Assessment of cytotoxicity, genotoxicity, and mutagenicity of the dexchlorpheniramine reference standard and pharmaceutical formula in human peripheral blood mononuclear cells

Abstract Dexchlorpheniramine is a first-generation classical antihistamine, clinically used to treat allergies. The main objective of our study was to evaluate the effects of the dexchlorpheniramine reference standard (DCPA Ref. St) and a pharmaceutical formula on DNA in human peripheral blood mononuclear cells (PBMCs). We exposed PBMCs to five different concentrations (0.5, 2.5, 5, 10, and 50 ng/mL) of DCPA Ref. St DCPA Ref. St and pharmaceutical formula in order to evaluate their cytotoxic, genotoxic, and mutagenic potential. The results showed that both dexchlorpheniramine formulations did not affect PBMC viability and CD3+, CD4+, or CD8+ lymphocyte subpopulations. The DCPA Ref. St and pharmaceutical formula neither induced genotoxic or mutagenic effects nor numerical or structural chromosomal alterations in PBMCs after 24 hours of exposure.

Clonagem, expressão recombinante e validação por microarray de proteínas alimentares potencialmente alergênicas / Cloning, recombinant expression and validation by microarray of potentially allergenic food proteins

A maioria das respostas alérgicas a alimentos é mediada por IgE, que pode ser detectada para fins de diagnóstico da alergia alimentar. No entanto, para isso é necessário que alérgenos purificados estejam disponíveis para a elaboração dos diferentes formatos de ensaio, inclusive por microarray, que se constitui em uma ferramenta bastante útil para análise simultânea, e também para a identificação de reatividade cruzada. A esse respeito, é imprescindível ampliar a plataforma de alérgenos que possam ser empregados para a confecção de microarrays. Atualmente, alguns alimentos que constituem objeto de interesse na clínica em função do número de casos de alergia, e sobre os quais as informações a respeito dos alérgenos são escassas, são: abacaxi, mamão, mandioca e manga. Assim, o objetivo desse trabalho foi clonar, expressar e purificar proteínas potencialmente alergênicas de alimentos de importância regional. Após confirmadas por ensaios imunológicos, essas proteínas foram utilizadas na construção e validação de um microarray através de ensaios com os soros de pacientes alérgicos aos alimentos selecionados. Para atingir esse objetivo, foram selecionadas proteínas potencialmente alergênicas coincidentes, apontadas tanto pela similaridade com espécies taxonomicamente mais próximas, quanto pela técnica 2D Western Blotting acoplada à espectrometria de massas. Dezenove proteínas, sendo 4 de abacaxi, 5 de mamão, 6 de mandioca e 4 de manga, foram expressas em Pichia pastoris, purificadas e impressas em um microarray. Após incubar essas proteínas com os soros dos pacientes alérgicos aos alimentos estudados, 18 proteínas mostraram-se potencialmente alergênicas. Além disso, foi observada reatividade cruzada entre proteínas dos alimentos estudados e também em relação ao látex e outros frutos

The majority of allergic reactions to foods is IgE-mediated, which can be detected for the diagnosis of food allergy. However, purified allergens are necessary to produce different kinds of allergy tests, including microarray, which is a useful tool for simultaneous analysis, as well as for the identification of cross-reactivity. In this respect, it is essential to expand the platform of allergens to include them on microarrays. Nowadays, some foods that are object of interest in the clinical area in Brazil and it is necessary a further evaluation about their potential allergens, since there is a limited information about them, are: pineapple, papaya, cassava and mango. Therefore, the aim of this study was cloning, expressing and purifying potentially allergenic proteins of important Brazilian foods. After confirmed by immunological tests, these proteins were used in microarray production and validation by assays with sera from allergic patients to the selected foods. Achieving this goal, matching potentially allergenic proteins were selected, which were identified by comparison among taxonomically closer species (in silico) and 2D Western Blotting coupled with Mass Spectrometry. Nineteen proteins: 4 from pineapple, 5 from papaya, 6 from cassava and 4 from mango were expressed in Pichia pastoris, purified and printed on a microarray. After incubating those proteins with sera from allergic patients to the selected foods, 18 proteins were detected as potentially allergenic. In addition, cross-reactivity was observed among the proteins from the studied foods, and also regarding to the latex and other fruits

