Leguminosas como causa infrecuente de alergia alimentaria en Colombia: reporte de dos casos y revisión de la literatura / Legumes as an infrequent cause of food allergy in Colombia: report of two cases and review of the literature

La alergia alimentaria se ha venido incrementando a nivel mundial, afectando alrededor del 1,5 % a 2,5 % de los adultos y 6 % de los niños, y tiene un gran impacto en la calidad de vida de los pacientes y sus cuidadores, debido a las dietas de restricción. Los alérgenos más prevalentes son la leche, el huevo, el trigo, la soja, los frutos secos, el maní, el pescado y los mariscos. Las leguminosas mejor estudiadas son el maní y la soja; otras leguminosas como las lentejas, garbanzos y arvejas representan la quinta causa de alergia alimentaria en el área mediterránea, en Turquía y en la India, siendo menos prevalentes en otras áreas geográficas. La alergia a las leguminosas es una entidad infrecuente en Colombia, se desconoce la prevalencia en el país. Describimos los primeros dos casos de anafilaxia por lentejas reportados en el país. Ambos pacientes menores de 18 años, con reacciones adversas tras la ingesta de leguminosas, en las cuales se demuestra alergia mediada por IgE a las lentejas y además sensibilización en el primer caso a las arvejas y garbanzos, y en el segundo caso a los frijoles. Diferentes datos sobre la prevalencia se han descrito en varias áreas geográficas, siendo mayor en países con dietas mediterráneas. Las reacciones mediadas por IgE suelen aparecer incluso con el alimento altamente cocido, debido a la termo-estabilidad de las proteínas. La reactividad cruzada más frecuente se relaciona con los garbanzos y las arvejas

Food allergy has been increasing worldwide. Affects around 1.5% to 2.5% of adults and 6% of children, and has a great impact on the quality of life of patients and their caregivers, due to restricted diets. The most prevalent allergens are milk, egg, wheat, soy, tree nuts, peanuts, fish and shellfish. The best studied legumes are peanuts and soybeans; other legumes such as lentils, chickpeas and peas represent the fifth cause of food allergy in the Mediterranean area, Turkey and India, being less prevalent in other geographical areas. Allergy to legumes is not common in Colombia, the prevalence in the country is unknown. We describe the first two cases of legumes anaphylaxis reported in the country. Both patients were under 18 years of age, with adverse reactions after ingesting legumes, in which IgE-mediated allergy was demonstrated; in the first case to lentils, peas and chickpeas, and in the second case, to lentils and beans. Different data on prevalence have been described in various geographical areas, being higher in countries with Mediterranean diets. IgE-mediated reactions usually appear even with highly cooked food, due to the thermo-stability of proteins. The most frequent cross-reactivity is related to chickpeas and peas

Pediatric asthma: impact of the disease in children receiving outpatient treatment in southern brazil / Asma pediátrica: impacto da doença em crianças em acompanhamento ambulatorial no sul do brasil

ABSTRACT Objective: To evaluate the impact of pediatric asthma on patients of a specialized outpatient clinic in Southern Brazil. Methods: The study included children aged 8 to 17 years old with asthma diagnosis (mild, moderate and severe) under treatment at the asthma clinic of Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil. Measurements of spirometry, quality of life, disease control and atopy tests were applied. Results: A total of 66 children were included in the study and divided into groups, according to the severity of the disease: mild, moderate or severe asthma. The results showed similarities in both the treatment and the impact of asthma between groups, except for adherence to treatment: the group with mild asthma showed least adherence to treatment, and the group with severe asthma, greater adherence (p=0.011). As to school absenteeism, the group with severe asthma showed higher frequency (p=0.012), with over 10 days per year (p=0.043). Spirometry showed lower volume/capacity for the group with moderate asthma, followed by the groups with severe and mild asthma. All groups had a high prevalence of allergic asthma, with mites as the main allergens. For quality of life (QOL), and health-related quality of life (HRQOL) levels, there were no differences between groups. In addition, the values were close to the acceptable levels for the total score and for each one of the six domains. The same occurred for the HRQOL-asthma module. Conclusions: QOL and HRQOL present acceptable levels regardless of the severity of the disease.

RESUMO Objetivo: Avaliar o impacto da asma pediátrica de pacientes em acompanhamento ambulatorial em um centro de referência em pneumopediatria do Sul do Brasil. Métodos: Participaram do estudo crianças com idade entre oito e 17 anos, com diagnóstico de asma (leve, moderada e grave), em acompanhamento no ambulatório de asma do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS). Foram verificadas medidas de espirometria, avaliação dos níveis de qualidade de vida, controle da doença e teste de atopia. Resultados: Sessenta e seis crianças participaram do estudo, divididas em três grupos (asma leve, moderada e grave). Evidenciaram-se semelhanças tanto no tratamento quanto no impacto da asma, exceto para a adesão ao tratamento (p=0,011), em que o grupo de asma leve é o que menos adere e o grupo de asma grave o que mais adere ao tratamento. Em relação ao absenteísmo escolar, o grupo de asma grave apresentou o maior valor (p=0,012), com mais de dez dias/ano (p=0,043). As espirometrias demonstram menor volume/capacidade para o grupo de asma moderada, seguido do grupo de asma grave e asma leve. Os grupos possuem alta prevalência de asma alérgica, tendo os ácaros como os principais alérgenos. Quanto à qualidade de vida (QV) e à qualidade de vida relacionada à saúde (QVRS), não houve diferença entre os grupos. Além disso, os valores apresentados estão próximos aos níveis aceitáveis, tanto para o escore total quanto para os seis domínios analisados. O mesmo ocorre para o módulo QVRS-asma. Conclusões: Os níveis de QV e de QVRS demonstram-se aceitáveis, independentemente da gravidade da doença.

