Prenatal mold exposure is associated with development of atopic dermatitis in infants through allergic inflammation / Exposição pré-natal a mofo está associada ao desenvolvimento de dermatite atópicaem neonatos por reação alérgica

Abstract Objective Mold exposure in early life may be associated with development of atopic dermatitis; however, studies of this link are inconclusive and evidence for the underlying mechanism(s) is lacking. This study identified the association between the time of mold exposure and development of atopic dermatitis and investigated the underlying mechanisms. Method The association between atopic dermatitis and mold exposure was examined in the Cohort for Childhood Origin of Asthma and Allergic Diseases birth cohort study (n = 1446). Atopic dermatitis was diagnosed at 1 year of age by pediatric allergists. Exposure to mold was assessed by questionnaire. The Illumina MiSeq platform was used to examine the environmental mycobiome in 20 randomly selected healthy infants and 20 infants with atopic dermatitis at 36 weeks of gestation. Results Prenatal, but not postnatal, mold exposure was significantly associated with atopic dermatitis (adjusted odds ratio, 1.36; 95% confidence interval, 1.01-1.83). Levels of total serum IgE at 1 year of age were higher in infants with atopic dermatitis exposed to mold during pregnancy than in healthy infants not exposed to mold during pregnancy (p = 0.021). The relative abundance of uncultured Ascomycota was higher in infants with atopic dermatitis than in healthy infants. The relative abundance of uncultured Ascomycota correlated with total serum IgE levels at 1 year of age (r = 0.613, p < 0.001). Conclusion Indoor mold exposure during the fetal period is associated with development of atopic dermatitis via IgE-mediated allergic inflammation. Avoidance of mold exposure during this critical period might prevent the development of atopic dermatitis.

Resumo Objetivo A exposição ao mofo no início da vida pode estar associada ao desenvolvimento de dermatite atópica; contudo, os estudos sobre esse vínculo são inconclusivos e faltam evidências dos mecanismos subjacentes. Identificamos a associação entre o momento da exposição ao mofo e o desenvolvimento de dermatite atópica e investigamos os mecanismos subjacentes. Método A associação entre dermatite atópica e exposição a mofo foi examinada em um estudo de coorte de nascimento da Origem da Asma e de Doenças Alérgicas em Crianças (COCOA) (n = 1446). A dermatite atópica foi diagnosticada em pacientes com um ano de vida por pediatras alergistas. A exposição ao mofo foi avaliada por um questionário. A plataforma Illumina MiSeq foi utilizada para examinar o microbioma ambiental em 20 neonatos saudáveis escolhidos aleatoriamente e 20 com dermatite atópica a 36 semanas de gestação. Resultados A exposição pré-natal, porém não pós-natal, ao mofo foi significativamente associada à dermatite atópica (razão de chances ajustada, 1,36; intervalo de confiança de 95%, 1,01-1,83). Os níveis séricos totais de Imunoglobulina E (IgE) no primeiro ano de vida foram maiores em neonatos com dermatite atópica expostos a mofo durante a gravidez do que em neonatos não expostos a mofo durante a gravidez (p = 0,021). A abundância relativa de Ascomycota não cultivado foi maior em neonatos com dermatite atópica do que em neonatos saudáveis. A abundância relativa de Ascomycota não cultivado correlacionou-se com os níveis séricos totais de IgE no primeiro ano de vida (r = 0,613, p < 0,001). Conclusão A exposição ao mofo no ambiente domiciliar durante a gravidez está associada ao desenvolvimento de dermatite atópica por meio de reação alérgica mediada por IgE. A prevenção à exposição ao mofo durante o período crítico da gravidez pode prevenir o desenvolvimento de dermatite atópica.

Aspectos de interés sobre dermatitis atópica, su diagnóstico y tratamiento / Interest aspects about Atopic Dermatitis, its diagnosis and treatment

RESUMEN La evolución favorable de los pacientes afectados con dermatitis atópica está muy relacionada con un diagnóstico y orientación precoz en la atención primaria, para un seguimiento más especializado en las consultas de dermatología y alergología, por ser una entidad que ofrece dificultades en su identificación. Es necesario incrementar el nivel de información en los médicos de las áreas de salud, por ser estos escenarios donde ocurre el primer contacto con el paciente. El objetivo es ofrecer una visión actualizada sobre el diagnóstico y tratamiento de la dermatitis atópica que contribuya a la formación de los médicos en la atención primaria. Se realiza una revisión bibliográfica de los últimos 5 años, principalmente en las bases de datos PubMed y Scielo sobre el tema. Se abordan aspectos de interés relacionados con las manifestaciones clínicas, criterios diagnósticos y tratamiento. Los resultados que se ofrecen en este trabajo contribuirán a la formación profesional para una mejor promoción, prevención, diagnóstico precoz y tratamiento de esta enfermedad, cuya prevalencia es mayor en la infancia.

