Environment control and healthy education are the most important methods for prevention and treatment of allergic rhinitis / 中华预防医学杂志

The almost all guidelines of allergic rhinitis (AR) diagnosis and treatment in the world agree the strategy of "combination of prevention and treatment, four in one". There are more descriptions about anti-allergic medications and allergen immunotherapy (AIT), but less contents of environmental control and health education. It is necessary to emphasize again that clinicians must attach great importance to environmental control and strengthen health education in order to realize the three-level prevention of AR and reduce its harm.

Predictive model of curative effect of mite subcutaneous immunotherapy in 5-18 years of age patients with allergic asthma / 中华儿科杂志

Objective: To analyze the factors affecting the efficacy of mite subcutaneous immunotherapy (SCIT) in allergic asthma patients aged 5-18 years, and to find the best predictive model for the curative effect. Methods: The data of 688 patients aged 5-18 years with allergic asthma who completed more than 3 years of mite SCIT from December 2006 to November 2021 in the Department of Respiratory Medicine, Children's Hospital Affiliated to Nanjing Medical University were retrospectively analyzed. Male, results of skin prick test (SPT), age, daily medication score (DMS), visual analogue scale (VAS) score, and enrollment season were defined as independent variables. R language models, including Logistic regression model, random forest model and extreme gradient boosting (XGboost) model, were used to analyze the impact of these independent variables on the outcomes. The receiver operating characteristic curve was applied to compare the predictive ability of the models. Hypothesis testing of the area under curve (AUC) of the 3 models was performed using DeLong test. Results: There were 435 males and 253 females in the 688 patients. There were 349 patients aged 5-<8 years, 240 patients aged 8-<11 years, and 99 patients aged 11-18 years. SPT showed that 429 cases (62.4%) were only allergic to mite, and 259 cases (37.7%) were also allergic to other allergens. According to the efficacy after 3 years of SCIT, 351 cases (51.0%) discontinued the treatment and 337 cases (49.0%) required continued treatment. The DMS was 4 (3, 6) at initiation, 3 (2, 5) at 3 months, 3 (2, 5) at 4 months, 2 (1, 3) at 12 months, and 0 (0, 1) at 3 years of SCIT treatment. The VAS was 3.5 (2.5, 5.2) at initiation, 3.2 (2.2, 4.8) at 3 months, 2.6 (1.4, 4.1) at 4 months, 1.0 (0.6, 1.8) at 12 months, and 0.5 (0, 1.2) at 3 years of treatment. At 3, 4, and 12 months, the rate of decline in DMS was 0 (0, 20%), 16.7% (0, 33.3%), and 50.0% (31.0%, 75.0%), respectively; and the VAS decreased by 7.1% (3.2%,13.8%), 27.6% (16.7%,44.4%), and 70.2% (56.1%, 82.3%), respectively. Regarding the enrollment season, 99 cases were in spring, 230 cases in summer, 171 cases in autumn, and 188 cases in winter. The R language Logistic regression model found that DMS>3 points at 3 months (OR=-3.5, 95%CI:-4.3--2.7, P<0.01), male (OR=-1.7, 95%CI:-2.3--1.0), P<0.01), DMS decline rate>16.7% at 4 months (OR=-1.6, 95%CI:-2.3--0.8, P<0.01) and DMS decline rate>0 at 3 months (OR=-0.7, 95%CI:-1.3--0.2, P<0.05) had higher possibility of drug discontinuation; whereas, the decline rate of DMS at 12 months>50.0% (OR=0.7, 95%CI: 0.1-1.3, P<0.05), VAS at 12 months>1.0 points (OR=0.9, 95%CI: 0.3-1.6, P<0.05), and initial VAS<4.0 points (OR=1.0, 95%CI: 0.4-1.6, P<0.01) had lower possibility of drug discontinuation. Both the random forest model and the XGboost model showed that DMS>3 points at 3 months (mean decrease accuracy=30.9, importance=0.45) had the greatest impact on drug discontinuation. The AUC of the random forest model was the largest at 0.900, with an accuracy of 78.2% and a sensitivity of 84.5%. Logistic regression model had AUC of 0.891, accuracy of 80.0%, and sensitivity of 80.0%; XGboost model had AUC of 0.886, accuracy of 76.9%, and sensitivity of 84.5%. The AUC of the pairwise comparison model by DeLong test found that all three models could be used for the prediction of this data set (all P>0.05). Conclusions: The more drugs used to control the primary disease, and the more careful reduction of the control medicine after starting SCIT treatment, the more favorable it is to stop all drugs after 3 years. The random forest model is the best predictive model for the efficacy of mite SCIT in asthmatic children.