The relationship between atopy and neurological manifestations in HTLV-1 infection

Abstract INTRODUCTION: Human T-cell lymphotropic virus type 1 (HTLV-1)induces exaggerated Th1 responses, whereas atopy is associated with exacerbated Th2 responses. METHODS: Here, a cross-sectional study compared the prevalence of atopy in HTLV-1 carriers and HAM/TSP patients. It also compared the spontaneous cytokine production in HTLV-1-infected individuals. A retrospective cohort study evaluated the development of neurological manifestations in atopic and non-atopic carriers. RESULTS: Atopic HAM/TSP patients with high IFN-γ production exhibited higher IL-5 levels than non-atopic patients. Allergic rhinitis accelerated the development of Babinski signals and overactive bladders. CONCLUSIONS: Abnormal Th1 and Th2 responses coexist in HTLV-1-infected individuals and allergic diseases may worsen the clinical course of HTLV-1 infections.

Association between allergic responses and Schistosoma mansoni infection in residents in a low-endemic setting in Brazil

Introduction Schistosomiasis is endemic in 76 countries and territories. Several studies have found an inverse correlation between parasitic disease and the development of allergies. The purpose of the present study was to determine whether infection with Schistosoma mansoni in subjects with a low parasite load is protective against allergy. The final sample consisted of 39 S. mansoni-positive and 52 S. mansoni-negative residents of a small community in northeastern Brazil. Methods All subjects were submitted to the Kato-Katz test, anti-S. mansoni IgG measurement, the prick test for aeroallergens, eosinophil counts and serum IgE measurement. Results Subjects who reacted to one or more antigens in the prick test were considered allergic. Only 7 S. mansoni-positive subjects (17.9%) reacted to one or more antigens, whereas 20 S. mansoni-negative subjects (38.5%) tested positive for allergy. Conclusions Our findings suggest that, in areas of low endemicity, infection with S. mansoni significantly reduces the risk of the development of allergy in subjects with a low parasite load. .

Padrão alimentar, asma e sibilo atópico e não atópico em crianças e adolescentes: estudo SCAALA, Salvador, Bahia, Brasil / Dietary pattern, asthma, and atopic and non-atopic wheezing in children and adolescents: SCAALA study, Salvador, Bahia State, Brazil / Patrón dietético, asma y sibilancias atópicas y no atópicas en niños y adolescentes: estudio SCAALA, Salvador, Bahía, Brasil

Avaliou-se, em estudo transversal, a influência do padrão alimentar sobre a ocorrência de sibilo e asma atópica e não atópica em 1.168 crianças e adolescentes em Salvador, Bahia, Brasil. Sibilo e sintomas de asma nos últimos 12 meses foram obtidos por meio do questionário ISAAC. Atopia foi definida pela presença de IgE específica a aerolérgenos. Questionário de frequência alimentar foi usado para definir padrões alimentares. Empregou-se regressões logística e logística politômica multivariadas. O consumo de pescados reduziu a ocorrência de sibilo em 27% (IC95%: 0,56-0,94) e asma em 37% (IC95%: 0,47-0,83); asma não atópica em 51% (IC95%: 0,31-0,79) e sibilo não atópico em 38% (IC95%: 0,46-0,83). O maior tercil do padrão alimentar reduziu o sibilo em 27% (IC95%: 0,57-0,95), sibilo atópico em 46% (IC95%: 0,30-0,98), asma em 36% (IC95%: 0,49-0,83) e asma atópica em 50% (IC95%: 0,28-0,89). O consumo de pescados pode conferir efeito protetor para sibilo e asma não atópica e o padrão alimentar para sibilo e asma atópica.

A cross-sectional study was conducted on dietary patterns and their influence on the occurrence of wheezing and atopic and non-atopic asthma in a sample of 1,168 children and adolescents in Salvador, Bahia State, Brazil. Wheezing and asthma symptoms in the previous 12 months were obtained using the ISAAC questionnaire. The presence of aeroallergen-specific IgE was identified. A food frequency questionnaire was used to define dietary patterns. The study applied logistic regression and multinomial polytomous logistic regression. Fish consumption was associated with a 27% reduction in wheezing (95%CI: 0.56-0.94), 37% in asthma (95%CI: 0.47-0.83), 51% in non-atopic asthma (95%CI: 0.31-0.79), and 38% in non-atopic wheezing (95%CI: 0.46-0.83). The highest tertile of dietary patterns reduced wheezing by 27% (95%CI: 0.57-0.95), atopic wheezing by 46% (95%CI: 0.30-0.98), asthma by 36% (95%CI: 0.49-0.83), and atopic asthma by 50% (95%CI: 0.28-0.89). Fish consumption may thus have a protective effect against wheezing and non-atopic asthma and dietary pattern against atopic asthma and wheezing.