ABSTRACT The favorable evolution of the patients affected with Atopic Dermatitis is quite related with a diagnosis and precocious orientation in the primary attention, for a more specialized follow up in the dermatology and alergology consultations, as it is an entity that offers difficulties in its identification. It is necessary to increase the level of knowledge of doctors in these medical areas as these are the scenarios where it occurs the first contact patient doctor. Offering an updated vision about Atopic Dermatitis that contributes to the continuous formation of the professionals of the health sector in the primary attention. A revision of articles in the PubMed and Scielo database is carried out principally during the last 5 years. Aspects of interest related with the clinical manifestations, diagnoses criteria and treatment are considered. The results that are offered in this work will contribute to the professional formation for a better promotion, prevention, precocious diagnosis and treatment of this illness that is more likely to be found in the childhood.

Prevalence of vitamin D deficiency and its relationship with factors associated with recurrent wheezing / Prevalência de deficiência de vitamina D e sua relação com fatores associados à sibilância recorrente

ABSTRACT Objective: To determine the prevalence of vitamin D deficiency/insufficiency in children 0-18 years of age with recurrent wheezing and/or asthma residing in the microregion of Viçosa, Minas Gerais, Brazil, and treated at a referral center, and to determine its association with major risk factors for wheezing. Methods: A cross-sectional study was performed using a semi-structured questionnaire, which was administered by trained interviewers to the legal guardians of the study participants. Data were obtained regarding general characteristics of recurrent wheezing; general sociodemographic, environmental, and biologic factors; and atopy-related factors. The magnitude of the statistical association was assessed by calculating ORs and their corresponding 95% CIs by using multiple logistic regression. Results: We included 124 children in the study. The prevalence of vitamin D deficiency/insufficiency in the sample was 57.3%. Vitamin D deficiency/insufficiency was found to be associated with wheezing in the first year of life, personal history of atopic dermatitis, environmental pollution, and vitamin D supplementation until 2 years of age. Conclusions: The prevalence of vitamin D deficiency/insufficiency was high in our sample. Vitamin D concentrations were directly associated with vitamin D supplementation until 2 years of age and were inversely associated with wheezing events in the first year of life, personal history of atopic dermatitis, and environmental pollution.

RESUMO Objetivo: Determinar a prevalência da deficiência/insuficiência de vitamina D em indivíduos com sibilância recorrente e/ou asma com idade de 0-18 anos e residentes na microrregião de Viçosa (MG) atendidos em um centro de referência e determinar sua associação com os principais fatores de risco para sibilância. Métodos: Estudo transversal utilizando um questionário semiestruturado por entrevistadores treinados, aplicado aos responsáveis pelos participantes do estudo. Foram obtidas informações sobre características gerais da sibilância recorrente, fatores sociodemográficos, ambientais e biológicos gerais e aqueles relacionados à atopia. A magnitude da associação estatística foi avaliada por meio do cálculo da OR e IC95% obtidos por regressão logística múltipla. Resultados: Foram incluídos 124 indivíduos no estudo. A prevalência da deficiência/insuficiência de vitamina D na amostra foi de 57,3%. Observaram-se associações da deficiência/insuficiência de vitamina D com sibilância no primeiro ano de vida, antecedentes pessoais de dermatite atópica, poluição ambiental e suplementação de vitamina D até os 2 anos de idade. Conclusões: A prevalência de deficiência/insuficiência de vitamina D foi alta em nossa amostra. As concentrações de vitamina D foram associadas diretamente com a suplementação de vitamina D até os 2 anos de idade e inversamente com eventos de sibilância no primeiro ano de vida, antecedentes pessoais de dermatite atópica e poluição ambiental.

Atopic dermatitis: allergic dermatitis or neuroimmune dermatitis?