Desensibilización con idursulfase en un niño con síndrome de Hunter (mucopolisacaridosis II) / Idursulfase desensitization in a child with Hunter syndrome (mucopolysaccharidosis ii)

La terapia de reemplazo enzimático disminuye la morbilidad y mejora la calidad de vida de los pacientes con mucopolisacaridosisii. Se han descrito reacciones de hipersensibilidad inmediata a este fármaco. La desensibilización es un tratamiento que induce la tolerancia temporaria a una droga y permite al paciente alérgico recibir la medicación.Se presenta el caso de un niño de 7 años con diagnóstico de síndrome de Hunter que, luego de 4 años de tratamiento con idursulfase, tuvo dos episodios de anafilaxia durante la infusión del fármaco. Se detectó inmunoglubulina E específica mediante pruebas cutáneas, y fue positiva la intradermorreacción con dilución 1/10 (0,2 mg/ml). Se realizó un protocolo de desensibilización de 12 pasos, sin presentar eventos adversos. La evaluación alergológica y la posibilidad de desensibilización constituyeron herramientas útiles en el manejo de nuestro paciente

Enzyme replacement therapy with idursulfase decreases morbidity and improves quality of life of patients with mucopolysaccharidosis ii. Immediate hypersensitivity reactions to this drug have been described. Desensitization is a treatment that induces temporary tolerance to a culprit drug, allowing the allergic patient to receive the medication.We present the case of a 7-year-old patient diagnosed with Hunter syndrome who presented, after 4 years of treatment, two episodes of anaphylaxis during the infusion of idursulfase. Detection of specific immunoglobulin E was carried out using skin tests, with intradermal reaction at a 1/10 dilution (0.2 mg/ml) being positive. A 12-step desensitization protocol was performed without presenting adverse events.The allergological evaluation and the possibility of desensitization were useful tools in the management of our patient.

Loss of tolerance 5 days after discontinuing sulphonamide introduced via desensitization in delayed reaction / Perda da tolerância 5 dias após suspensão de sulfonamida introduzida através de dessensibilização por reação tardia

ABSTRACT The fixed drug eruption is a non-immediate hypersensitivity reaction to drug, characterized by recurrent erythematous or violaceous, rounded, well-defined border plaques, which always appear in the same location every time the culprit drug is administered. The usual practice is to avoid the drug involved and to use a structurally different drug. However, there are situations in which there is no safe and effective therapy. In such situations, desensitization is the only option. We describe the case of a patient who presented fixed eruption due to sulfamethoxazole-trimethoprim, who underwent successful desensitization, but required a repeat procedure twice due to relapse after inadvertent full-dose reintroduction. In non-immediate hypersensitivity reaction to drug, the indication is controversial and there is no technical standardization. Furthermore, the time at which such tolerance is lost after discontinuing the drug involved is unknown. In severe non-immediate reactions of types II and III, desensitization is contraindicated. The patient underwent desensitisation to sulfamethoxazole-trimethoprim three times − the first with recurrence of lesions and the second and third without manifestations, all concluded successfully and with no premedication.

