levels compared with the other combination therapies (p < 0.05). Meanwhile, montelukast + mometasone furoate and montelukast + mometasone furoate + loratadine considerably improved the nasal obstruction symptom and decreased the leukotriene D4 levels compared with the other combination therapies (p < 0.05). Conclusion Clinical symptom evaluation combined with experimental detection of histamine and leukotriene levels can be an objective and accurate method to clinically classify the allergic rhinitis types. Furthermore, individualized treatment based on allergic rhinitis classification can result in a good treatment efficacy.

Resumo Introdução A rinite alérgica é basicamente classificada de acordo com os antígenos causadores, tipos de doença, peridiocidade e gravidade dos sintomas. Objetivo Avaliar os tipos clínicos e a abordagem terapêutica individualizada para cada tipo de rinite alérgica e determinar o método de tratamento ideal utilizando várias terapias de combinação de fármacos. Método Um total de 108 participantes com rinite alérgica foram divididos em três grupos com base nos sintomas. Posteriormente, cada grupo foi subsequentemente categorizado em quatro subgrupos com base nos medicamentos recebidos. A eficácia dos tratamentos foi avaliada utilizando os escores da escala visual analógica EVA dos sintomas nasais totais e individualmente, índice de declínio do escore de sintomas, níveis de histamina e leucotrienos e níveis de expressão de mRNA e proteína dos receptores de histamina 1 e cisteinil-leucotrieno 1. Resultados As associações entre loratadina + furoato de mometasona, assim como a de loratadina + furoato de mometasona + montelucaste melhoraram significativamente o sintoma de espirros e reduziram os níveis de histamina em comparação às outras terapias combinadas (p < 0,05). Por outro lado, a associação montelucaste + furoato de mometasona, assim como a associação montelucaste + furoato de mometasone + loratadina melhoraram consideravelmente o sintoma de obstrução nasal e diminuíram os níveis de leucotrieno D4 em comparação com as outras combinações (p < 0,05). Conclusão A avaliação clínica dos sintomas combinada com a detecção experimental dos níveis de histamina e leucotrieno pode ser um método objetivo e preciso para classificar clinicamente os tipos de rinite alérgica. Além disso, o tratamento individualizado baseado na classificação da rinite alérgica pode resultar no aumento da eficácia do tratamento.

Estudio de la expresión del receptor de vitamina D en la ontogenia del testículo y en tumores de células de leydig: posible interacción con el sistema histaminérgico

RESUMEN La vitamina D (VD), un esteroide pleiotrópico, ha sido relacionada con la función reproductiva masculina, pero aún no se ha estudiado la expresión de su receptor (RVD) en el desarrollo testicular. RVD regula la expresión de componentes del sistema histaminérgico, y la histamina (HA) modula la esteroidogénesis en células de Leydig (CL). Se ha relacionado a la deficiencia de VD con múltiples patologías, entre ellas cáncer. Los tumores de células de Leydig (TCL) son los más frecuentes del intersticio testicular, y al malignizar no responden a radio/quimioterapia. VD fue descripta como tratamiento para varios tumores, pero se desconoce su aplicación en TCL. Por lo expuesto, hemos estudiado la expresión de RVD en la ontogenia de testículo de rata, evaluando su correlación con los niveles de testosterona séricos (T) y el contenido de HA; y además evaluamos la expresión de RVD en testículo humano fetal, neonatal, prepuberal, TCL e hiperplasia de CL. En testículo de rata, se observó un aumento en la expresión de RVD en CL con la edad, en línea con el incremento de T, y en contraposición con la disminución del contenido de HA, lo cual fue consistente con la reducción en los niveles de la enzima que cataliza su síntesis, HDC. Esto sugiere que la VD podría ejercer una función en el desarrollo testicular normal, ya sea en forma directa sobre las CL o mediante la regulación de la expresión de componentes del sistema histaminérgico (HDC y/o receptores de HA). Por su parte, el TCL humano presentó sobreexpresión de RVD y HDC. Considerando que las hormonas esteroideas se encuentran aumentadas en esta patología y funcionan como factores de crecimiento, si el calcitriol pudiera modular la esteroidogénesis podría tener una aplicación terapéutica.

ABSTRACT Vitamin D (VD) is a steroid hormone traditionally related to bone health. However, several authors have associated VD with reproduction and steroidogenesis in males. The presence ofVD receptor (VDR) and the enzymes involved in its activation had been reported in several cell types of the testes. Until now, nobody has studied RVD expression during testicular development. In addition, VDR in association with its co-activators or co-repressors, regulates the expression of several genes, including those related to the histaminergic system. Previously, we demonstrated that histamine (HA) can modulate steroidogenesis in Leydig cells (LC) in a concentration-dependent manner. Also, we observed a decrease in the endogenous HA content, consistent with the previously described decrease of HDC (histidine decarboxylase, the enzyme responsible of HA synthesis) levels, during LC ontogeny. Epidemiologic studies strongly suggest that a relationship exists between VD deficiency and multiple pathologies, particularly cancer. Leydig cell tumors (LCT) are rare endocrine tumors ofunknown etiology, which originate in the testicular interstitium. The incidence worldwide is 1-3% in adults and 4% in prepubertal boys, but recent publications indicate that these figures have been increasing. While usually benign, approximately 10% of LCT in adults become malignant and do not respond to chemo or radiotherapy. It is imperative to deeply investigate the biology of LCT, to identify new therapeutic targets. The potential role of calcitriol (1a,25(OH)2-vitamin-D3) in cancer treatment has been described for several types of tumors, but it remains unexplored in LCT. Thus, as a first step, it is worth evaluating VDR expression in LCT.In view of the aforecited evidence, herein we studied VDR expression during the rat testicular ontogeny, evaluating a possible correlation withserum testosterone (T) levels in blood, endogenous levels of HA and the previously described HDC expression levels. We also analized VDR expression in human testes corresponding to three different stages of development (fetal, neonatal andjuvenile), in LCT and in LC hyperplasia. Methods: Rat testes of different ages (7, 21, 35, 90 y 240 days), human fetal, neonatal and pre pubertal testes, a human LCT and a human LC hyperplasia; were used for detection of VDR by immunohistochemistry. Results: In the rat testes, VDR expression increased with age in LC, in line with the increase in serum testosterone; and in contrast with the decrease in the endogenous content of HA and HDC levels. Likewise, we detected an increase in VDR expression with age in the human testes samples. LCT presentedVDR and HDC overexpression. We also detected VDR in LC hyperplasia. Conclusions: Given that VDR testicular expression increases with age in LC, as well as testosterone serum levels, it is reasonable to speculate thatVD may play a role in normal testicular development, either acting directly on LC or by regulating one of more components of the histaminergic system (HDC or HA receptors). Considering that VDR is overexpressed in LCT, and that steroids are increased in this pathology (and act like growth factors); if calcitriol could modulate steroidogenesis, it could have a therapeutic role.