Penicillin desensitization in allergic pregnant women with syphilis. Report of two cases / Desensibilización a penicilina en mujeres embarazadas alérgicas. Informe de dos casos

ABSTRACT Syphilis during pregnancy has a high risk of congenital transmission with disastrous fetal consequences. Penicillin (PNC) is the only effective antimicrobial for the treatment of pregnant women with syphilis. Chilean guidelines do not consider desensitization to PNC in these women. We report two cases of pregnant women aged 32 and 23 years, with immediate allergy to PNC and syphilis who were safely and successfully desensitized using a four-hour intravenous protocol in the critical care unit and who subsequently received benzathine G PNC. An electronic survey was conducted among approximately 100 Clinical Pharmacists (CP) in the country. Of these, 16 answered and 13 reported having experience in drug desensitization, in at least five cases with PNC and none reported deaths or cardiorespiratory arrest. Desensitization to PNC can be carried out safely and in Chile, this alternative should be incorporated to the management of pregnant women with syphilis and immediate allergy to PNC, instead of using erythromycin.

La sífilis durante el embarazo tiene un alto riesgo de transmisión congénita con consecuencias desastrosas para el feto. La penicilina (PNC) es el único compuesto efectivo para el tratamiento de sífilis en una mujer embarazada.. En Chile, ante alergias de tipo inmediata, no se considera la desensibilización a la PNC en mujeres embarazadas por norma ministerial. Se comunican dos casos de mujeres embarazadas con alergia tipo inmediata y sífilis durante la gestación que fueron desensibilizadas a este compuesto con un protocolo endovenoso de 4 horas en la unidad de pacientes críticos, sin observar complicaciones, recibiendo posteriormente PNC G Benzatina. Se efectuó una encuesta electrónica a farmacéuticos clínicos del país que incluyó más de 100 profesionales. De ellos, 16 contestaron y 13 declararon poseer experiencia en desensibilización de fármacos, en al menos cinco casos con PNC y ninguno reportó muertes o paro cardiorrespiratorio. La desensibilización a PNC puede ser efectuada en forma segura en embarazadas con alergia de tipo inmediata a PNC que cursan con sífilis. En Chile se debería incorporar esta alternativa en el manejo de mujeres embarazadas con sífilis y alergia inmediata a PNC en lugar de solo considerar por norma el uso de eritromicina.

Crossense em paciente portador de marcapasso por hipersensibilidade do seio carotídeo / Far-field in patient with pacemaker due to carotid sinus hypersensitivity

Relata-se o caso de um paciente portador de marcapasso dupla-câ- mara, implantado por hipersensibilidade do seio carotídeo, que, em consulta ambulatorial, manifestou reaparecimento tardio dos sintomas que apresentava antes do implante do dispositivo. Após descartar alterações de limiares, sensibilidade ou impedância do sistema de estimulação cardíaca, foi realizada massagem do seio carotídeo e evidenciada inibição inadequada da estimulação ventricular. A radiografia de tórax revelou tratar-se de cabo-eletrodo ventricular posicionado em região látero-basal do ventrículo esquerdo via seio coronário. O problema foi corrigido com ajustes dos parâmetros, devidamente comprovado com a não reprodutibilidade do evento

We report the case of a patient with a dual-chamber pacemaker for carotid sinus hypersensitivity who, at an outpatient visit, presented a late resumption of the symptoms observed before the implantation of the device. After discarding threshold, sensitivity or impedance changes of the cardiac stimulation system, carotid sinus massage was performed and inadequate ventricular pacing inhibition was evidenced. A chest X-ray showed the ventricular lead had been placed at the laterobasal region of left ventricle through the coronary sinus. The problem was corrected by adjusting the parameters, and this was confirmed by a discontinuation of the event

Factores desencadenantes de las complicaciones en pacientes con apendicitis / Trigger factors for complications in patients with Acute Appendicitis