RESUMO A erupção fixa por drogas é uma reação de hipersensibilidade a medicamento não imediata, caracterizada por placas eritematosas ou violáceas, arredondadas, recorrentes, de bordas bem definidas e que aparecem sempre na mesma localização cada vez que o medicamento culpado é administrado. A prática habitual é evitar a droga envolvida e utilizar um medicamento estruturalmente diferente. Contudo, há situações em que não há terapêutica segura e eficaz. Em tais situações, a dessensibilização é a única opção. Descrevemos o caso de um paciente que apresentou erupção fixa por drogas por sulfametoxazol-trimetoprim, tendo sido submetido à dessensibilização com sucesso, mas necessitou repetição do procedimento duas vezes, por recidiva da reação após reintrodução inadvertida em dose plena. Em reação de hipersensibilidade a medicamento não imediata, a indicação é controversa e não há padronização técnica. Além disso, não se conhece o tempo durante o qual essa tolerância é perdida após a suspensão da droga envolvida. Nas reações não imediatas graves e dos tipos II e III, a dessensibilização está contraindicada. O paciente foi submetido a dessensibilização ao sulfametoxazol-trimetoprim por três vezes − a primeira com recorrência de lesões, e a segunda e terceira sem manifestações, sendo todas concluídas com sucesso e sem uso de pré-medicação.

Desensibilización a levotiroxina: caso clínico / Successful oral desensitization to levothyroxine: report of one case

We report a 39-year-old female who underwent a total thyroidectomy as treatment for a thyroid papillary cancer. She suffered several episodes of mild angioedema in lips and tongue, after using different commercial Levothyroxine formulations, with and without excipients. Given the need to use this drug, the patient was admitted in our hospital and we proceeded to desensitize her with oral Levothyroxine. The patient fasted throughout the whole procedure, was properly monitored and had an adequate peripheral venous access. On the first day of the procedure, a 15-step protocol was performed, first administering placebo and then, compounded formulations of Levothyroxine starting from 0.01 ug, followed by doubling doses every 15 minutes until the cumulative dose of 111.95 ug was completed, corresponding to the daily dose of Levothyroxine her endocrinologist prescribed (112 ug). The patient was monitored at baseline, between each dose and up to 3 hours after the procedure was completed. There were no incidents such as urticaria, angioedema, or others. On the second day, the patient received a single-full dose of 112 ug on an empty stomach. The medication was successfully tolerated and she was discharged. Thereafter, she tolerates daily Levothyroxine.

Retrospective Analysis on the Effects of House Dust Mite Specific Immunotherapy for More Than 3 Years in Atopic Dermatitis

PURPOSE: In extrinsic atopic dermatitis (AD), house dust mites (HDM) play a role in eliciting or aggravating allergic lesions. The nature of skin inflammation in AD has raised a growing interest in allergen-specific immunotherapy (SIT). Thus, we assessed clinical improvement and laboratory parameters for evaluation of the benefit of long-term SIT. MATERIALS AND METHODS: A total of 217 AD patients who were treated with SIT for at least 3 years were retrospectively assessed, by using their investigator global assessment, pruritus scores, loss of sleep (LOS), total serum IgE, and eosinophil counts collected. Patients were additionally classified into subgroups according to age, initial AD severity and mono- or multi-sensitization to include different individual factors in the evaluation of SIT efficacy. Lastly, we compared laboratory data of good responders to SIT with that of poor responders to SIT. RESULTS: Improvement after SIT therapy was observed in 192 out of 217 patients (88.4%). Among these patients, 138 (63.5%) achieved excellent, near-complete or complete clinical remission. Significant reduction of pruritus, LOS, and the mean value of total serum IgE were observed (p0.05). CONCLUSION: We emphasize the usefulness of long-term HDM SIT as a disease-modifying therapy for AD.