Síndrome de Kounis como manifestación de anafilaxia / Kounis Syndrome as a manifestation of anaphylaxis

Introducción: el síndrome de Kounis corresponde a la isquemia miocárdica aguda relacionada con la liberación de mediadores inflamatorios que llevan a vasoespasmo coronario y/o complicación de una placa ateromatosa durante una reacción alérgica. La incidencia de eventos coronarios en procesos alérgicos en Estados Unidos es de 8 casos por 100000 habitantes por año. Métodos: describimos el caso de una mujer que desarrolla síndrome de Kounis, posterior a múltiples picaduras de abeja, recibiendo manejo en una unidad de cuidado intensivo de una institución de salud de Colombia. La paciente presentó un síndrome coronario agudo tipo infarto agudo de miocardio con elevación del segmento ST, con arteriografía coronaria en la cual se evidenció ausencia de lesiones vasculares o vasoespasmo, con presencia de un trombo flotante en la arteria descendente anterior, sin evidencia de enfermedad ateroesclerótica. Resultados: el síndrome de Kounis es frecuente en los pacientes con anafilaxia, sin embargo, se informa poco en la literatura, debido a la falta de sospecha diagnostica y al poco reconocimiento clínico. Los síntomas de este síndrome pueden ser típicos como el dolor torácico opresivo de gran intensidad irradiado a miembro superior izquierdo o a cuello, o atípicos como disnea, nauseas o palpitaciones, los cuales pueden confundirse con las manifestaciones del proceso anafiláctico. Conclusiones: en la actualidad no existen guías para el tratamiento del síndrome y depende de la forma de presentación, comorbilidades y disponibilidad de un grupo médico interdisciplinar, que incluya monitoria y vigilancia en una unidad de cuidado intensivo.(AU)

Introduction: Kounis syndrome refers to the myocardial ischemia which results from the release of inflammatory-provoking mediators during an allergic reaction thereby causing coronary vasospasm and/or complication brought on by atheromatous plaque. The incidence of coronary disease induced by allergies in the United States is 8 cases per 100000 inhabitants per year. Methods: we cite the case of a woman who developed Kounis syndrome after receiving multiple bee stings. She was treated in the intensive care unit of a Colombian health institution. The patient presented with acute myocardial infarction with ST-segment elevation, and with no presence of vascular lesions or vasospasm during the coronary arteriography. It was further noted that there was a floating thrombus in the anterior descending artery without evidence of atherosclerotic disease. Results: Kounis syndrome is frequent in patients with anaphylaxis, however, only a few cases are reported in studies due to the lack of diagnostic suspicion and little clinical recognition. Symptoms suggesting this syndrome may be typical, such as oppressive chest pain which radiates to the upper left limb or neck, or atypical such as dyspnea, nausea, or palpitations which may be confused with the manifestations of the anaphylactic process. Conclusions: currently there are no directives for the treatment of the syndrome. It depends upon the manner of presentation, comorbidities, and the availability of an interdisciplinary medical group. It requires monitoring and surveillance in an intensive care unit.(AU)

Inhibidores de histidina decarboxilasa atenúan la actividad proangiogénica de células de Leydig tumorales: ¿Potencial terapia neoadyuvante para el tratamiento de leydigiomas? / Histidine decarboxylase inhibitors attenuate the pro angiogenic activity of Leydig tumor cells: Potential neoadjuvant therapy for the treatment of leydigiomas?

Resumen Los tumores de células de Leydig (TCL) son tumores endócrinos del intersticio testicular, cuya incidencia se encuentra en aumento. Los síntomas incluyen feminización o virilización en pacientes prepuberales, y pérdida de libido, disfunción eréctil, infertilidad y/o ginecomastia en adultos. Si bien son usualmente benignos, cuando malignizan en adultos no responden a radio y quimioterapia. Múltiples trabajos han reportado que la histidina decarboxilasa (HDC), enzima que cataliza la conversión de L-histidina en histamina (HA), tiene un rol importante en el desarrollo de tumores. A su vez, en nuestro laboratorio demostramos que la HA induce la proliferación de células de Leydig tumorales (CLT) murinas, mientras que la inhibición de HDC disminuye su proliferación y capacidad esteroidogénica. Además, observamos elevada expresión de HDC en TCL pediátricos vs. controles de distintos estadios de madurez sexual; y se ha descrito que ratones knock out para HDC poseen una angiogénesis incompleta. Para evaluar el rol de HDC en la modulación de la angiogénesis se empleó la línea de CLT de rata R2C, principal modelo utilizado en estudios de Leydigioma. También se realizaron estudios en TCL pediátricos. Los medios condicionados por las CLT R2C estimularon la angiogénesis tanto in vitro como in vivo (empleando HUVEC y analizando el grado de vascularización de membranas corioalantoideas de codorniz, respectivamente). El efecto in vitro se revirtió al tratar previamente las CLT R2C con α-metil-DL-histidinadihidrocloruro, inhibidor específico de HDC. A su vez, tanto la HA como los medios condicionados provenientes de TCL pediátricos, produjeron un aumento en la proliferación de las HUVEC. Nuestros resultados sugieren que las CLT producen HA y otros factores proangiogénicos, y que la inhibición selectiva de HDC atenúa la capacidad proangiogénica de las CLT. En base a estos resultados y evidencias previas del laboratorio, inhibidores específicos de HDC podrían ser utilizados como potencial terapia neoadyuvante en TCL.