Antecedentes: La apendicitis aguda es la urgencia quirúrgica más frecuente en las emer- gencias y lleva a serias complicaciones. Su incidencia anual es de 1,33 por 1000 hombres y 0,09 por 1000 mujeres. El diagnóstico temprano, profilaxis antibiótica y terapia postoperatoria correcta, evitan complicaciones. Objetivo: Demostrar los principales factores desencadenantes de las complicaciones en los pacientes con Apendicitis Aguda en el Hospital General del Sur de Junio de 2015 a Febrero de 2016. Pacientes y métodos: Estudio no experimental, transversal, analítico, con universo de 568 pacientes operados por apendicitis aguda, muestra de 300 pacientes, constituida por 179 casos y 121 controles. Se determino un intervalo de confianza de 3.88, con nivel de confianza de 95%, el valor de precisión 0.6, dando como resultado una muestra de 237 la cual se cambio a 300 por tener más disponibilidad de los expedientes y realizar un estudio más preciso. Resultados: 179 (59%) de los pacientes eran hombres, 128 (70.1%) tenían entre 1-29 años, el diagnóstico se realizó con: hipersensibilidad en cuadrante inferior derecho del abdomen (98%), neutrofilia mayor a 70% (93%). No se le aplico profilaxis antibiótica a 204 pacientes (68%), hubieron apéndicitis complicadas en 59.7% y no complicadas en 40.3%, infección de la herida quirúrgica en un 10%, y la relación entre uso de profilaxis e infección de herida quirúrgica dio un OR 0.37 Conclusiones: la dificultad en los accesos de salud, la demora en el manejo y tratamiento de los pacientes y la falta de profilaxis antibiótica se vieron como factores desen- cadenantes. El más importante de estos fue la profilaxis antibiótica ya que su OR de 0.37 nos da un porcentaje de beneficiencia de 63% para prevenir infección de sitio quirúrgico...(AU)

Changes in mast cell infiltration: a possible mechanism in detrusor overactivity induced by visceral hypersensitivity

ABSTRACT Objective: To establish the detrusor overactivity (DO) model induced by visceral hypersensitivity (VH) and investigate the relationship between mast cell (MC) infiltration and DO. Materials and Methods: Sixty rats are divided into 4 groups randomly: Group 1:Baseline group; Group 2: DO group; Group 3: CON group; Group 4: VH group. The colorectal distension (CRD) and abdominal withdral reflex (AWR) scores are performed to evaluate VH. The cystometric investigation and histological test of MC infiltration are assessed. Results: The threshold pressure of CRD in the VH group is significantly lower than that in the CON group (P<0.001). At the distension pressure ≥20 mmHg, the AWR scores of the VH group are significantly higher than those of the CON group (10 mmHg: P=0.33; 20 mmHg: P=0.028; 40 mmHg: P<0.001; 60 mmHg: P<0.001; 80 mmHg: P<0.001). DO model is successfully established in the VH group (DO rate=100%). Compared with the CON group, the numbers of MC infiltration are significantly increased in the VH group, including submucosa of bladder (P<0.001), mucosa lamina propria/mesentery of small intestine (P<0.001), and mucosa lamina propria/mesentery of large intestine (P<0.001). Furthermore, more MC activation as well as degranulation are observed in the VH group. Conclusions: It is indicated that DO model can be established in the VH rats. The MC infiltration may play an important role in DO induced by VH, and may be helpful to understand the mechanisms of DO in VH patients.

Relato preliminar sobre a concentração sanguínea de níquel após oclusão percutânea de comunicação interatrial com a prótese cocoon® / Preliminary report of serum nickel concentration after atrial septal defect occlusion with the cocoonTM device

Introdução: A possibilidade de ocorrer liberação de níquel na corrente sanguínea após implante de dispositivos oclusores de comunicação interatrial de última geração (Cocoon Septal Occluder®), cujo principal componente é o nitinol (55% de níquel e 45% de titânio), ainda permanece controversa, principalmente em determinados grupos de pacientes, como crianças e mulheres em idade fértil. Dessa maneira, o objetivo do presente estudo foi avaliar a correlação entre o implante da prótese e os níveis séricos de níquel. Métodos: Estudo prospectivo de coorte, longitudinal e observacional, realizado em um hospital público. Pacientes submetidos à oclusão percutânea de comunicação interatrial foram avaliados clinicamente, por meio de ecocardiograma transtorácico, e foi feita coleta de amostras de sangue em veia periférica, para a dosagem do níquel antes e após (1 dia, 1 e 3 meses) o implante. Resultados: O procedimento e os exames subsequentes foram realizados com sucesso em dez pacientes, com média de idade de 34,4 anos (variação de 5 a 60 anos). O ecocardiograma seriado comprovou a manutenção dos resultados adequados do implante dos dispositivos. Os pacientes não apresentaram manifestações que pudessem sugerir reação ao metal, como rash cutâneo, dispneia, desconforto torácico, palpitações ou migrânea. Níveis séricos de níquel não apresentaram variação significativa e se mantiveram dentro dos limites de normalidade populacional dos métodos de dosagem até os 3 meses decorridos do procedimento. Conclusões: Os resultados preliminares desta investigação com a prótese Cocoon demonstraram que, durante o período inicial de endotelização após o procedimento, não ocorreu liberação apreciável de níquel para a corrente sanguínea...