Impacto de la inmunoterapia subcutánea con Dermatophagoides farinae y Dermatophagoides pteronyssinus sobre la calidad de vida de pacientes con rinitis y asma alérgica / The impact of subcutaneous immunotherapy with Dermatophagoides farinae and Dermatophagoides pteronyssinus on the quality of life of patients with allergic rhinitis and asthma

Introducción. Como sucede en otras partes del mundo, la prevalencia de asma y rinitis alérgica en Colombia está en aumento. Se ha establecido que la inmunoterapia subcutánea con alérgenos es eficaz a largo plazo en pacientes con rinitis alérgica y asma sensibilizados a Dermophagoides. Objetivo. Proveer evidencia sobre los cambios relacionados con la calidad de vida inducidos por la inmunoterapia subcutánea en sujetos con alergia respiratoria. Materiales y métodos. Se seleccionaron 76 sujetos con diagnóstico de alergia respiratoria con sensibilización a Dermatophagoides farinae y Dermatophagoides pteronyssinus . Para la evaluación de la calidad de vida se emplearon los instrumentos Kidscreen-27 y SF-36 ( Short form 36 ). Estos instrumentos se aplicaron en dos ocasiones: durante la primera visita, en la cual se iniciaba la inmunoterapia subcutánea, y un año después de haberse iniciado el tratamiento. Resultados. Al año de estar recibiendo la inmunoterapia, los 22 sujetos que completaron el estudio presentaron cambios positivos en términos de calidad de vida. En los niños, el principal cambio se presentó en el dominio del ´entorno escolar´ mientras que en los adultos fue en el de la ´función física´ . Discusión. Se evaluaron por primera vez en Colombia los beneficios inducidos por la inmunoterapia subcutánea para ácaros de polvo en la calidad de vida de sujetos con rinitis alérgica y asma mediante los cuestionarios Kidscreen-27 y SF-36. Los resultados proveen evidencia de que la inmunoterapia subcutánea influye positivamente en la calidad de vida en sujetos con rinitis asmática y asma sensibilizados a los ácaros de polvo.

Introduction: The prevalence of asthma and allergic rhinitis in Colombia is increasing at the same rate as it is in other parts of the world. It has been determined that allergen-specific subcutaneous immunotherapy is effective in subjects with allergic rhinitis and asthma that are sensitized to house dust mites: Dermatophagoides farinae and Dermatophagoides pteronyssinus . Objective: To provide evidence on changes in the quality of life of subjects induced by allergen-specific subcutaneous immunotherapy with Dermatophagoides farinae and Dermatophagoides pteronyssinus . Materials and methods: We selected 76 subjects with a diagnosis of respiratory allergy with sensitization to Dermatophagoides farinae and Dermatophagoides pteronyssinus . The instruments used for evaluating the quality of life were Kidscreen-27 and SF-36. These instruments were applied twice for each subject: once during the first visit, and during the twelfth visit corresponding to the one-year follow-up. Results: Twenty-two subjects completed this study. After one year of treatment with allergen-specific subcutaneous immunotherapy, we found positive changes in terms of the quality of life. In children, the main change was in the School Environment domain while in adults it was in the Physical Function domain. Conclusion: We evaluated, for the first time in Colombia, benefits induced by allergen-specific subcutaneous immunotherapy for dust mites in terms of quality of life in subjects with allergic rhinitis and asthma. These results demonstrated that allergen-specific subcutaneous immunotherapy produces a positive influence on subjects sensitized to dust mites that received allergen-specific subcutaneous immunotherapy to Dermatophagoides farinae and Dermatophagoides pteronyssinus after one year.

Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer, Model for End-Stage Liver Disease Score, and Graft Liver Volume

Several studies have suggested that a positive lymphocyte cross-matching (XM) is associated with low graft survival rates and a high prevalence of acute rejection after adult living donor liver transplantations (ALDLTs) using a small-for-size graft. However, there is still no consensus on preoperative desensitization. We adopted the desensitization protocol from ABO-incompatible LDLT. We performed desensitization for the selected patients according to the degree of T lymphocyte cross-match titer, model for end-stage liver disease (MELD) score, and graft liver volume. We retrospectively evaluated 230 consecutive ALDLT recipients for 5 yr. Eleven recipients (4.8%) showed a positive XM. Among them, five patients with the high titer (> 1:16) by antihuman globulin-augmented method (T-AHG) and one with a low titer but a high MELD score of 36 were selected for desensitization: rituximab injection and plasmapheresis before the transplantation. There were no major side effects of desensitization. Four of the patients showed successful depletion of the T-AHG titer. There was no mortality and hyperacute rejection in lymphocyte XM-positive patients, showing no significant difference in survival outcome between two groups (P=1.000). In conclusion, this desensitization protocol for the selected recipients considering the degree of T lymphocyte cross-match titer, MELD score, and graft liver volume is feasible and safe.