ABSTRACT Leydig Cell tumors (LCT) are a rare group of endocrine tumors in the testicular interstitium. Between 1 and 3% of testicular malignances in adults and 4% in prepubertal children belong to LCT. An increasing incidence of this type of neoplasia has been reported recently all around the world. Particularly, a strong relationship between LCT and the use of anabolic steroids (which are commonly used nowadays) has been reported recently. In prepubertal boys, symptoms include feminization or virilization, depending on the major circulating steroid (estradiol or testosterone respectively). Adult patients show loss of libido, penile dysfunction, infertility and/or gynecomastia. Although the etiology still is unknown, several studies indicate that tumoral Leydig cells have an excessive production of insulin-like growth factor (IGF-1), as well as aromatase (CYP19) overexpression, which causes an enormous amount of estrogens (particularly estradiol, E2), and both factors play an important role in tumorigenesis. While usually benign, when LCT became malignant in adults they respond poorly to radio and chemotherapy. Likewise, it has been reported that both therapies increase the incidence of several tumors. All these data imply the need of new therapeutic targets to avoid the chirurgical dissection of the testes and the consequences of the hormonal therapies associated, which implicate not only the loss in reproductive function, but also psychological disorders. Several publications have reported that histidine decarboxylase (HDC), the only enzyme capable of catalyzing the conversion from L-histidine to histamine (HA) in mammals, has an important role in the development of several types of tumors, such as colorectal, breast and melanoma. At the same time, in our laboratory we have reported that HA induces cell proliferation of murine Leydig cells, and complementary, this cell proliferation decreases when inhibiting selectively HDC, as well as steroid synthesis (progesterone and E2). Also, we observed a higher expression of HDC in pediatric LCT (n = 3) than normal controls corresponding to different stages of sexual maturation (n = 9). It has been described that HDC knock out mice have an incomplete angiogenesis, and also that MA-10 Leydig cells HDC expression correlates with vascular endothelial growth factor (VEGF). The aim of this study is to improve our knowledge about the role of HDC in LCT biology, particularly, the angiogenesis modulation. We used the R2C Leydig cell line, the most used model for in vitro studies of Leydigioma, because it overexpresses CYP19 and constitutively produces high levels of IGF-1 and E2, as well as human LCT. R2C and pediatric LCT angiogenic capability was evaluated in vitro by measuring proliferation of human umbilical vein endothelial cells (HUVEC). In addition, we verified R2C cells angiogenic capability in vivo, using quail embryo vasculature (chorioallantoic membrane assay). Both models have been validated for the study of angiogenesis. Conditioned medium obtained from R2C cell culture stimulated angiogenesis in vitro (p <0.001) as well as in vivo (p <0.001). The in vitro effect was reverted with a previous treatment on the R2C cell culture using α-methyl-DL-histidine hydrochloride (α-MHD, 10 µM), a specific HDC activity inhibitor (p <0.001). Finally, human conditioned medium from pediatric LCT increased HUVEC proliferation (p <0.01). In the same way, the analyzed patients showed higher testosterone and estradiol levels than normal serum concentrations, which was in concordance to phenotypical features observed in presence of LCT. Our results indicate that tumoral Leydig cells (TLC) produce HA, as well as other angiogenic factors, and it could be stimulating the vascular endothelium. The selective inhibition of HDC attenuates the pro-angiogenic capability in TLC. Considering all these results and previous observations of our laboratory, specific inhibitors of HDC could be used, in the future, as a potential therapeutic target for the treatment of LCT.

Tradução e adaptação transcultural para o idioma português (Brasil) do instrumento "Angioedema Activity Score" / Translation and cross-cultural adaptation to the Portuguese language (Brazil) of the instrument "Angioedema Activity Score"

Introdução: Tradução e adaptação transcultural do instrumento Escore de Atividade do Angioedema (Angioedema Activity Score - AAS) para o idioma português do Brasil. Métodos: O documento original em alemão foi traduzido para o português (cultura brasileira) e posteriormente retrovertido para a língua alemã. As traduções foram analisadas pelos pesquisadores brasileiros e alemães para definição da versão final em português. A versão final foi respondida por 10 pacientes com angioedema recorrente, com o intuito de identificar possíveis dificuldades na compreensão e nos termos utilizados. Resultados: Todos os pacientes compreenderam as perguntas, embora apenas a metade tenha preenchido adequadamente o questionário. Conclusões: O documento do Escore de Atividade do Angioedema adaptado para a cultura brasileira se mostrou um instrumento fidedigno à versão alemã original.

Introduction: To translate and validate the Angioedema Activity Score to Brazilian Portuguese aiming further use of this tool in patients with recurrent angioedema. Methods: The original questionnaire in German was translated into Portuguese (Brazilian culture) and subsequently back translated into the German language. The translations were analyzed by Brazilian and German researchers to define the final version in Portuguese. The final version was administered to 10 patients with recurrent angioedema in order to identify possible issues in understanding the terms used. Results: All patients had a good comprehension of the questions, but only half of them completed the questionnaire properly. Conclusions: The Angioedema Activity Score adapted to the Brazilian culture proved to be a reliable instrument to the original German version.