Background: The possibility of nickel release to the bloodstream after implantation of latest generation atrial septal defect occlusion devices (Cocoon Septal OccluderTM), whose main component is nitinol (55% nickel and 45% titanium), remains controversial, especially in certain groups of patients such as children and women of childbearing age. Thus, the aim of this study was to evaluate the correlation between the device implantation and serum levels of nickel. Methods: This was a prospective longitudinal observational study conducted at a public hospital. Patients undergoing percutaneous atrial septal defect occlusion were clinically evaluated using transthoracic echocardiography and peripheral vein blood sampling for serum nickel before and after (1 day, 1 and 3 months) implantation. Results: The procedure and subsequent examinations were successfully performed in ten patients, with mean age of 34.4 years (range 5 to 60 years). Serial echocardiography confirmed the maintenance of adequate results of the procedure. Patients did not show manifestations that might suggest a reaction to metal, such as skin rash, dyspnea, thoracic discomfort, palpitations or migraine. Serum nickel levels did not show any significant changes and remained within the normal range for the population, according to the dosing methods within 3 months of the procedure. Conclusions: Preliminary results of this investigation with the Cocoon device have shown that during the initial period of endothelization after the procedure there was no significant nickel release into the bloodstream...

Current Issues on Irritable Bowel Syndrome: Diet and Irritable Bowel Syndrome / 대한소화기학회지

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multifactorial disorder with its pathogenesis attributed to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, communication in the gut-brain axis, and so on. Traditionally, IBS has been treated with diet and lifestyle modification, fiber supplementation, psychological therapy, and pharmacological treatment. Carbohydrates are intermingled with a wide range of regularly consumed food including grains such as rye and wheat, vegetables, fruits, and legumes. Short-chain carbohydrates that are poorly absorbed exert osmotic effects in the intestinal lumen increasing its water volume, and are rapidly fermented by bacteria with consequent gas production. These effects may be the basis for the induction of most of the gastrointestinal symptoms. This has led to the use of lactose-free diets in those with lactose intolerance and of fructose-reduced diets for fructose malabsorption. As all poorly absorbed short-chain carbohydrates have similar and additive effects in the intestine, a concept has been developed to regard them collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and to evaluate a dietary approach that restricts them all. Based on the observational and comparative studies, and randomized-controlled trials, FODMAPs have been shown to trigger gastrointestinal symptoms in patients with IBS. Food choice via the low FODMAPs and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for managing symptoms of IBS.

Atopia e hipertrofia adenoamigdaliana em pacientes respiradores bucais em um centro de referencia / Atopy and adenotonsillar hypertrophy in mouth breathers from a reference center

O respirador bucal utiliza a cavidade oral como principal via durante a respiração. Dentre as principais causas, destacam-se: as hipertrofias adenoamigdalianas e as doenças inflamatórias como a rinite alérgica. OBJETIVO: Verificar a presença de atopia, os principais alérgenos envolvidos e verificar a coexistência de atopia com o grau de hipertrofia das tonsilas faríngeas e palatinas, em pacientes respiradores bucais. MÉTODO: Estudo de coorte histórico com corte transversal com revisão de 308 prontuários de pacientes acompanhados em um centro do respirador bucal de um hospital terciário, no período de 2008 a 2010. Foram coletados dados sobre a história clínica de respirador bucal e realizados exames clínico otorrinolaringológico, nasofibroscópico e teste cutâneo de leitura imediata aos aeroalérgenos. RESULTADOS: Dos 308 pacientes, 36% apresentaram positividade no teste alérgico, sendo que dos atópicos 95% foram positivos para ácaros. Do total de pacientes, 46% apresentaram hipertrofia adenoideana. Destes, 37% são atópicos e 47% apresentaram hipertrofia amigdaliana e, destes, 33% são atópicos. CONCLUSÃO: Nenhuma correlação direta entre atopia e o grau de aumento das tonsilas palatinas e faríngeas foi observada nos pacientes respiradores bucais avaliados. .