Use of Bortezomib as Anti-Humoral Therapy in Kidney Transplantation

This study aimed to investigate the effect of bortezomib in the desensitization and treatment of acute antibody mediated rejection (AAMR) in kidney transplantation. Nine patients who received bortezomib therapy for desensitization (DSZ group, n = 3) or treatment of AAMR (AAMR group, n = 6) were included in this study. In the DSZ group, 2 patients required DSZ owing to positive cross match and 1 owing to ABO mismatch with high baseline anti-ABO antibody titer (1:1,024). Bortezomib was used at 1, 3, 8, and 11 days from the start of the treatment. In the AAMR group, 3 patients showed full recovery of allograft function after bortezomib use and decrease in donor specific anti-HLA antibody (HLA-DSA). However, 3 patients did not respond to bortezomib and experienced allograft failure. In the DSZ group, negative conversion of T-CDC (complement-dependent cytotoxicity) was achieved, and HLA-DSA was decreased to lower than a weak level (median fluorescence intensity [MFI] < 5,000) in 2 patients. In the case of ABO mismatch kidney transplantation, the anti-A/B antibody titer decreased to below the target (< or = 1:16) after bortezomib therapy. Therefore, bortezomib could be an alternative therapeutic option for desensitization and treatment of AAMR that is unresponsive to conventional therapies.

Desensibilización rápida en pacientes con hipersensibilidad a aspirina sometidos a angioplastía coronaria: Reporte de cuatro casos / Rapid aspirin desensitization in patients with a history of aspirin hypersensitivity requiring coronary angioplasty: Report of four cases

Background: Aspirin use is necessary after a coronary angioplasty. It should not be used in patients with a history of hypersensitivity. However, rapid desensitization protocols have been reported to allow its use in such patients. One of these protocols consists in the administration of progressive doses of aspirin, from 1 to 100 mg in a period of 5.5 hours, in a controlled environment. We report four male patients aged 45,49, 59 and 73 years with a history of aspirin hypersensitivity, who were subjected to a coronary angioplasty. In all, the rapid aspirin desensitization protocol was successfully applied, allowing the use of the drug after the intervention without problems.

Treatment of Severe Atopic Dermatitis with a Combination of Subcutaneous Allergen Immunotherapy and Cyclosporin

PURPOSE: The clinical efficacy of subcutaneous allergen immunotherapy (SCIT) for the treatment of patients with severe atopic dermatitis (AD) using house dust mite (HDM) extract has been reported. Cyclosporin has been regarded as an effective medication for treatment of severe AD. In this study, we investigated a clinical usefulness of combined treatment with SCIT and cyclosporin in patients with severe AD. MATERIALS AND METHODS: Nine patients with severe AD and hypersensitivity to HDM were treated with a combination of SCIT using HDM extract and cyclosporin for 12 months. The primary efficacy outcome was the change in the standardized clinical severity scoring system for AD (SCORAD) values, measured at 6 and 12 months, in comparison with the values at baseline. Daily dose of cyclosporin was decreased or discontinued according to the degrees of clinical improvements in individual patients. RESULTS: In 8 patients who completed 12 months of treatment, the SCORAD values significantly decreased from 71.5+/-15.5 (mean+/-SD) at baseline to 20.4+/-14.6 at 6 months and 26.3+/-13.6 at 12 months (Wilcoxon signed-rank test, p=0.01), and no significant systemic side effects were observed. Cyclosporin was discontinued in 4 of 8 patients within 8 months after starting the combined treatment. CONCLUSION: In this study, combined treatment with SCIT and cyclosporin resulted in significant clinical improvements in patients with severe AD. Further studies are needed to test the clinical usefulness of this combined treatment for patients with severe AD.