Este estudio transversal se llevó a cabo para estudiar la influencia de los hábitos alimentarios en la aparición del asma y sibilancias atópicas y no atópicas en una muestra de 1.168 niños y adolescentes en Salvador, Bahía, Brasil. Las sibilancias y síntomas de asma en los últimos 12 meses se han obtenido a partir del cuestionario ISAAC. Se identificó la presencia de IgE específica de alérgeno aéreo. Se utilizó un cuestionario de frecuencia de alimentos para definir hábitos alimentarios. Se aplicó la regresión logística y el modelo logístico multinomial. El consumo de pescado redujo las sibilancias en un 27% (IC95%: 0,56-0,94) y el asma en un 37% (IC95%: 0,47-0,83), las sibilancias atópicas en un 51% (IC95%: 0,31-0,79) y no atópicas en un 38% (IC95%: 0,46-0,83). El tercil más alto de los hábitos alimentarios reduce sibilancias en un 27% (IC95%: 0,57-0,95), sibilancias atópicas en un 46% (IC95%: 0,30-0,98), el asma en un 36% (IC95%: 0,49-0,83) y un 50% en el asma atópico (IC95%: 0,28-0,89). El consumo de pescado puede promover un efecto protector, dentro el patrón de dieta, contra sibilancias atópicas y no atópicas y asma.

Murciélagos y ácaros en la alergia respiratoria / Bats and house-dust mites in respiratory allergy

Se valoró la posibilidad de que estos mamíferos ingirieron ácaros del hábitat (dermatophagoides pteronyssinus), y que sus antígenos formaran parte de las heces del murciélago (murcielaquina), y resultaren indirectamente alergénicos para los pacientes atópicos que habían revelado hipersensibilidad a dichas heces...

The possibility that house-dust mite antigens coming from dermatophagoides pteronyssinus were hidden in bat feces was studied in those atopic patients suffering rhinitis and asthma that revealed hypersensibility to bat feces...

Estudo longitudinal do efeito do tratamento, com drogas anti-helmínticas, sobre os níveis de anticorpos IgE anti-Dermatophagoides pteronyssius (Der p1) e anti-antígeno bruto de Ascaris lumbricoides, em indivíduos portadores de infecção por helmintos

No presente trabalho investigou-se a relação entre infecções por geohelmintos e S. mansoni e os fatores de risco para alergia em duas áreas endêmicas com diferentes prevalências de infecção e co-infecção. A intensidade das infecções, eosinofilia,fatores de risco para alergia, co infecção e os níveis de IgE anti-Der p 1 e antiAscarisantes e 2 anos (população 1) e 3 anos (população 2) após o tratamento com drogas anti-helmínticas foram avaliados. Observou-se que na população com baixa prevalência e intensidade de infecção (população 2) apresentou menor contagem de eosinófilos (>600/mm3) e maior contato com animais do que a população com alta prevalência e intensidade de parasitos (população 1). Após o tratamento a intensidade da infecção por S. mansoni diminuiu, mas não foram observadas mudanças nos indivíduos infectados por geohelmintos ou co-infectados. Na população 1, o tratamento anti-helmíntico aumentou os níveis de densidade óptica pelo método de ELISA de IgE anti-Der p1 e anti-Ascaris nos subgrupos que se tornaram negativos para infecção helmíntica independente da condição prévia ao tratamento. Diante disso, avaliou-se o index de reatividade de IgE anti-Der p1, e a razão (após/antes tratamento) foi significativamente maior em pacientes coinfectados antes do tratamento. Por outro lado, nenhuma associação entre o index de reatividade de IgE anti-Der p1 e a intensidade foram observados. Conclui-se que o tratamento antihelmíntico de indivíduos de áreas endêmicas com alta prevalência para infecções por geohelmintos e S.mansoni aumenta os níveis de IgE anti-Der p1e que há uma correlação direta entre os níveis de IgE anti-Der p1 com os níveis de IgE e anti- Ascaris, mostrando que altos níveis de IgE anti- Ascaris e não somente a infecção, é um fator de risco para o desenvolvimento de doenças alérgicas.