Abstract: Advances in knowledge of neurocellulars relations have provided new directions in the understanding and treatment of numerous conditions, including atopic dermatitis. It is known that emotional, physical, chemical or biological stimuli can generate more accentuated responses in atopic patients than in non-atopic individuals; however, the complex network of control covered by these influences, especially by neuropeptides and neurotrophins, and their genetic relations, still keep secrets to be revealed. Itching and airway hyperresponsiveness, the main aspects of atopy, are associated with disruption of the neurosensory network activity. Increased epidermal innervation and production of neurotrophins, neuropeptides, cytokines and proteases, in addition to their relations with the sensory receptors in an epidermis with poor lipid mantle, are the aspects currently covered for understanding atopic dermatitis.

Ultraviolet index: a light in atopic dermatitis and vitamin D research?

Abstract BACKGROUND: The role played by vitamin D in atopic dermatitis is controversial and has been the focus of many studies. The ultraviolet index has not been considered in this type of research. OBJECTIVES: The objectives of the study were to assess 25-hydroxy vitamin D [25(OH)D] serum level in atopic dermatitis patients and control group, to investigate the association between atopic dermatitis clinical severity (using the SCORing Atopic Dermatitis index - SCORAD) and 25(OH)D serum levels, and to evaluate the independent predictors, including Ultraviolet index, SCORAD and 25(OH)D. METHODS: We conducted a cross-sectional study of 106 atopic dermatitis patients. A control group was matched with a subsample of 54 participants with atopic dermatitis. SCORAD index, laboratory tests, and local Ultraviolet index were assessed. RESULTS: The atopic dermatitis patients had serum 25(OH)D levels and mean UVI significantly higher than the control group. Immunoglobulin E and Ultraviolet index were associated with the SCORAD index. Skin type, age and Ultraviolet index were independent predictors of 25(OH)D. CONCLUSIONS: Although statistically significant, the different levels of 25(OH)D between the paired groups may be attributed to the higher mean Ultraviolet index in atopic dermatitis patients. Since Ultraviolet index is an independent predictor of SCORAD index and of 25(OH)D level, it may work as a confounding factor in studies involving atopic dermatitis and 25(OH)D and must be considered in this kind of research.

Pet avoidance in allergy cases: Is it possible to implement it? / Evitación de mascotas en casos de alergia. ¿Es factible lograrla?

Introduction: Among allergic patients, pet avoidance is commonly recommended. It is difficult for patients to accomplish this because of their emotional attachment to the pets, and its effectiveness is controversial. Objective: To explore the applicability and effectiveness of pet avoidance measures among sensitized patients. Materials and methods: We evaluated 288 patients with asthma, rhinitis, conjunctivitis and/or dermatitis using skin prick test to measure their sensitization to cats, dogs and other animals to which they were exposed. Exposure to animals was evaluated in each patient (pets at home, frequent indirect exposure or no exposure). In those patients sensitized to animals some avoidance measures, such as removing pets from home and preventing indirect exposure, were recommended. On the following two appointments, we evaluated patients' fulfillment of these recommendations. Results: Sensitization to cats, dogs and birds was high (9%, 48%, 14%, respectively), as well as direct and indirect exposure (30%, 46%, 24%, respectively). Most patients denied contact with other animals (horses, hamsters, rabbits or cows), and sensitization to them was low. During the follow-up of patients sensitized to their pets at home (n=50), most of them refused to remove them from their house due to emotional attachment, and only two followed this recommendation. Conclusions: High exposure to animals could explain the frequency of sensitization to pets in this population. However, emotional attachment and prevalent indirect exposure to animals among sensitized patients make avoidance recommendations impractical or impossible to achieve.

Introducción. Entre los pacientes alérgicos se recomienda comúnmente la evitación de mascotas; sin embargo, es difícil que los pacientes cumplan con esta recomendación debido al apego emocional y, además, su efecto clínico no es claro. Objetivo. Explorar la aplicabilidad de las medidas de evitación entre pacientes sensibilizados a mascotas . Materiales y métodos. En 284 pacientes con asma, rinitis, conjuntivitis y dermatitis, se evaluó la sensibilización a gatos, perros y otros animales mediante pruebas de punción epidérmica. Se evaluó, igualmente, el nivel de exposición a animales (mascotas en la casa y exposición indirecta frecuente). A aquellos pacientes sensibilizados a los animales, se les recomendaron medidas de evitación como retirar la mascota de la casa y evitar la exposición indirecta. En las dos citas médicas siguientes se evaluó el cumplimiento de estas recomendaciones. Resultados. La sensibilización a gatos, perros y aves fue alta (9, 48, y 14 %, respectivamente), al igual que la exposición directa o indirecta a estos animales (30, 46, 24 %, respectivamente). La mayoría de los pacientes negó el contacto frecuente con otros animales (caballos, hámsteres, conejos, vacas) y la sensibilización a estos fue baja. La mayoría de los pacientes sensibilizados a su propia mascota (n= 50) se rehusó a retirar la mascota de la casa y solo dos de ellos siguieron la recomendación de hacerlo. Conclusiones. La exposición frecuente a los animales podría explicar la gran frecuencia de sensibilización a las mascotas en esta población. Sin embargo, el apego emocional y la exposición indirecta frecuente, hacen que las recomendaciones de evitación sean imprácticas o casi imposibles de lograr.