Mouth breathers use the oral cavity as their principal breathing route. The main causes include: adenotonsillar hypertrophy and inflammatory diseases such as allergic rhinitis. OBJECTIVE: To look for atopy, the main allergens involved and to check for atopy as a comorbidity with the degree of hypertrophy of the tonsils and adenoids in mouth breathers. METHOD: A historical cohort study with cross-sectional review of 308 medical charts of patients treated at a mouth breather care center of a tertiary hospital in the period of 2008-2010. We collected data on the mouth breather's clinical history and we ran otolaryngological exams, flexible nasal endoscopy and skin prick test to aeroallergens. RESULTS: Of 308 patients, 36% were positive on allergy testing, with 95 % of atopic patients being positive for mites. Among all patients, 46% had adenoid hypertrophy; of these, 37% were atopic and 47% had tonsillar hypertrophy, and among these, 33% were atopic. CONCLUSION: We found no direct correlation between atopy and the degree of tonsils and adenoid hypertrophy observed among the mouth-breathing patients assessed. si. .

Asociación entre ansiedad y depresión en la enfermedad alérgica / [Association between anxiety and depression in allergic illnesses].

This study aims at determining whether there was an association among anxiety, depression and allergic illnesses. It suggests the proper therapeutic treatment. During a year, our research work team worked with a group of 82 female and male patients (from 13 to 76 years old) who suffered from various types of allergies. Two psychometric scales were used to carry out this study: Hamilton’s scale for anxiety whereas Beck Depression Inventory (BDI-II) and Zung’s for depression. The association and its percentage were analyzed in patients who reported typical symptoms during their first check-up. They were free of psychopharmacologic drugs and psychotherapies. The presence of anxiety and depression was interpreted as another factor in the development of allergic symptoms. The following results were achieved as regards: for anxiety, an association positive 95

. For depression, the results showed that there was a positive tendency for the association with an allergic illness. The conclusions showed that there is a positive association between anxiety and allergies. As regards depression and allergic illness, there is only a positive tendency. These final results would raise awareness of how to deal with anxiety and depression in allergic patients, both psychopharmacologically and psychotherapeutically.

Angioneurotic edema: report of two cases

Pediatric angioedema exhibits a different cause and clinical manifestations than does adult angioedema. Unlike angioedema in adults, pediatric angioedema is caused mostly due to food, followed by insect bites, infection and antibiotics. Reactions to insect stings, both allergic and toxic, are commonly seen in medical pediatric practice but uncommonly encountered by pediatric dentists. Here we present two cases of angioedema involving the face mainly in children who presented insect bite in the affected region. Treatment and case resolution are described.

The recurrence of leprosy reactional episodes could be associated with oral chronic infections and expression of serum IL-1, TNF-á, IL-6, IFN-ã and IL-10

The aim of this study was to determine whether the presence of leprosy reactional episodes could be associated with chronic oral infection. Thirty-eight leprosy patients were selected and divided into 2 groups: group I - 19 leprosy patients with oral infections, and group II - 19 leprosy patients without oral infections. Ten patients without leprosy, but presenting oral infections, were assigned to the control group. Leprosy patients were classified according to Ridley and Jopling classification and reactional episodes of the erythema nodosum type or reversal reaction were identified by clinical and histopathological features associated with serum IL-1, TNF-?, IL-6, IFN-? and IL-10 levels. These analyses were performed immediately before and 7 days after the oral infection elimination. Patients from group I presenting oral infections reported clinical improvement of the symptoms of reactional episodes after dental treatment. Serum IL-1, TNF-?, IL-6, IFN-? and IL-10 levels did not differ significantly before and after dental treatment as determined by the Wilcoxon test (p>0.05). Comparison of the 2 groups showed statistically significant differences in IL-1 and IL-6 at baseline and in IL-1, IL-6 and IL-10 on the occasion of both collections 7 days after therapy. Serum IL-6 and IL-10 levels in group I differed significantly at baseline compared to control (Mann-Whitney test; p<0.05). These results suggest that oral infection could be involved as a maintenance factor in the pathogenesis of leprosy reactional episodes.