Prevalence of allergen sensitization, most important allergens and factors associated with atopy in children / Prevalencia de sensibilizacao a alergenos, alergenos mais relevantes e fatores associados com a atopia em criancas

CONTEXT AND OBJECTIVE: Knowledge of the profile of allergen sensitization among children is important for planning preventive measures. The objective of this study was to assess the prevalence and profile of sensitization to inhaled allergens and food among children and adolescents in an outpatient population in the city of Palmas. DESIGN AND SETTING: Cross-sectional study at outpatient clinics in Palmas, Tocantins, Brazil. METHODS: Ninety-four patients aged 1-15 years who were attending two pediatric outpatient clinics were selected between September and November 2008. All of the subjects underwent clinical interviews and skin prick tests. RESULTS: A positive skin prick test was observed in 76.6% of the participants (72.3% for inhalants and 28.9% for food allergens). The most frequent allergens were Dermatophagoides pteronyssinus (34%), cat epithelium (28.7%), dog epithelium (21.3%), Dermatophagoides farinae (19.1%), Blomia tropicalis (18.1%), cow's milk (9.6%) and grasses (9.6%). A positive skin prick test correlated with a history of atopic disease (odds ratio, OR = 5.833; P = 0.002), a family history of atopic disease (OR = 8.400; P < 0.001), maternal asthma (OR = 8.077; P = 0.048), pet exposure (OR = 3.600; P = 0.012) and cesarean delivery (OR = 3.367; P = 0.019). CONCLUSION: Dermatophagoides pteronyssinus was the most frequent aeroallergen and cow’s milk was the most prevalent food allergen. There was a positive correlation between a positive skin prick test and several factors, such as a family history of atopic disease, maternal asthma, pet exposure and cesarean delivery. .

CONTEXTO E OBJETIVO: O conhecimento sobre o perfil da sensibilização a alérgenos em crianças é importante para o planejamento de medidas preventivas. O objetivo deste estudo foi avaliar a prevalência e perfil de sensibilização a alérgenos inalados e alimentares em crianças e adolescentes em uma população ambulatorial na cidade de Palmas. TIPO DE ESTUDO E LOCAL: Estudo transversal em unidades ambulatoriais em Palmas, Tocantins, Brasil. MÉTODOS: Foram selecionados 94 pacientes com idades entre 1 a 15 anos em 2 ambulatórios de pediatria entre setembro e novembro de 2008. Todos os sujeitos foram submetidos a entrevistas clínicas e testes cutâneos de puntura. RESULTADOS: Um teste cutâneo de puntura positivo foi observado em 76,6% dos participantes (72,3% para inalantes, 28,9% para alérgenos alimentares). Os alérgenos mais frequentes foram Dermatophagoides pteronyssinus (34%), epitélio de gato (28,7%), epitélio de cão (21,3%), Dermatophagoides farinae (19,1%), Blomia tropicalis (18,1%), leite de vaca (9,6%) e gramíneas (9,6%). Um teste cutâneo de puntura positivo foi relacionado à história de doença atópica (razão de chances RC = 5,833, P = 0,002), história familiar de atopia (RC = 8,400, P < 0,001), asma materna (RC = 8,077, P = 0,048), exposição a animal de estimação (RC = 3,600, P = 0,012) e parto cesáreo (RC = 3,367, P = 0,019). CONCLUSÃO: Dermatophagoides pteronyssinus foi o aeroalérgeno mais prevalente e, dentre alérgenos alimentares, o leite de vaca. Houve correlação positiva entre o teste cutâneo e alguns fatores, como história familiar de atopia, asma materna, exposição a animais domésticos e parto cesáreo. .

Estudo longitudinal do efeito do tratamento, com drogas anti-helmínticas, sobre os níveis de anticorpos IgE anti-Dermatophagoides pteronyssius (Der p1) e anti-antígeno bruto de Ascaris lumbricoides, em indivíduos portadores de infecção por helmintos / Longitudinal study of the effect of treatment with anthelmintic drugs on levels of anti-IgE antibodies pteronyssius Dermatophagoides (Der p1) and crude anti-antigen of Ascaris lumbricoides, in individuals with helminth infection

No presente trabalho investigou-se a relação entre infecções por geohelmintos e S. mansoni e os fatores de risco para alergia em duas áreas endêmicas com diferentes prevalências de infecção e co-infecção. A intensidade das infecções, eosinofilia,fatores de risco para alergia, co infecção e os níveis de IgE anti-Der p 1 e antiAscarisantes e 2 anos (população 1) e 3 anos (população 2) após o tratamento com drogas anti-helmínticas foram avaliados. Observou-se que na população com baixa prevalência e intensidade de infecção (população 2) apresentou menor contagem de eosinófilos (>600/mm3) e maior contato com animais do que a população com alta prevalência e intensidade de parasitos (população 1). Após o tratamento a intensidade da infecção por S. mansoni diminuiu, mas não foram observadas mudanças nos indivíduos infectados por geohelmintos ou co-infectados. Na população 1, o tratamento anti-helmíntico aumentou os níveis de densidade óptica pelo método de ELISA de IgE anti-Der p1 e anti-Ascaris nos subgrupos que se tornaram negativos para infecção helmíntica independente da condição prévia ao tratamento. Diante disso, avaliou-se o index de reatividade de IgE anti-Der p1, e a razão (após/antes tratamento) foi significativamente maior em pacientes coinfectados antes do tratamento. Por outro lado, nenhuma associação entre o index de reatividade de IgE anti-Der p1 e a intensidade foram observados. Conclui-se que o tratamento antihelmíntico de indivíduos de áreas endêmicas com alta prevalência para infecções por geohelmintos e S.mansoni aumenta os níveis de IgE anti-Der p1e que há uma correlação direta entre os níveis de IgE anti-Der p1 com os níveis de IgE e anti- Ascaris, mostrando que altos níveis de IgE anti- Ascaris e não somente a infecção, é um fator de risco para o desenvolvimento de doenças alérgicas...