Dermografismo "mixto o bifásico" / "Mixed or biphasic" Dermographism

El dermografismo, conocido como "escritura sobre la piel", fenómeno que ocurre en forma espontánea o a la provocación física de la misma, es un síntoma, signo o síndrome semiológico, característico de procesos clínicos alérgicos y no alérgicos. Se expresa comúnmente como dermografismo rojo (urticaria dermatográfica, con o sin angioedema acompañante), con eritema y/o roncha muy frecuente en procesos alérgicos, pero también en las urticarias físicas, autoinmunes o tóxicas por aditivos alimentarios, infecciones, medicamentos y otros agentes. El dermografismo blanco, que se evidencia como un área que palidece alrededor de la línea de estimulación física, muy característico de la atopia; y, el que en esta comunicación hemos denominado dermografismo "mixto o bifásico", por su carácter bimodal, en el que se alternan las expresiones de los dermografismos rojo y blanco, en forma casi simultánea o en sucesión de blanco temprano en el primer minuto a rojo tardío a los cinco minutos o más, o al contrario, rojo inmediato y blanco posterior, típico de atopia. El paciente con hiperreactividad atópica en piel es el que exhibe el dermografismo mixto o bifásico, pues muestra el dermografismo blanco como estigma de atopia y el dermografismo rojo de la urticaria sintomática aguda o crónica. Esta última forma de dermografismo no se encuentra en las descripciones clásicas y es el objetivo de esta comunicación, que se acompaña de una amplia discusión sobre la ocurrencia de dermografismo en la práctica clínica. Material y Métodos: Se realizó una extensa revisión bibliográfica, consultando bases de datos como Medline, PubMed, DocChek, Wiley, Amedeo, Cochrane, Scielo, Hinari y Lilacs; se presentan viñetas clínicas de casos de pacientes atópicos. Conclusión: En esta revisión se ha presentado la ocurrencia clínica del dermografismo como un fenómeno frecuente de diferentes orígenes, pero que, muchas veces, es acompañante casi invariable de expresiones atópicas, en donde el dermografismo es un signo de ayuda para la tipificación del paciente alérgico...(AU)

Mastocitosis cutánea: reporte de un caso / Cutaneous mastocytosis: A case report

Introducción La mastocitosis representa un grupo de enfermedades caracterizadas por una acumulación excesiva de mastocitos en uno o múltiples tejidos. Puede limitarse a la piel o tener un compromiso sistémico, siendo de baja prevalencia y pronóstico benigno en la infancia. Objetivo Reportar un caso de urticaria pigmentosa como subtipo de mastocitosis cutánea y hacer una revisión bibliográfica enfocada en los hallazgos clínicos, el diagnóstico y el manejo inicial básico. Caso clínico Lactante de 6 meses de edad con múltiples máculas y pápulas de color café claro localizadas en el tronco, los brazos y las piernas, cuadro compatible con una urticaria pigmentosa, confirmada mediante biopsia. Se solicitaron exámenes para descartar compromiso sistémico. La paciente fue tratada con medidas generales, educación y antihistamínicos, con excelente evolución. Conclusiones La mastocitosis cutánea es una enfermedad poco común, de buen pronóstico. En la infancia generalmente bastan las medidas generales y educación para obtener resultados favorables. La terapia farmacológica de primera línea son los antagonistas H1.

Introduction Mastocytosis represents a group of diseases characterised by an excesive accumulation of mastocytes in one or multiple tissues. It can affect only the skin, or have a systemic involvement. It has a low prevalence, and the prognosis is benign in children. Objective To report a case of urticaria pigmentosa as a subtype of cutaneous mastocytosis, and present a literature review focused on clinical findings, diagnosis and initial basic management. Clinical case A child of six months of age presenting with multiple blemishes and light brown papules located on the trunk, arms and legs. The symptoms were compatible with urticaria pigmentosa, and was confirmed by biopsy. Tests to rule out systemic involvement were requested. The patient was treated with general measures, education, and antihistamines, with favourable results. Conclusions Cutaneous mastocytosis is a rare disease with a good prognosis. In childhood general measures and education are usually enough to obtain favourable results. Histamine H1 antagonists are the first line drug treatment.

Inflammatory mediators of neuropathic pain / Mediadores inflamatórios na dor neuropática

ABSTRACT BACKGROUND AND OBJECTIVES: Pro-inflammatory chemical mediators and algogenic substances seem to be confused by the sharing of their actions and by interactions in painful and inflammatory presentation. This study aimed at presenting a review of major inflammatory chemical mediators and place them in neuropathic pain pathophysiology. CONTENTS: Inflammation is the homeostatic response of vascularized tissues to remove harmful agents and restore their normal functions. Nervous system (central and/or peripheral) diseases and injuries may induce neuropathic pain and may also modify inflammatory process nervous mediation. In such pathological conditions, there might be pain without restrict link with admitedly harmful or painful stimuli, as well as there might be inflammation without restrict link with the presence of harmful agents and the need to remove them. Chemical mediators involved in neuropathic pain and inflammation pathophysiology modulate the presentation of both. CONCLUSION: Studies on inflammation offer evidences to support the important role of their chemical mediators in neuropathic pain pathogenesis. In peripheral and central sensitization, a thin borderline between reversibility or not of neuropathic pain may be respected or exceeded by inflammatory mediators actions.

RESUMO JUSTIFICATIVA E OBJETIVOS: Mediadores químicos pró-inflamatórios e substâncias algogênicas parecem se confundir pelo compartilhamento de suas ações e pelas interações no quadro doloroso e inflamatório. O objetivo deste estudo foi apresentar uma revisão sobre os principais mediadores químicos inflamatórios e situá-los na fisiopatologia da dor neuropática. CONTEÚDO: A inflamação é a resposta homeostática de tecidos vascularizados no sentido de remoção de agentes lesivos e restauro de suas funções normais. Doenças e lesões no sistema nervoso (central e/ou periférico) podem causar dor neuropática, e, também modificar a mediação nervosa do processo inflamatório. Nessas condições patológicas a dor pode ocorrer sem o vínculo restrito com estímulo reconhecidamente nocivo ou doloroso, assim como ocorrer quadro inflamatório sem o vínculo restrito com a presença de agentes lesivos e a necessidade de removê-los. Os mediadores químicos envolvidos na fisiopatologia da dor neuropática e da inflamação modulam o quadro de ambas. CONCLUSÃO: Os estudos sobre inflamação oferecem evidências para embasar a importância do papel dos seus mediadores químicos na patogênese da dor neuropática. Na sensibilização periférica e, também na central uma fronteira tênue entre a reversibilidade ou não do quadro neuropático pode ser respeitada ou ultrapassada pelas ações de mediadores inflamatórios.