Sensitization rates of causative allergens for dogs with atopic dermatitis: detection of canine allergen-specific IgE

Allergen-specific IgE serology tests became commercially available in the 1980s. Since then these tests have been widely used to diagnose and treat allergic skin diseases. However, the relationship between a positive reaction and disease occurrence has been controversial. The purpose of this study was to evaluate allergens using a serologic allergy test in dogs with atopic dermatitis (AD). Dogs clinically diagnosed with AD (n=101) were tested using an allergen-specific IgE immunoassay. Among the total 92 environmental and food allergens, house dust and house dust mites were the most common. Several allergens including airborne pollens and molds produced positive reactions, and which was considered increasing allergens relating to the climate changes. The presence of antibodies against staphylococci and Malassezia in cases of canine AD was warranted in this study. Additionally, strong (chicken, turkey, brown rice, brewer's yeast, and soybean) and weakly (rabbit, vension, duck, and tuna) positive reactions to food allergens could be used for avoidance and limited-allergen trials.

Atopic dermatitis and vitamin D: facts and controversies / Dermatite atopica e vitamina D: fatos e controversias

Patients with atopic dermatitis have genetically determined risk factors that affect the barrier function of the skin and immune responses that interact with environmental factors. Clinically, this results in an intensely pruriginous and inflamed skin that allows the penetration of irritants and allergens and predisposes patients to colonization and infection by microorganisms. Among the various etiological factors responsible for the increased prevalence of atopic diseases over the past few decades, the role of vitamin D has been emphasized. As the pathogenesis of AD involves a complex interplay of epidermal barrier dysfunction and dysregulated immune response, and vitamin D is involved in both processes, it is reasonable to expect that vitamin D's status could be associated with atopic dermatitis' risk or severity. Such association is suggested by epidemiological and experimental data. In this review, we will discuss the evidence for and against this controversial relationship, emphasizing the possible etiopathogenic mechanisms involved.

Pacientes com dermatite atópica têm fatores de risco geneticamente determinados que afetam a função de barreira da pele e as respostas imunes, as quais interagem com fatores ambientais. Clinicamente, isso resulta em uma pele intensamente pruriginosa, inflamada, que permite a penetração de irritantes e alérgenos e predispõe os pacientes à colonização e à infecção por micro-organismos. Dentre os diversos fatores etiológicos responsáveis pelo aumento da prevalência de doenças atópicas nas últimas décadas, o papel da vitamina D tem ganhado destaque. Uma vez que a patogênese da dermatite envolve uma interação complexa da disfunção da barreira epidérmica e desregulação da resposta imune - e a vitamina D está envolvida em ambos os processos-, é razoável esperar que a vitamina D esteja associada ao risco ou à gravidade da dermatite atópica. Tal associação é sugerida por dados epidemiológicos e experimentais. Nessa revisão, serão abordadas as evidências favoráveis e contrárias a essa polêmica relação, enfatizando os possíveis mecanismos etiopatogênicos envolvidos.