Exhaled Nitric Oxide is Associated with Allergic Inflammation in Children

Exhaled nitric oxide (eNO) has been proposed as a noninvasive marker of airway inflammation in asthma. In asthmatic patients, exhaled NO levels have been shown to relate with other markers of eosinophilic recruitment, which are detected in blood, sputum, bronchoalveolar lavage fluid and bronchial biopsy samples. The purpose of this study was to assess the possible relationship between eNO and allergic inflammation or sensitization in childhood asthma and allergic rhinitis. Subjects consisted of 118 asthmatic children, 79 patients with allergic rhinitis, and 74 controls. Their age ranged from 6 to 15 yr old. eNO level, peripheral blood eosinophil count, eosinophil cationic protein (ECP), serum total IgE level and specific IgE levels were measured. Methacholine challenge test and allergic skin prick test for common allergens were performed in all subjects. Atopic group (n = 206, 44.48 +/- 30.45 ppb) had higher eNO values than non-atopic group (n = 65, 20.54 +/- 16.57 ppb, P < 0.001). eNO level was significantly higher in patients with asthma (42.84 +/- 31.92 ppb) and in those with allergic rhinitis (43.59 +/- 29.84 ppb) than in healthy controls (27.01 +/- 21.34 ppb, P < 0.001) but there was no difference between asthma and allergic rhinitis group. eNO also had significant positive correlations with Dermatophagoides pteronyssinus IgE level (r = 0.348, P < 0.001), Dermatophagoides farinae IgE level (r = 0.376, P < 0.001), and the number of positive allergens in skin prick test (r = 0.329, P = 0.001). eNO had significant positive correlations with peripheral blood eosinophil count (r = 0.356, P < 0.001), serum total IgE level (r = 0.221, P < 0.001), and ECP (r = 0.436, P < 0.001). This study reveals that eNO level is associated with allergic inflammation and the degree of allergic sensitization.

Asthma cases in childhood attributed to atopy in tropical area in Brazil / Asma infantil atribuida a atopia en la zona tropical de Brasil

OBJECTIVE: This study aimed to explore the association between asthma and atopy in a cohort of children living in a large urban center in Brazil. Atopy was defined by the presence of allergen-specific IgE in serum or by a positive skin prick test. METHODS: In a sample of 1 445 Brazilian children, the association between the prevalence of asthma, skin prick test positivity, and allergen-specific IgE in serum was investigated. RESULTS: The prevalence of asthma was 22.6 percent. The presence of serum allergen-specific IgE was frequent in asthmatics and nonasthmatics, and the prevalence of asthma increased only with levels of allergen-specific IgE > 3.5 kilounits/L. The proportion of asthma attributable to atopy was estimated to be 24.5 percent when atopy was defined by the presence of allergen-specific IgE. With a given level of specific IgE, no association between skin test reactivity and asthma was observed. Skin prick tests were less sensitive than specific IgE for detection of atopy. CONCLUSIONS: Most asthma cases in an urban underprivileged setting in Brazil were not attributable to atopy. This observation has important implications for understanding the risk factors for the asthma epidemic in Latin America.

OBJETIVO: Explorar la relación entre el asma y la atopia en una cohorte de niños que viven en un gran centro urbano de Brasil. En este estudio, se considera atopia la detección de IgE sérica específica de algún alérgeno o un resultado positivo a la prueba de punción cutánea. MÉTODOS: Se estudió la relación entre la prevalencia del asma, el resultado positivo a la prueba de punción cutánea y la detección de IgE sérica específica de algún alérgeno en una muestra de 1 445 niños brasileños. RESULTADOS: El asma registró una prevalencia de 22,6 por ciento. La presencia de IgE séricas específicas de alérgenos fue frecuente tanto en los asmáticos como en los no asmáticos, y la prevalencia del asma fue mayor solo cuando el valor detectado de la IgE específica del alérgeno era > 3,5 kilounidades/litro. Se calculó que la atopia definida como la detección de IgE específicas de alérgenos es responsable de 24,5 por ciento de los casos de asma. No se observó ninguna relación entre la reactividad a la prueba de punción cutánea y el asma en función de los valores de IgE específicas. La prueba de punción cutánea es menos sensible que la detección de IgE específicas en lo que respecta al diagnóstico de atopia. CONCLUSIONES: La mayoría de los casos de asma que se registran en entornos urbanos desfavorecidos de Brasil no son atribuibles a atopia. Esta observación tiene implicaciones importantes en lo que respecta a la comprensión de los factores de riesgo que predisponen a la epidemia de asma en América Latina.