Histamina e rastreamento de pescado: revisão de literatura / Histamine and traceability of fish: literature review

A preocupação com a qualidade do pescado sempre foi um tema recorrente, visto que é um alimento de alto valor nutricional para toda população, porém com grande susceptibilidade à deterioração e formação de substâncias prejudiciais ao homem, caso não sejam obedecidas as condições de conservação. Um exemplo de substância formada é a histamina, uma diamina biogênica primária e heterocíclica, não volátil, termoestável, originada pela descarboxilação da L-histidina, quando as condições de manuseio e estocagem são inadequadas, favorecendo a multiplicação da microbiota natural do pescado. A histamina possui potencial alergênico, podendo causar um quadro de intoxicação no ser humano e, em casos graves, levar à morte. Para tal problema, um sistema de rastreabilidade poderia ser a solução. Seu objetivo é garantir ao consumidor um produto seguro e saudável por meio do controle de todas as fases da produção, industrialização, distribuição e comercialização, possibilitando uma perfeita correlação entre o produto final e a matéria-prima que lhe deu origem. Em diversos países existem atualmente sistemas de rastreabilidade controlando a cadeia de pescado. No Brasil, vários entraves podem ser apontados para a não obrigatoriedade da rastreabilidade em pescado. A divisão de regulamentação do setor entre diferentes órgãos, tais como Ministério da Pesca e Aquicultura (MPA), Ministério da Agricultura, Pecuária e Abastecimento (MAPA) e a Agência Nacional de Vigilância Sanitária (ANVISA), a falta de articulação entre esses órgãos fiscalizadores, a baixa capacitação de mão de obra e a desvalorização dos produtos da pesca, o que trazem a descapitalização da base da cadeia produtiva. De tal maneira, pode-se afirmar que há uma série de desafios para que ocorra a implantação de um sistema de rastreabilidade em território nacional. De acordo com o exposto, este estudo objetivou, através de uma revisão bibliográfica sistemática da literatura, informar a situação atual da escombrotoxicose e da rastreabilidade da histamina em pescado.(AU)

Concern about the quality of the fish has always been a recurring theme since it is a food of high nutritional value for the whole population, but with greater ease of formation and decay of harmful substances to man, if not well maintained. An example of a substance formed is histamine, a biogenic diamine primary and heterocyclic, non-volatile, thermoestable, originated by the decarboxylation of L-histidine when the conditions of handling and storage are inadequate, favoring the multiplication of natural microbiota. It has allergen potential and can cause intoxication in humans and, in severe cases, lead to death. For this problem, a traceability system could be the solution. The aim is to ensure the consumer a safe and wholesome product by controlling all stages of production, processing, distribution and marketing, enabling a perfect correlation between the final product and the raw material. In several countries, there are currently traceability systems controlling the chain of fish. In Brazil, several factors can be identified as barriers to the adoption of traceability: different regulatory agencies such as the Ministry of Fisheries and Aquaculture (MPA), Ministry of Agriculture, Livestock and Supply (MAPA), and the National Health Surveillance Agency (ANVISA), the lack of coordination between these sectors, the lack of training of skilled labor and the devaluation of fishery products, which brings decapitalization of the base of the production chain. According to this, there are a number of challenges to deploy a traceability system in the country. This study aimed, through a systematic literature review of the literature, to report the current status of escombrotoxicose and traceability of histamine in fish.(AU)

O risco das aminas biogênicas nos alimentos / The risk of biogenic amines in food

Aminas biogênicas são bases orgânicas de baixo peso molecular com atividade biológica, produzidas a partir da ação da enzima descarboxilase. Microrganismos utilizados na fermentação de alimentos são capazes de produzi-las. O consumo desses compostos causam graves efeitos toxicológicos, indesejáveis para a saúde humana. Embora não exista legislação específica sobre a quantidade máxima permitida de aminas em alimentos e bebidas, a presença e o acumulo destes compostos é de grande importância. O objetivo desta revisão é evidenciar a necessidade de mais estudos e discutir a presença de aminas biogênicas em alimentos variados.

Biogenic amines are low molecular weight organic bases with biological activity, produced by the action of the decarboxylase enzyme. Microorganisms used in food fermentation are able to produce them. Consumption of these compounds causes serious toxicological effects, which are undesirable for human health. Although there is no specific legislation regarding the amine content in food and beverages, the presence and accumulation of amines is a matter of great importance. The aim of this review is to highlight the need for further studies and foment debate about the presence of biogenic amines in a variety of foods.