Safety of Accelerated Schedules of Subcutaneous Allergen Immunotherapy with House Dust Mite Extract in Patients with Atopic Dermatitis

The safety of accelerated schedules of allergen immunotherapy (ASAI) in patients with bronchial asthma (BA) has been reported but there are little data on the safety of ASAI for patients with atopic dermatitis (AD). In this study, we investigated the safety of ASAI in patients with AD. Sixty patients with AD and 18 patients with BA sensitized to house dust mites (HDM) were studied. A maximum maintenance dose of HDM extract, adsorbed to aluminum hydroxide, was administered to patients by subcutaneous injection with either a 3-day protocol (rush immunotherapy) or 1-day protocol (ultra-rush immunotherapy). Systemic reactions were observed 4 of 15 patients (26.7%) with AD during rush immunotherapy, 13 of 45 patients (28.9%) with AD during ultra-rush immunotherapy, and 4 of 18 patients (22.2%) with BA during rush immunotherapy (P > 0.05). No severe or near fatal systemic reactions occurred in 78 subjects of this study. Systemic reactions developed within 4 hr after administration of the maximum allergen dose in 20 of 21 patients (95.2%) with AD and BA who showed systemic reactions during rush or ultra-rush immunotherapy. In conclusion, ASAI was safe and well tolerated in patients with AD. ASAI can be a useful therapeutic option for AD.

Factors associated with non-adherence to specific allergen immunotherapy in management of respiratory allergy.

Background. Non-adherence to specific allergen immunotherapy is a major hurdle faced by the allergist, contributing to poor clinical outcomes. Objectives. To assess the independent association of various factors with non-adherence to specific allergen immunotherapy. Methods. Fifty consecutive (non-adherent) and control (adherent) subjects receiving specific allergen immunotherapy were included in the study and various factors related to non-adherence including socio-demographic, clinical and immunotherapy related variables were compared between the two groups by univariate and multivariate analysis. Results. On univariate analysis, gender, allergic conjunctivitis, family history, progression of disease, perception of immunotherapy, medicine requirement, and the pattern of missed doses greater than two in the last 10, 20 and 30 doses were found to be significantly associated with non-adherence. On multivariate analysis, independent association was observed with allergic conjunctivitis, family history, perception of immunotherapy, missed doses greater than two in the last 10 doses of immunotherapy and medicine requirement. Conclusions. The independent factors associated with non-adherence may vary between different settings and countries. There is a need for developing individual case holding programmes to improve clinical outcomes in patients receiving specific allergen immunotherapy.

Inmunoterapia específica para enfermedades alérgicas respiratorias: estado de la cuestión de acuerdo a los metanálisis actuales / Specific inmunotherapy for respiratory allergy: state of the art according to current meta-analyses

Objetivos: evaluar la eficacia de la inmunoterapia alergeno especifica (IT)en el tratamiento del asma y la rinitis alérgica de niños y adultos, mediante el examen de diferentes metanálisis (MTA) realizados hasta la actualidad.

Efectos preventivos de la inmunoterapia sublingual en niños: un estudio abierto, aleatorizado y controlado / Preventive effects of sublingual immunotherapy in childhood: an open randomized controlled study