Neuropéptidos, estrés y alergia / Neuropeptides, stress and allergy

Histophysiological and biochemical data are exposed supporting the close connection between the central nervous system (cortex limbic system hypothalamus hypophysis) and the endocrine one. Evidences that some neural peptides (opioid neuropeptides: ONP) have specific receptors in immune cells and on the other hand that these cells produce cytokines that influence the neurons are described. It seems reasonable that under acute or chronic stress situations both systems strongly interconnected to maintain the homeostasis. The acute stress influences the innate immune response meanwhile the chronic one seems to affect the adaptative or acquired mechanism specially at the cytotoxic level. Allergic patients are deeply worsened by acute and chronic stress considering that the mastocytes are the tarjet of numerous cytokines and ONP released during the unpleasant events. So, we recommend peace in the mind, faith in the heart and work in the hands.

Laboratorial atopy markers in children with human immunodeficiency virus

Changes in immune system functions are one of the most important consequences of human immunodeficiency virus (HIV) infection. Studies have reported a higher prevalence of disease mediated by immunological hypersensitivity mechanisms in HIV-positive patients. This study aims to observe how immunological changes in HIV-infected children interfere in atopy determinants. Fifty-seven HIV-positive children were studied between June 2004-August 2005 to evaluate the possible modifications in atopy diagnosis from prick test environmental allergen reactivity. Patients were subjected to two evaluations: on both occasions, atopic and non-atopic groups were correlated with immunological (CD4+ and CD8+ lymphocyte concentrations and serum levels of IgA, IgM, IgG and IgE) and viral parameters (HIV viral load). The percent atopy was 20.05 in the first and 29.82 in the second evaluation and atopy was diagnosed in patients without immunosuppression or with moderate immunosuppression. Six patients changed from a negative to a positive atopy profile. One patient with a decreased CD4+ T lymphocyte concentration failed to demonstrate prick test positivity between evaluations. Multivariate analysis showed that the variables associated with atopy diagnosis included a personal history of allergic diseases as well as elevated IgE for age and elevated IgE levels. Atopy development in HIV-infected children seems to be modulated by genetic and environmental factors as well as immunological condition.

Prevalência de aspergilose broncopulmonar alérgica em pacientes com fibrose cística na Bahia, Brasil / Prevalence of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis in the state of Bahia, Brazil

OBJETIVO: Determinar a prevalência de aspergilose broncopulmonar alérgica (ABPA) em pacientes com fibrose cística acompanhados em um centro de referência da Bahia. MÉTODOS: Estudo transversal, com coleta prospectiva de dados, realizado no Centro de Referência de Fibrose Cística da Bahia do Hospital Especializado Octavio Mangabeira. Foram incluídos no estudo 74 pacientes que tinham diagnóstico de fibrose cística, com idade acima de 6 anos e tratados entre 9 de dezembro de 2003 e 7 de março de 2005. Foram analisadas as seguintes variáveis: gênero, idade, capacidade vital forçada, volume expiratório forçado no primeiro segundo, resposta a prova farmacodinâmica, achados em radiografia torácica e de seios de face, presença de sibilância, culturas para Aspergillus spp., imunoglobulina E (IgE) total, IgE específica para Aspergillus fumigatus e teste cutâneo de leitura imediata para aspergilina. RESULTADOS: Dos 74 pacientes, 2 foram diagnosticados com ABPA. Níveis de IgE total > 1.000 UI/mL foram observados em 17 pacientes (23%), teste cutâneo de leitura imediata para A. fumigatus positivos em 19 (25,7%) e sibilância em 60 (81,1%). CONCLUSÕES: A taxa de prevalência de ABPA foi de 2,7%. As altas taxas de IgE total, de teste cutâneo imediato para A. fumigatus positivos e de sibilância sugerem que estes pacientes devam ser acompanhados cuidadosamente por haver a possibilidade do desenvolvimento de ABPA.

OBJECTIVE: To determine the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis treated at a referral center in the state of Bahia, Brazil. METHODS: A cross-sectional study, with prospective data collection, carried out at the Cystic Fibrosis Referral Center of Bahia of the Octavio Mangabeira Specialized Hospital. We evaluated 74 patients diagnosed with cystic fibrosis, older than six years of age, treated between December 9, 2003 and March 7, 2005. We analyzed the following variables: gender, age, forced vital capacity, forced expiratory volume in one second, pharmacodynamic response, chest X-ray findings, facial sinus X-ray findings, wheezing, cultures for Aspergillus spp., total immunoglobulin E (IgE), specific IgE for Aspergillus fumigatus and immediate skin test reactivity to A.fumigatus antigen. RESULTS: Of the 74 patients, 2 were diagnosed with ABPA. We found total IgE levels > 1,000 IU/mL in 17 (23%), positive immediate skin reactivity to A. fumigatus antigen in 19 (25.7%) and wheezing in 60 (81.1%). CONCLUSIONS: The prevalence of ABPA was 2.7%. The high levels of total IgE, high incidence of wheezing and high rate of immediate skin test reactivity to A. fumigatus antigen suggest that these patients should be carefully monitored due to their propensity to develop ABPA.