Incidencia de histamina y de bacterias indicadoras de calidad higiénica, en filetes, ruedas y trozos de pescado de especies pelágicas comercializadas en un mercado de pescado de la isla de Margarita (Venezuela) / Incidence histamine and hygienic quality indicators´s bacteria in fillets, slice and pieces pelagic fish´s marketing in one fish´s market of Margarita´s Island (Venezuela)

Se estudió la incidencia de histamina y de bacterias indicadoras de manejo higiénico en filetes, ruedas y trozos de diez especies de pescado en estado fresco, (Euthynnus alletteratus; Caranx latus; Ophisthonema oglinum; Alectis crinitus; Sardinella aurita; Thunnus alalunga; Sarda sarda; Scomberomorus cavalla; Coryphaena hippurus y Xyphias gladius), comercializadas en un mercado de pescado de Isla de Margarita (Venezuela). Según normas COVENIN se enumeraron (UFC g-1) aerobios a 25 y 32 °C, coliformes fecales y Escherichia coli (NMP g-1); histamina (mg/100 g) y pH. También recuentos (UFC g-1) de enterobacterias (ICMSF) y bacterias descarboxiladoras de histidina (Niven y otros). Todos los recuentos de aerobios a 25 °C excedieron el valor m (Log10 = 5,70 UFC g-1) fijado por ICMSF (1986). La prueba r de Pearson indicó que los recuentos a 25 y 32 °C estuvieron altamente relacionados (n = 90; r = 0,89; p < 0,01). E. coli superó en el 76% de las muestras el valor m (Log10 = 1,04 NMP g-1). Las mayores cifras de histamina se detectaron en T. alalunga (promedio 43,5 mg/100 g en uno de tres muestreos); seguido por S. aurita (promedios de 23,7 y 28,0 mg/100 g respectivamente, en dos muestreos). Sólo en muestras de T. alalunga se detectaron olores penetrantes y músculos con elasticidad disminuida. Estos datos y la observación de factores adversos, tales como contacto directo con superficies y utensilios sucios, restos de vísceras, desangrado deficiente, presencia de insectos, utilización de agua no potable y la exposición a temperaturas no apropiadas, reflejan que la manipulación del pescado no fue adecuada. Se recomienda que inspectores sanitarios implementen acciones tendentes a corregir estas deficiencias.

The incidence of histamine and of bacteria that indicate hygienic handling of fillets, slices and pieces of ten pelagic fresh fish (Euthynnus alletteratus; Caranx latus; Ophisthonema oglinum; Alectis crinitus; Sardinella aurita; Thunnus alalunga; Sarda sarda; Scomberomorus cavalla; Coryphaena hippurus and Xyphias gladius), sold in a fish market at Margarita Island (Venezuela) was assessed. According to COVENIN´s norms, total aerobic plate count (FCU g-1) at 25 and 32 °C; fecal coliforms and Escherichia coli (MPN g-1); histamine (mg/100 g) and pH were measured. Also, members of the Enterobacteriaceae family (FCU g-1) and histamine producing bacteria were counted, according to ICMSF and Niven et al respectively. All total aerobic plate count at 25 °C surpassed the m number (Log10 = 5.70 CFU g-1) established by ICMSF (1986). The Pearson test (r) showed that bacteria total counts at 25 and 32 °C were highly related (n = 90; r = 0.89; p < 0.01). E. coli exceeded in 76% of samples the number (Log10 = 1.04 MPN g-1). Histamine biggest numbers were detected in T. alalunga (average 43.5 mg/100 g in one of three samplings), followed by S. aurita (averages of 23.7 and 28.0 mg/100 g respectively, in two samplings). Only in T. alalunga samples were penetrating odors detected and muscles with reduced elasticity. This data and the adverse factors observed, such as: fish in direct contact with dirty areas and utensils, leftover viscera, faulty bleeding, presence of insects, use of non potable water and the exposition of fish at inappropriate temperatures, revealed the handling of fish was not suitable. It is recommended that sanitary officers carry out actions necessary to correct these deficiencies.

Phytochemistry, anti-inflammatory and analgesic activities of the aqueous leaf extract of Lagenaria breviflora (Cucurbitaceae) in laboratory animals

The plant, and especially the fruit of Lagenaria breviflora is widely used in folklore medicine in West Africa as a herbal remedy for the treatment of human measles, digestive disorders, and as wound antiseptics (e.g. umbilical incision wound), while livestock farmers use it for Newcastle disease and coccidiosis treatment in various animal species, especially poultry. The purpose of this study was to contribute with new information on this plant leaves extract effect, as few studies have considered their effects. We collected fresh leaves of Lagenaria breviflora from the school farm of the University of Ibadan, Nigeria in May 2011. Dried leaves were ground and a 200g sample was used to prepare the extract. The grounded leaves material was allowed to shake in 1 000mL distilled water for 48h, in an orbital shaker at room temperature of 24°C. The obtained extract was filtered and concentrated to dryness under reduced pressure at 40ºC, and the thick solution was lyophilized, for a final extract yield of 12.6%. Standard phytochemical methods were used to test the presence of saponins, alkaloids, tannins, anthraquinones, cardiac glycosides, cyanogenetic glycosides and flavonoids. The anti-inflammatory activity of the aqueous leaf extract of the plant was assessed using carrageenan-induced paw edema and histamine-induced paw edema in rats. The analgesic effect was determined using the acetic acid writhing method as well as formalin test in mice. Our results showed that the extract at 100 and 200mg/ kg body weight significantly reduced the formation of the oedema induced by carrageenan and histamine. In the acetic acid-induced writhing model, the extract showed a good analgesic effect characterized by reduction in the number of writhes when compared to the control. The extract caused dose-dependent decrease of licking time and licking frequency in rats injected with 2.5% formalin, signifying its analgesic effect. These results were however less than those of indomethacin, the reference drug used in this study. Since the plant extract reduced significantly the formation of oedema induced by carrageenan and histamine, as well as reduced the number of writhes in acetic acid-induced writhing models and dose-dependent decrease of licking frequency in rats injected with 2.5% formalin, the results have validated the basis for the traditional use of Lagenaria breviflora against inflamed purulent wounds, swellings, and bruises seen in some infectious diseases such as New Castle disease.