[Evaluation of the concentration of proinflammatory/Pro Th1 Cytokines IFN-gamma and TNF-alpha and anti inflammatory/Pro Th2 cytokines IL-13 and IL-4 in breast milk and their relationship to atopic dermatitis]

Atopic dermatitis [AD] is one of the most common chronic, highly pruritic and inflammatory skin diseases. The exclusive influence of breastfeeding in the prevention of inflammatory diseases is a matter of debate. In this study, we aimed to determine the concentration of interferon-gamma [IFN-gamma], tumor necrosis factor-alpha [TNF-alpha], interleukin-13 [IL-13] and interleukin-4 [IL-4] cytokines as anti Th2 or anti Th1 cytokines in breast milk and their relationship with atopic dermatitis in breastfed infants. This study carried out in Afzalipour Hospital of kerman during one year from 2010 to 2011, we selected 50 breastfed infants with AD as cases and 50 healthy infants without AD or any other allergic disease as the controls. The concentrations of pro- and anti-inflammatory cytokines were measured by ELISA in the mothers' milk. The demographic characteristics were recorded in a data collection form. Moreover, severity of the disease was determined by SCORAD index. T-test and logistic regression were used for assessment of the correlation among study variables. The concentrations of IFN-gamma and IL-13 were significantly higher [respectively, P=0.04, and P=0.02] in the case group. However, logistic regression revealed that only IFN-gamma significantly increased the risk for atopic dermatitis [P=0.02]. Concentration of TNF-alpha was similar in the milk from mothers belonging to the two groups. The results indicate that the concentrations of IFN-gamma, IL-13 and IL-4 cytokines are higher in the milk of mothers whose infants have AD. However, the risk for atopic dermatitis increases by 49% by every ten-unit [in pg/mL] increase in the level of IFN-gamma

Atopy patch test (APT) in the diagnosis of food allergy in children with atopic dermatitis / Teste de contato atópico (TCA) no diagnóstico de alergia alimentar em crianças com dermatite atópica

BACKGROUND: Atopic Dermatitis is a chronic inflammatory skin disease. Food allergens are important in the pathogenesis in 1/3 of the cases. Several mechanisms are involved in the pathogenesis of Atopic Dermatitis. Immediate reactions are identified by both measurement of specific IgE and skin prick test. Atopy Patch Test seems to be relevant in the investigation of patients with suspected delayed-type reactions. OBJECTIVES: To evaluate the standardization of this method concerning allergen concentration, occlusion time and interpretation, and determine the specificity and sensitivity of the Atopy Patch Test according to the skin prick test and specific IgE levels in food allergy diagnosis in children with Atopic Dermatitis. METHODS: Seventy-two children, aged 2-12 years were selected and followed at the allergy clinic of the Hospital São Zacharias. Skin prick test, specific IgE and food Atopy Patch Test (cow's milk, egg, soy and wheat) were carried out. Three groups were submitted to the Atopy Patch Test: (1) Atopic Dermatitis with or without Rhinitis and Asthma; (2) Rhinitis and or Asthma without AD; (3) Healthy individuals. RESULTS: In group 1, 40% of the patients presented positive reactions. The longer the exposure time (48h and 72h), the higher the sensitivity. In group 2, the test was more specific than sensitive for all the extracts, with increased sensitivity the longer the time of exposure (72h). In group 3, 8.3% presented positive tests. CONCLUSION: APT evidenced a great diagnostic value in late-phase reactions to food, with high specificity. It showed to be a specific and reliable tool in comparison with the healthy group's results.

FUNDAMENTOS: A Dermatite Atópica é uma doença inflamatória crônica da pele. Os alimentos são importantes na patogênese da doença em 1/3 dos casos. Diversos mecanismos estão envolvidos na fisiopatogenia da dermatite Atópica. As reações imediatas são identificadas pela dosagem de IgE específica e teste de puntura. O teste de contato atópico parece ter relevância na investigação de pacientes com suspeita de reação tardia. OBJETIVOS: Avaliar a padronização do método com relação à concentração do alérgeno, tempo de oclusão e de interpretação; e determinar a especificidade e a sensibilidade do teste de contato atópico em relação ao teste de puntura e a dosagem de IgE específica, no diagnóstico de alergia alimentar em crianças com dermatite Atópica. MÉTODOS: Setenta e duas crianças com 2 a 12 anos foram submetidas a teste de puntura e dosagem de IgE específicas para alimentos (leite de vaca, ovo, soja, trigo). O teste de contato atópico foi aplicado em 3 grupos: (1) Dermatite Atópica com ou sem Rinite e Asma; (2) Rinite e ou Asma sem Dermatite Atópica; (3) Saudáveis. RESULTADOS: No grupo 1, 40% dos pacientes apresentaram reação positiva. Quanto maior o tempo de exposição, maior foi a sensibilidade. No grupo 2, o teste foi mais específico que sensível para todos os extratos; com aumento da sensibilidade com maior tempo de exposição (72h). No grupo 3, 8.3% apresentaram testes positivos. CONCLUSÃO: O teste de contato atópico mostrou ter valor diagnóstico em relação às reações de fase tardia a alimentos, com elevada especificidade. Mostrou-se um teste específico e confiável ao comparar com os resultados do grupo controle.