Expression of CD38 and CXCR3 in children with atopic dermatitis

Atopic dermatitis [AD] is a chronic or chronically relapsing inflammatory skin disease with a prevalence ranging from 10% to 20% in children of developed countries. Skin-infiltrating leukocytes play a pivotal role in the initiation and amplification of atopic skin inflammation. The cytokines produced by T helper-,2 [Th2] cells are crucial factors in the induction and maintenance of the disease. to study the percentage of expression and mean fluorescence intensity[ MFI] of the activation marker CD38 and the chemokine receptor CXCR3 on peripheral blood CD3+ lymphocytes in children with atopic dermatitis. Also total serum IgE and absolute differential count were evaluated .This might be targets for therapy in disease. This study was conducted on thirty cases of AD children. Their age range was 3- 10 years. Also non atopic fifteen children age and sex matched with disease group were included as a control group. The percentage of expression of the CD38, CXCR3 and MFI were analyzed by flow- cytometry on peripheral blood CD3+ T lymphocytes. Also total serum IgE levels was measured by immunonephelometry. The absolute eosinophil, absolute lymphocytes, absolute neutrophil count were evaluated. The mean percentage of CD38 expression on CD3 + lymphocytes and MFI were 70.5% and 5.8 respectively in AD children compared with 17.8% and 5.1 in non -atopic children healthy control [p < 0.01 and p > 0.05 respectively]. The mean percentage of CXCR3 expression on CD3+ T lymphocytes and MFI in AD children were 17.9% and 2.9 respectively compared with 67.93%and 3.3 in healthy controls [p < 0.01 and p > 0.05 respectively]. The mean of the total serum IgE in the patient group was 199.3 lU/ml compared with 62.27 lU/ml in-non-atopic children [p < 0.01]. These results suggest that there is a relation between atopic conditions and an increase in peripheral blood T lymphocyte expressing CD38% and decrease expression of CXCR3%.The presence of high expression of CD38 in atopic patients seems to confirm the role of this molecule as an activation marker useful for evaluation of Th2 immune response. whereas CXCR3-expression on CD3+ lymphocytes decreased in AD than normal control as the chemokine receptor profile determine the migratory patterns of leukocytes. These results may suggest the dysbalance between Th1/ Th2 in AD patients

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.

Controvérsias na associação entre diabetes mellitus tipo 1 e asma / Controversies in the association between type 1 diabetes and asthma

OBJETIVO: Revisão crítica da literatura sobre a associação entre asma e diabetes mellitus tipo 1 (DM1). FONTE DOS DADOS: Pesquisa bibliográfica na base de dados MEDLINE e LILACS nos últimos vinte anos. SíNTESE DOS DADOS: Muitos estudos mostram associação inversa entre asma, atopia e o risco de desenvolver DM1. De acordo com a "Hipótese da Higiene", o risco de doenças alérgicas diminui com infecções precoces na infância no sentido de afastar-se do perfil Th2, predominante ao nascimento, em direção ao fenótipo Th1. No entanto, outros trabalhos demonstram associação positiva ou ausência de associação entre DM1 e alergias. Existe a possibilidade de fatores ambientais contribuírem para ocorrência de doenças mediadas por células Th1 e Th2 no mesmo indivíduo, por provável deficiência de mecanismos imunomodulatórios mediados pela interleucina-10 e células regulatórias. CONCLUSÃO: As informações sobre a associação inversa entre doenças mediadas por resposta Th1 (por exemplo, DM1), e aquelas mediadas por resposta Th2 (por exemplo, alergias) são conflitantes, requerendo mais estudos para esclarecer esta questão.

OBJECTIVE: Critical review of the literature to investigate the relationship between asthma and type 1 diabetes mellitus (DM1). SOURCE OF DATA: Bibliography search in MEDLINE and LILACS databases in the last twenty years. SUMMARY OF DATA: Several studies demonstrate an inverse relationship between asthma, atopic diseases and the risk to develop DM1. According to the "Hygiene Hypothesis", the risk of allergic diseases decreases with infections early in childhood, towards distance of Th2 profile, common at birth, to the Th1 phenotype. Other articles described lack of association or positive association between DM1 and allergies. There is a possibility of environmental factors interfering in the development of disorders mediated by Th1 and Th2 cells, in the same individual, due to the absence of immunomodulatory mechanisms mediated by interleukin-10 and regulatory cells. CONCLUSION: The existing information about the inverse association between Th1-mediated diseases (e.g., DM1), and those that are Th2-mediated (e.g., allergies) are conflicting requiring more investigation to explain this question.