La planta, y sobre todo el fruto de Lagenaria breviflora es ampliamente utilizada en medicina tradicional en África occidental como un remedio herbal para el tratamiento del sarampión humano, trastornos digestivos y como antiséptico de la herida umbilical (por ejemplo, herida de incisión), mientras que los ganaderos la utilizan para tratar la enfermedad de Newcastle y la coccidiosis en varias especies animales, especialmente aves de corral. El propósito de este estudio fue analizar el efecto del extracto de esta planta, ya que hay pocos estudios sobre la temática. Se recolectaron hojas frescas de Lagenaria breviflora en la finca demostrativa de enseñanza de la Universidad de Iba- dan, Nigeria, en mayo 2011. Las hojas secas se trituraron y una muestra de 200g fue utilizada para preparar el extracto. El material se mezcló en 1 000ml de agua destilada durante 48 horas, en un agitador orbital a temperatura ambiente de 24 C. El extracto obtenido se filtró y se concentró hasta sequedad a una presión baja y a 40 C, la solución espesa se liofilizó, para un rendimiento de extracto final de 12.6. Para probar la presencia de saponinas, alcaloides, taninos, antraquinonas, glucósidos cardíacos, glucósidos cianogénicos y flavonoides se utilizaron los métodos fitoquímicos estándares. La actividad anti-inflamatoria del extracto acuoso de hojas de la planta se evaluó mediante la inducción de un edema por carragenina e histamina en la pata de las ratas. El efecto analgésico se determinó utilizando el método de contorsiones inducidas por ácido acético y la prueba de formalina en ratones. Nuestros resultados mostraron que el extracto de 100 y 200mg/kg de peso corporal redujo significativamente la formación de edema inducido por la carragenina e histamina. En el modelo de contorsiones inducidas por ácido acético, el extracto mostró un buen efecto analgésico caracterizado por una reducción en el número de retortijones en comparación con el control. El extracto causó una disminución dependiente de la dosis en el tiempo y frecuencia de lameo en ratas inyectadas con 2.5% de formalina, demostrando su efecto analgésico. Estos resultados sin embargo fueron menores que los de la indometacina, fármaco de referencia utilizado en este estudio. El extracto de la planta redujo significativamente la formación de edema inducido por carragenina e histamina, así como la baja en el número de retortijones por ácido acético y una disminución de la dosis-dependiente de la frecuencia de lameo en ratas inyectadas con formalina al 2.5%, los resultados validan el uso tradicional de Lagenaria breviflora contra la inflamación de las heridas purulentas, inflamaciones y contusiones que se dan en algunas enfermedades infecciosas como la enfermedad de New Castle.

Antihistamínicos Parte 1 - Historia y características de los receptores histaminérgicos / Antihistamines. Part 1 - History and characteristics of histaminergic receptors

Los antihistamínicos han sido usados durante los últimos 50 años y se han convertido en los medicamentos de mayor prescripción en el mundo. En este artículo se revisa el desarrollo de nuestro conocimiento referente a la histamina en el transcurso del siglo, como mediador biológico almacenado y liberado mayormente por los basófilos y mastocitos; mediador biológico situado en diferentes tejidos corporales, y otras células, con un papel fisiológico fundamental en el control de la secreción de ácido gástrico y un papel fisiopatológico en una gama de trastornos alérgicos. La síntesis y estudios farmacológicos de agonistas y antagonistas selectivos han establecido la existencia de cuatro tipos de receptores de histamina y antagonistas de ellos, que han encontrado muy importantes aplicaciones terapéuticas. Debido al aumento de la prevalencia de las enfermedades alérgicas según el Libro Blanco de Alergia (WAO), se deben crear normas que promuevan el uso de los antihistamínicos de manera adecuada y racional. De esta manera, la correcta elección debe ser realizada de acuerdo a su eficacia, tolerabilidad, seguridad, grupo etario, situaciones y precauciones particulares en pacientes con algún riesgo incrementado. El crear normas que promuevan una práctica terapéutica óptima o uso racional de dichos medicamentos. Elegirlos de acuerdo a su eficacia, tolerabilidad, seguridad, grupo etario, situaciones y precauciones especiales en pacientes portadores de ciertas enfermedades de riesgo a utilizarlos.(AU)

Antihistamines have been used for the last 50 years and have become the most prescribed medications in the world. In this article we review the development of our knowledge regarding histamine in the course of the century, as a biological mediator stored and released mostly by basophils and mast cells; biological mediator located in different body tissues, and other cells, with a fundamental physiological role in the control of gastric acid secretion and a physiopathological role in a range of disorders allergic The synthesis and pharmacological studies of selective agonists and antagonists have established the existence of four types of histamine receptors and antagonists of them, who have found very important therapeutic applications. Due to the increased prevalence of allergic diseases according to the White Paper on Allergy (WAO), standards should be created that promote the use of antihistamines in an adequate and rational way. In this way, the correct choice must be made in accordance to its efficacy, tolerability, safety, age group, situations and special precautions in patients with an increased risk. The creation of norms that promote an optimal therapeutic practice or rational use of said medications. Choose them according to their effectiveness, tolerability, safety, age group, situations and special precautions in patients with certain risk diseases to use them.

Antihistamínicos Parte II - ¿Cuáles son las opciones y en qué basarse para elegir la mejor? / Antihistamines Part II - What are the options and how to choose the best?

Los antihistamínicos han sido usados durante los últimos 50 años y se han convertido en los medicamentos de mayor prescripción en el mundo. En este artículo se revisa el desarrollo de nuestro conocimiento referente a la histamina en el transcurso del siglo, como mediador biológico almacenado y liberado mayormente por los basófilos y mastocitos; mediador biológico situado en diferentes tejidos corporales, y otras células, con un papel fisiológico fundamental en el control de la secreción de ácido gástrico y un papel fisiopatológico en una gama de trastornos alérgicos. La síntesis y estudios farmacológicos de agonistas y antagonistas selectivos han establecido la existencia de cuatro tipos de receptores de histamina y antagonistas de ellos, que han encontrado muy importantes aplicaciones terapéuticas. Debido al aumento de la prevalencia de las enfermedades alérgicas según el Libro Blanco de Alergia (WAO), se deben crear normas que promuevan el uso de los antihistamínicos de manera adecuada y racional. De esta manera, la correcta elección debe ser realizada de acuerdo a su eficacia, tolerabilidad, seguridad, grupo etario, situaciones y precauciones particulares en pacientes con algún riesgo incrementado. El crear normas que promuevan una práctica terapéutica óptima o uso racional de dichos medicamentos. Elegirlos de acuerdo a su eficacia, tolerabilidad, seguridad, grupo etario, situaciones y precauciones especiales en pacientes portadores de ciertas enfermedades de riesgo a utilizarlos.(AU)