Dermatite atópica em pediatria: atualização / Atopic dermatitis in pediatrics: a review

O trabalho discorre sobre a importância da dermatite atópica (DA) em Pediatria, descrevendo as formas de apresentação clínica, critérios diagnósticos, fisiopatologia, alterações na imunidade inata e nas respostas imunes adaptativas, papel das citocinas, inter-relações entre infecções e DA e os recursos terapêuticos, compreendendo hidratação da pele, controle da inflamação e do prurido, identificação e afastamento dos fatores desencadeantes e formas alternativas de tratamento.

Manifestaciones alérgicas en el primer año de vida / Allergic manifestations in the first year of life in a an upper middle and upper socioeconomic group of children

There is a lack of information in our country regarding allergies among infants. Objective: Measure the frequency of allergic reactions among children of an upper middle and upper socioeconomic group in Santiago, during their first year of life. Method: Chart information and telephone follow up every 3 months for a period of 12 months. Results: 7.2% of the children presented symptoms suggestive of allergies, and represented the "candidate group". At 12 months, all cases were reviewed, and 3.4% were thought to be probably allergic (48% of candidates). In all cases, the stimulus was thought to be cow's milk. Most frequent were digestive symptoms (88%), while three children had serious illness which included skin, respiratory and digestive symptoms. Treatment included maintenance of nursing when posible, and withdrawal of cow's milk from the diet, with success in all cases. Conclusion: The frequency of allergic type manifestations obtained by phone along the first year of life nearly doubled the number of diagnoses at 12 m of age. Figures obtained in the segment of population assessed were lower than those reported in other countries, mainly in Europe.

En nuestro país falta información sobre las manifestaciones de alergia en lactantes. Objetivo: Medir la frecuencia de manifestaciones alérgicas durante el primer año de vida en una cohorte de nivel socioeconómico medio y alto, nacida de Santiago. Metodología: Seguimiento de cohorte mediante llamadas telefónicas cada tres meses, durante 12 meses e información de fichas de médicos tratantes. Resultados: 7,2% reportaron síntomas potencialmente alérgicos y representaron al "grupo candidato". A los 12 meses, la evaluación caso a caso llevó a considerar que en 3,4% de la cohorte el diagnóstico más probable era alergia (48% de los candidatos); en todos los casos la proteína ofensora fue de leche de vaca. Las manifestaciones digestivas fueron las más frecuentemente informadas (88% de los casos). Tres niños tuvieron manifestaciones graves que incluían piel, aparato respiratorio y digestivo. El tratamiento mantuvo el amamantamiento cuando fue posible y retiró la leche de vaca de la dieta materna. Este tratamiento fue exitoso en todos los casos. Conclusión: La frecuencia de manifestaciones tipo alérgico a lo largo del año fue alrededor del doble de los casos considerados probablemente alérgicos a los 12 meses. Las frecuencias encontradas en el segmento de la población chilena evaluada fueron menores que la informada en otros países, especialmente europeos.

Risk factors of bronchial asthma in two contrasting settings–metropolitan and coastal areas of Bangladesh: A case control study.

Background. Seven million people are suffering from bronchial asthma in Bangladesh. But scanty data is available to explain the risk factors for asthma in Bangladesh. Methods. This population-based, age, sex, and economic status matched case-control study was conducted to identify the risk factors responsible for the development of bronchial asthma in two contrasting settings, the metropolitan capital city and coastal area of Bangladesh. A structured pre-tested questionnaire was filled up by face-to-face interviews with the patients or parents of patients with bronchial asthma and the normal controls after a respiratory physician confirmed the diagnosis on the basis of history, physical examination and spirometry. Results. Presence of allergic problems was recognised as risk factors for the development of bronchial asthma. Concomitant existence of atopic diseases, like allergic rhinitis, eczema and allergic conjunctivitis were found to be significant risk factors in both the settings. History of early childhood lung infections, like pneumonia, bronchiolitis and intake of antibiotics and paracetamol in last 12 months were also observed to be the risk factors in both the areas. Though most of the so-called allergic foods were statistically found to be a protective factor in both the settings [odds ratio (OR) 0.48, 95% confidence intervals (CI) 0.37-0.63 in city area and OR 0.80, 95% CI 0.66-0.96 in coastal area], this was considered to be an artifact. Conclusions. Several common risk factors for the development of bronchial asthma were identified in both city and coastal areas of Bangladesh. Bronchial asthma prevention campaign in Bangladesh may focus on sensitising the people on these risk factors.