Objetivos. Evaluar los efectos clínicos y preventivos de la inmunoterapia sublingual (SLIT) con respecto a la aparición de asma persistente, nuevas sensibilizaciones, síntomas clínicos e hiperreactividad bronquial (HRB). Los objetivos secundarios fueron: evaluar la magnitud del efecto clínico y el efecto sobre la HRB; ver la seguridad y adhesión a la SLIT. Material y métodos: Participaron 216 niños, de ambos sexos, entre 5 y 17 años, pacientes del Hospital Cuasso al Monte, Varese, Italia, con rinitis alérgica de al menos 2 años de evolución, con o sin síntomas de asma intermitente, y con diagnóstico de etiología alérgica confirmado para ácaros, gramíneas, árboles y malezas. Se excluyeron pacientes con asma persistente o VEF1 <80%, uso previo de inmunoterapia, anormalidades anatómicas de las vías aéreas superiores, enfermedades sistémicas crónicas (malignas o autoinmunes) y sensibilizaciones a epitelios y hongos anemófilos. Para los diagnósticos de rinitis y asma se emplearon las guías actuales (ARIA, GINA). Se realizaron prick test con panel estándar de alérgenos relevantes (ALK Abelló), histamina 1% y control negativo al principio y al final del estudio. Las pruebas de función pulmonar consistieron en espirometría computarizada con cabina pletismográfica y prueba de provocación no específica con metacolina con dosis progresivas desde 30 a 1.290 µg, durante el período de máxima exposición alérgenica según sensibilidad de cada paciente, al inicio y al final del estudio. A los pacientes con prueba negativa (descenso del VEFI <20%) se los consederaba con diagnóstico de rinitis exclusivamente. El estudi tuvo un período basal de 1 año de observación y luego una fase de aleatorización de 3 años de tratamiento abierto con dos ramas. Un grupo de pacientes utilizó drogas exclusivamente, y otro grupo drogas más SLIT (con una distribución 1/2).

Inmunoterapia con veneno de himenópteros: presentación de diez casos clínicos / Immunotherapy against hymenoptera venom: Report of ten patients

Background: Immunotherapy can be used to treat allergic reactions to insect stings, specially bees and wasps. Aim: To report the experience with immunotherapy with aqueous extracts of hymenoptera venoms (bees and wasps). Material and methods: Ten patients aged 6 to 58 years were treated in an allergy center of a University Clinical Hospital. The medical indication for this treatment was, in all patients, anaphylactic reactions after hymenoptera stings. Immunotherapy was carried out using standardized vaccines (Aqueous extracts Venomvac LETI, Spain), applied in a traditional protocol, with subcutaneous injections. This protocol had two phases: a buildup phase (between weeks 1 and 13) and a monthly maintenance phase, from the 13th week. The monthly maintenance dose was 100 fig of hymenoptera specific venom extract. Results: Six patients had adverse reactions of different severity, during the treatment protocols and all had a good response to immediate therapeutic measures. After these events, they followed the protocol without problems. Two patients, treated with bee vaccines, suffered an accidental bee sting during the maintenance phase and they developed only local reactions. Conclusions: The lack of adverse reactions to bee stings in these two patients indicates the acquisition of clinical tolerance.

Quando devemos utilizar a dessensibilização tuberculínica / When we shall use tuberculin desensitizing therapy

Dessensibilização tuberculínica é uma das principais terapias para tuberculides. Alguns relatos de caso da doença referem apenas tratamento com drogas antituberculosas. Embora haja polêmica sobre o assunto, a dessensibilização tuberculínica possui importante papel nas reações de hipersensibilidade aos antígenos do bacilo e deve ser considerada sempre que pacientes tiverem diagnóstico de tuberculides. Este artigo descreve as indicações clínicas da dessensibilização, seu preparo, posologia nas diferentes formas de tuberculides e possíveis efeitos colaterais observados.

Anafilaxia por picadura de hormiga colorada: casos clínicos pediátricos. Importancia del diagnóstico y tratamiento / Anaphylaxis for sting of red ant: paediatric clinical cases. Importance of the diagnose and treatment