Antihistamines have been used for the past 50 years and have become the most prescribed drugs in the world. This article reviews the development of our knowledge concerning the histamine in the course of the century, as a biological mediator mostly stored and released by basophils and mast cells biological mediator located in different body tissues, and other cells, having a fundamental physiological role in the control of gastric acid secretion and pathophysiological role in a variety of allergic disorders. The synthesis and pharmacological studies of selective agonists and antagonists has established the existence of four types of histamine receptor antagonists and histamine receptor found important therapeutic applications. Power demonstrations relate most allergic diseases whose symptoms are chronic and persistent emphasis by (WAO) White Paper on Alergia1 a steady increase in allergic diseases with a prevalence of 30-40% of the world population affected at least one allergic condition, considering the most common allergic rhinitis and chronic diseases common in our modern society. Creating standards that promote optimal therapeutic practice or rational use of such drugs. Choose them according to their efficacy, tolerability, safety, age group, situations and special precautions in patients with certain diseases risk to use. (AU)

Urticária: diagnóstico e tratamento / Urticaria: diagnosis and treatment

A urticária apresenta-se com diversas formas clínicas e causas distintas. Constitui uma das dermatoses mais frequentes: 15% a 20% da população têm pelo menos um episódio agudo da doença em sua vida. A urticária é classificada do ponto de vista de duração da evolução temporal em aguda (inferior a seis semanas) ou crônica (superior a seis semanas). O tratamento da urticária pode compreender medidas não farmacológicas e intervenções medicamentosas, as quais são agrupadas em tratamentos de primeira (anti-histamínicos), segunda (corticosteróides e antileucotrienos) e terceira linha (medicamentos imunomoduladores). Essa entidade clínica acarreta importante perda na qualidade de vida e deve ser prontamente tratada pelo profissional de saúde.

The urticaria presents itself with diverse clinical forms and distinct causes. It is one of the most common dermatosis: 15% to 20% of the population has at least one acute episode of illness in their life. Urticaria is classified based on its temporal evolution as acute (less than 6 weeks) or chronic (more than 6 weeks). Management strategies may involve nonpharmacological measures and drug interventions, which are grouped into first-(antihistamines), second (corticosteroids and antileukotrienes) and third-line therapies (immunomodulators). This clinical entity has a major loss in quality of life and should be promptly treated by a health professional.

Neuromodulación e histamina: regulación de la liberación de neurotransmisores por receptores H3 / Neuromodulation and histamine: regulation by H3 receptors of neurotransmitter release

Histamine regulates at the pre- and post-synaptic levels several functions of the mammalian Nervous System, in which three (H1, H2, and H3) out of the four G protein-coupled histamine receptors cloned so far are widely distributed. The histamine H3 receptor (H3R) was first identified as an auto-receptor controlling histamine synthesis and release, but several lines of evidence have shown the H3R to regulate as a hetero-receptor the release of a number of neuroactive substances, namely acetylcholine, 5-hydroxytryptamine (5-HT, serotonin), noradrenaline, dopamine, glutamate, y-aminobutyric acid (GABA) and the neuropeptides sustance P and calcitonin gene-related peptide (CGRP). H3R-mediated regulation of the release of these neurotransmitters and neuro-modulators, both in normal and pathological conditions, suggest that drugs acting at the receptor may have therapeutic use in a number of diseases such as sleep disorders, ischemia-induced cardiac arrhythmias, migraine, obesity, Alzheimer's disease and schizophrenia.

La histamina regula a nivel pre y postsináptico diversas funciones del Sistema Nervioso de los mamíferos, el cual expresa de manera abundante tres (H1, H2 y H3) de los cuatro receptores a histamina acoplados a proteínas G descritos a la fecha (H1-H4). El receptor a histamina H3 (H3R) se identificó inicialmente como el autorreceptor responsable del control de la liberación y la síntesis de la histamina. Posteriormente se estableció que este receptor se encuentra también en las terminales axónicas de otras neuronas del Sistema Nervioso Central y periférico, donde regula como heterorreceptor la liberación de varios transmisores. En este trabajo se revisan los efectos de la activación del H3R en la liberación de histamina, acetilcolina, 5-hidroxitriptamina (5-HT, serotonina), noradrenalina, dopamina, glutamato, ácido y-aminobutírico (GABA) y los neuropéptidos sustancia P y el péptido relacionado al gen de la calcitonina (CGRP). La regulación por el receptor H3 de la liberación de estos neurotransmisores y neuromoduladores, tanto en condiciones normales como patológicas, sugiere que los fármacos que actúen sobre dicho receptor pueden tener uso terapéutico en alteraciones diversas como los transtornos del sueño, las arritmias cardiacas causadas por isquemia, la migraña, la obesidad, la enfermedad de Alzheimer y la esquizofrenia.

Aminas biogênicas nos alimentos: revisão de literatura / Biogenic amines in foods: a literature review

Muitos estudos têm sido realizados acerca da presença e quantificação de aminas biogênicas nos diversos alimentos devido ao seu potencial tóxico. Histamina, putrescina, cadaverina, tiramina, triptamina, espermidina e espermina se destacam como as principais, sendo a análise da presença na matriz alimentar uma importante ferramenta tanto para indicar o grau de frescor ou de deterioração dos alimentos como para prevenir efeitos deletérios à saúde humana. Esta revisão aborda a importância da presença das aminas biogênicas nos alimentos, os efeitos tóxicos e os métodos analíticos.