Dermatite atópica em Pediatria / Atopic dermatitis in Pediatrics

A autora procede a uma revisão do tema Dermatite atópica em Pediatria, ressaltando sua importância e freqüência na prática de consultório, descrevendo o quadro clínico e o roteiro diagnóstico, a fisiopatologia da moléstia, as respostas imunes adaptativas, inter-relações entre infecção e dermatite atópica e, finalmente, a terapêutica, compreendendo identificação e afastamento dos fatores desencadeantes ou agravantes, hidratação da pele, controle da inflamação e do prurido e outras formas de tratamento, eventualmente indicadas. O trabalho se acompanha de extensa relação de referências bibliográficas.

Incidence of allergen specific IgE in atopic dermatitis patients by immunoblot assay

To determine the incidence of allergens specific IgE by immunoblot assay in atopic dermatitis patients. Prospective study. South Riyadh, Dermatology clinic Alfalah International Hospital, Saudi Arabia. Sixty-five adult patients and twenty volunteer controls sera were collected from atopic dermatitis patients. IgE antibodies specific to allergens of food, pollens, animal epithelia, house dust mites, and moulds were determined using an immunoblot assay. The sensitization rate of all allergens was found to be 65% [42/65; 26 males, 39 females]. The subjects were most commonly allergic to pollen [35.2%], food [31.5%] and animal epithelial dander [21.0%]. House dust mite [11.4%] and mould [0.9%] were less frequent than the others were. The result indicates that pollen allergens, food allergens, animal epithelia and dander should be taken into account as possible exacerbating factors in adult patients with AD within the specific geographical area studied

Características clínicas de los niños asmáticos hospitalizados en un Servicio de Pediatría / Clinical characteristics of asthmatic children hospitalized in a pediatric unit

Introducción:El asma es una enfermedad heterogénea con prevalencia descrita en aumento. En Chile, existen escasos estudios en que se describa las características clínicas de los pacientes pediátricos hospitalizados. Objetivos: Describir las características clínicas de los niños hospitalizados por episodios de crisis asmáticas. Pacientes y Método: Estudio descriptivo, restrospectivo en niños con asma entre 6 y 15 años, hospitalizados en el Servicio de Pediatría del Hospital Clínico de la Pontificia Universidad Católica de Chile, entre los años 1998 y 2004. Resultados: De un total de 317 fichas clínicas que correspondían a pacientes asmáticos hospitalizados, se pudo acceder sólo a 188, de las cuales 113 cumplían con los criterios de inclusión. Sesenta y ocho fichas correspondían a niños (61 por ciento), setenta y cinco niños iniciaron cuadros obstructivos antes de los 3 años (66 por ciento), el desencadenante más frecuente fueron los virus respiratorios en 53 casos (47 por ciento), el 93 por ciento (105 casos) requirió FiO2 < 0,5 por ciento, y 60 pacientes (53 por ciento) tenían antecedentes de atopía. Conclusión: La mayoría de los pacientes hospitalizados presentó crisis leves o moderadas, sin requerir ingreso a la unidad de paciente crítico. La atopía fue un antecedente frecuente. Es importante realizar un estudio prospectivo que evalúe el tipo y adherencia a tratamiento en relación a la evolución clínica del asma en niños.

Prurito cutaneo / Cutaneous pruritus

Concepto: El prurito (de prurio: picor, picazón, comezón) es un síntoma subjetivo y de difícil definición, sin embargo también es de fácil compresión, pues con seguridad todos los individuos lo han experimentado alguna vez en la vida. La definición clásica del prurito es: ‘sensación desagradable que conduce al rascado’. Es un hecho fisiológico que surge ante estímulos externos o internos en forma súbita y autolimitada y que provoca como repuesta el rascado. No obstante, el prurito también puedes ser patológico y acompañarse de diversas enfermedades cutáneas o sistémicas. El prurito es un síntoma aflictivo tan difícil de soportar como el dolor, ya que puede deteriorar la calidad de vida desde el punto de vista psíquico y psicológico...