Debido a la alta incidencia de reacciones adversas a la picadura de la hormiga colorada (HC) en la ciudad de Villa María, sudeste de la provincia de Córdoba, Argentina, y a la escasa bibliografía respecto de su prevención y posterior tratamiento en pacientes pediátricos, el presente trabajo tuvo como objetivo demostrar la gravedad de las reacciones y su importancia clínica y diagnóstica en niños, para su prevención y tratamiento. Para ello fueron seleccionados pacientes pediátricos entre 5 y 10 años con clínica de anafilaxia grave a picadura de HC, con antecedentes personales y familiares de atopía o sin ellos. Los pacientes ingresaron al Servicio de Alergia de la Clínica FUSAVIM en el período comprendido entre enero de 2003 y julio de 2004. Fueron sometidos a ensayos in vivo e in vitro de sensibilización a picaduras de HC y dosaje de Inmunoglobulina E total. Los resultados obtenidos demostraron la importancia de la prevención y diagnóstico a través del Prick Test, y la seguridad y eficacia de la inmunoterapia con extractos de cuerpo entero de HC

Intranasal sensitization with Blomia Tropicalis antigens induces allergic responses in mice characterized by elevated antigen-specific and non-specific serum ige and peripheral blood eosinophil counts

Para avaliar a capacidade alergizante do antígeno da Blomia tropicalis (Bt) a produção de IgE específica e não específica a antígeno Bt foi monitorada em camundongos BALB/c após exposição ao antígeno por via nasal. Foi evidenciado que Bt contem um alérgeno funcional em seus componentes. Os componentes alergênicos entretanto, quando administrados por via intra-nasal, sem qualquer adjuvante, não induzem resposta IgE durante um pequeno período. Por outro lado, a inoculação intra-nasal de antígenos Bt aumentou a resposta sérica de IgE em camundongos pré-tratados por uma injeção inicial sensibilizante sub-cutânea aos mesmos antígenos. A inoculação do antígeno Bt sem as injeções sensibilizantes iniciais induziu a produção de anticorpos IgE somente quando o antígeno foi administrado de maneira contínua, por um período longo de mais de 24 semanas. Mesmo quando as injeções sensibilizantes iniciais foram ausentes, o antígeno Bt inoculado com a toxina de cólera (CT) como adjuvante mucoso também aumentou de maneira significante a resposta IgE antígeno específica do Bt dependendo da dose de CT administrada conjuntamente. O presente estudo também demonstrou que camundongos inoculados com antígeno Bt/CT mostram aumento do nível IgE não específico no soro e médias de eosinófilos no sangue periférico sem qualquer elevação da contagem total de leucócitos. A análise por Immunoblot demonstrou cinco principais componentes antigênicos reativos aos anticorpos IgE induzidos. Estes componentes na posição 44-64 kilodaltons foram considerados importantes antígenos-candidatos para o diagnóstico da alergia relacionada ao ácaro.

Avaliação do BCG como adjuvante na imunoterapia específica para asmáticos / Assessment of BCG as an adjuvant in specific immunotherapy in asthmatic patients

A falta de estímulos infecciosos é apontada como uma das causas do aumento de doenças alérgicas. Existem evidências de que a atopia teria como base a disfunção imune. Por ocasião da apresentação do antígeno citocinas são decisivas no tipo de resposta imune resultante. Num estudo randomizado duplo cego avaliamos a associação da vacina BCG com imunoterapia específica para o ácaro Dermatophagoides pteronyssinus em 21 pacientes asmáticos. Observamos após imunoterapia: melhora dos sintomas clínicos e da função pulmonar, redução da reatividade cutânea, da linfoproliferação com Dpt, aumento dos níveis da IgG especifica e da IL-10, nos dois grupos, com e sem BCG. Não houve diferença dentre eles. / Decreased exposure to infectious agents has been pointed as one of the factors involved in the increasing of allergic diseases. Immune dysfunction underlines atopy. Cytokines profile during antigen presentation is decisive to define immune response. Association of BCG vaccine with specific immunotherapy for Dermatophagoides pteronyssinus were assessed in double blind randomized study in 21 asthmatic patients. Improvement in clinical symptoms and in pulmonary function, reduction in cutaneous reactivity and in lymphoproliferation with Dpt extract and increase in specific IgG and IL-10 levels, were observed in both groups, with or without BCG. No difference were observed between groups...