Determinación de sensibilización alérgica a dermatofagoides en niños de 5 años y menores por fluoroinmuno ensayo-UniCAP / Dust mite allergic sensitization in children aged 1 month to 5 years-old using specific IgE determination by unicap fluoroimmunoassay

Dust mite sensitization is considered a major risk factor for pediatric asthma; however, there are few data about early sensitization in Chilean children available. This study aimed to investigate allergic sensitization to mites in infancy and early childhood. The patient population, 224 children aged 0 to 5 years with suspected respiratory allergy, was divided into 3 groups of age: 1 to 12 months-old, 13 to 35 months-old, and 3 to 5 years-old. Sensitization status was ascertained by assessing the specific IgE to mite by UniCAP fluoroimmunoassay (Pharmacia). Sixty eight (30.6 percent) patients were sensitized to mites. The frequency and level of sensitization increased with the age of the children. Our data support that avoidance measures in the domestic environment aimed at the primary prevention of mite-driven sensitization should be introduced at the earliest possible stage.

La sensibilización a dermatofagoides es un factor de riesgo para el desarrollo de asma. Hay escasa información sobre la sensibilización temprana en niños chilenos. Objetivo: Investigar la sensibilización a dermatofagoides en niños de 5 años y menores. Método: Revisión de resultados de IgE específica por ensayo UniCAP (Pharmacia) contra dermatofagoides de niños de hasta 5 años con sospecha de alergia respiratoria, divididos en 3 grupos de edad: 1-12 meses, 13-35 meses y 3-5 años. Resultados: Se estudió un total de 224 niños, entre 1 mes y 5 años de edad (x 2,65 años +/- 1,48 DS), 57,1 por ciento de sexo masculino. Su distribución según grupo etario fue: 66 en el grupo 1; 45 en el grupo 2 y 113 en el grupo 3. El 30,6 por ciento presentó sensibilización a dermatofagoides (18,2 por ciento grupo 1; 33,3 por ciento grupo 2 y 36,3 por ciento grupo 3). El grupo 3 presentó concentraciones de IgE específica significativamente más elevadas que los otros grupos. Conclusiones: La sensibilización a dermatofagoides es detectable en menores de un año, con frecuencia y nivel que aumentan en forma paralela a la edad.

Inter-relação entre asma, atopia e infecções helmínticas / Interrelationship among asthma, atopy, and helminth infections

Este estudo teve como objetivo descrever as principais evidências encontradas na literatura acerca da inter-relação entre infecções helmínticas, atopia e asma. Foi feita uma revisão não sistemática da literatura. Encontramos numerosas publicações sobre o tema nas quais se verifica controvérsia quanto à capacidade das infecções por geohelmintos de inibir a reatividade ao teste alérgico cutâneo e os sintomas das doenças alérgicas. Por outro lado, estudos em pacientes infectados por Schistosoma spp., apesar de escassos, sugerem que estes helmintos são capazes de inibir a reatividade ao teste alérgico cutâneo e os sintomas de asma. Nos estudos in vitro, as evidências sugerem que as helmintíases inibem as respostas imunes mediadas por linfócitos T auxiliares do tipo 1 e 2, o que abre novas possibilidades terapêuticas para o tratamento de doenças do sistema imunológico.

To describe the principal evidence in the literature regarding the interrelationship among helminth infections, atopy, and asthma, a nonsystematic review of the literature was conducted. Among the publications on the subject, we found a number in which there was controversy regarding the capacity of geohelminth infections to inhibit responsiveness to skin allergy tests and to minimize the symptoms of allergic diseases. However, although small in number, studies of patients infected with Schistosoma spp. suggest that these helminths can inhibit the responsiveness to skin allergy testing and minimize asthma symptoms. Evidence provided by in vitro studies suggests that helminthiases inhibit T helper 1- and T helper 2-type immune responses. This opens new therapeutic possibilities for the treatment of immune system diseases.

Allergic Asthma and Rhinitis Caused by Household Rabbit Exposure: Identification of Serum-Specific IgE and Its Allergens

Although rabbits are common domestic pets, severe respiratory allergic reactions to rabbits in households are unusual. Ory c 1, a 17-kDa glycoprotein found in saliva and fur, has previously been identified as a major rabbit allergen. In this report, we describe the cases of three patients with rabbit allergy who presented with asthma and/or rhinitis while living in households with detectable levels of serum-specific IgE and major IgE binding components. Three patients with rabbit allergy and 18 unexposed nonatopic healthy controls were enrolled. Enzyme-linked immunosorbent assays (ELISA) for serum-specific IgE and IgG4 to rabbit epithelium and inhibition ELISA were performed followed by sodium dodecye sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and IgE immunoblotting. All three patients with rabbit allergy had high serum-specific IgE antibody levels compared with controls. The results of the inhibition ELISA showed significant inhibition with the addition of rabbit epithelium, whereas no significant inhibition was noted with the addition of cat and dog epithelia. Two IgE-binding components with molecular weights of 16 kDa and 67.5 kDa were identified by IgE immunoblotting. In conclusion, rabbit exposure may induce IgE-mediated bronchial asthma and/or rhinitis in domestic settings.