O objetivo deste estudo foi determinar se os episódios reacionais da hanseníase podem estar associados a infecções orais crônicas. Trinta e oito pacientes com hanseníase foram selecionados e divididos em dois grupos: grupo I & 19 pacientes com hanseníase apresentando infecções orais, e grupo II & 19 pacientes com hanseníase sem infecções orais. Os pacientes foram classificados, quanto à forma clínica da doença, de acordo com Ridley and Jopling, e os episódios reacionais, tipo eritema nodoso e reação reversa, foram identificados pelas características clínicas, histopatológicas associadas à quantificação no soro de IL-1, TNF-?, IL-6, IFN-? e IL-10. Estas analises foram realizadas imediatamente antes e 7 dias após a resolução dos focos de infecção. Pacientes do grupo I aprentando infecções orais relataram melhora clínica dos sintomas dos episódios reacionais após o tratamento odontológico. Os níveis séricos de IL-1, TNF-?, IL-6, IFN-? e IL-10 não diferiram significantemente antes e após o tratamento odontológico, como determinado pelo teste Wilcoxon (p>0,05). As comparações entre os grupos mostrou diferenças estatisticamente significantes nos níveis de IL-1 e IL-6 na coleta inicial e nos níveis de IL-1, IL-6 e IL-10 nas duas coletas 7 dias após o tratamento (teste Mann-Whitney; p<0,05). Estes resultados sugerem que infecções orais estão envolvidas na patogênese dos episódios reacionais da hanseníase, como fatores mantenedores.

A Case of Hypersensitivity to Mosquito Bite Associated with Epstein-Barr Viral Infection and Natural Killer Cell Lymphocytosis

Hypersensitivity to mosquito bites (HMB) is a disorder characterized by a necrotic skin reaction and generalized symptoms subsequent to mosquito bites. It has been suggested that HMB is associated with chronic Epstein-Barr virus (EBV) infection and natural killer cell leukemia/lymphoma. We describe here a Korean child who had HMB associated with chronic EBV infection and natural killer cell lymphocytosis. A 5-yr-old boy was suffered from necrotic skin lesions on the right ear lobe. Type A EB virus was detected from hlood cells and bone marrow biospy recognized hemophagocyrosis.

Anaphylaxis following the ingestion of flour contaminated by house dust mites--a report of two cases from Singapore.

This study presents two patients who developed anaphylaxis after eating mite-contaminated food, and also contains a survey of dust-mites contamination in flour samples from Singapore households. The clinical records of each patient was studied. Patient A developed anaphylaxis twenty minutes following the ingestion of home-made fried fish coated with Japanese flour, while Patient B developed similar life-threatening symptoms one hour after the ingestion of home baked scones. Both patients were NSAID-intolerant and had a history of allergic rhinitis. Skin prick tests showed a strong positive result for dust-mites and for extracts prepared from the ingested flour. Flour samples were also examined microscopically which revealed large numbers of live Dermatophagoides farinae dust-mites. A survey of 57 flour samples showed that 4 samples (7%) were contaminated with dust mites. The findings in the present study confirm that mite-contamination of flour exists in Singaporean households, and it may trigger anaphylaxis in susceptible individuals.

Alergia a sulfas / Sulfonamide allergy

Objetivo: o Grupo de Estudos de Alergia a Drogas da ASBAI visa apresentar um plano operacional de estratégia alergológica prática, que auxilie o médico no Brasil, a manejar adequadamente o paciente alérgico a sulfas, em conformidade com as atuais diretrizes da literatura médica internacional, estabelecendo assim parâmetros eficazes de conduta terapêutica. Uma visão abrangente das alternativas disponíveis é buscada através da análise crítica da razão risco/benefício. Métodos: É feita a revisão da literatura sobre o tema. O diagnóstico de alergia a sulfas é baseado principalmente na obtenção da história clínica detalhada e na avaliação das lesões cutâneas observadas. A gravidade destas reações adversas deverá ser estabelecida e os tratamentos alternativos considerados. Não há até o presente momento testes diagnósticos in vivo e in vitro padronizados. A dessensibilização cautelosa é uma possibilidade terapêutica em casos selecionados. Resultados: As reações alérgicas associadas à administração das sulfas ocorrem em 29-65% dos pacientes com HIV-AIDS, quando comparadas a 2-4% em outros pacientes. As erupções não urticariformes e as reações de hipersensibilidade cutânea como a síndrome de Stevens-Johnson são atribuídas aos metabólitos oxidativos das sulfas, denominados de hidroxilaminas. As citocinas também podem participar na imunopatogênese das reações de hipersensibilidade a sulfas. Cerca de 90% dos pacientes com alergia a sulfas antibióticas (sulfonilarilaminas) não apresentam reações a sulfonamidas que não tenham ação antibiótica (desprovidas de arilaminas)...

Objective: The goal of the ASBAI Drug Allergy Study Grou is to present a practical allergy working plan to help physiciar in Srazil manage patients allergic to sulfonamides according t the international medical literature. Therapeutical appropriat and objective parameters are therefore established. Oifferer approaches are discussed through a risk/benefit ratio visiono Methods: The diagnosis of sulfonamide allergy is most based on a detailed clinical history and on the commonly see skin lesions. The severity of these reactions should be assesse and alternative treatments be considered. There are no dia, nostic tests both in vivo and in vitro. Careful desensitization a possible therapeutical approach in selected cases. Results: Allergic reactions to sulfonamides occur in 29-65C of the HIV-AIDS patients compared to 2-4% in other p atie nt: Rashes and the Stevens-Johnson syndrome could be provoke by oxidative metabolites of sulfonamides called hidroxilarnine: Cytokines might also have a role in the immune pathogenes of the hypersensitivity reactions to sulfonamides. About 90% ( patients allergic to antimicrobial sulfonamides (sulfonylarylam nes) do not have cross reactivity with other sulfonamides wit! out the antibiotic activity (nonarylamines). Conclusions: Once the diagnosis of sulfonamide allergy established another treatment modality should be contemple ted. ln the case of prophylaxis and treatment of opportunist infections in HIV-AIDS patients, such as those caused by Pnei: mocystis carinii and Toxoplasma gondi, desensitization protc cols in these patients, always in a hospital, should be carrie out with the direct supervision of a trained allergist.

Teste de provocação em indivíduos com suspeita de hipersensibilidade a anestésicos locais - Proposta de uma abordagem prática / Provocatíon test in patíents wíth suspected local anesthetícs hypersensítívíty - A practícal proposal approach

Objetivo: Os anestésicos locais (AL) podem desencadear grande variedade de eventos adversos, mas raramente são responsáveis por hipersensibilidade alérgica IgE mediada. Ainda são causa de grande preocupação para profissionais de saúde e para pacientes. O teste de provocação com a droga (TPD) constitui método de escolha para prover alternativa se¬gura para estes pacientes. Outras causas de hipersensibilidade alérgica, como a alergia ao látex, podem mimetizar as reações aos AL e devem ser investigadas. Propomos uma abordagem prática para a realização do TPD diante da suspeita de hiper¬sensibilidade alérgica aos AL. Pacientes e Métodos: Foram estudados 33 pacientes com suspeita de hipersensibilidade a AL, submetidos a TPD. Estes pacientes foram atendidos em nosso serviço entre julho de 2003 e julho de 2006. Os TPD foram indicados e realizados de acordo com as orientações da European Network for Orug Allergy (ENDA) e a droga testada foi escolhida a partir da his¬tória clínica. Todos os pacientes foram avaliados (história clí¬nica e testes in vivo e vitro) para se verificar alergia ao látex previamente à realização do TPD. Foi procedido contato telefó¬nico com estes pacientes em abril de 2007 a fim de verificar se a droga disponibilizada havia sido utilizada e se houve intercor¬rências com a sua utilização. Resultados: Foram realizadas 33 provocações em pacien¬tes com suspeita de reação a AL (18 com Bupivacaína e 15 com Lidocaína), todos negativos. Dois desses pacientes tive¬ram avaliação para látex positiva. Foi verificado por contato telefónico que todos os pacientes utilizaram sem intercorrên¬cias o AL testado...

Objective: Although local anesthetic (LA) drugs can elicit variety of adverse reactions, but true allergic hypersensitivi' reactions are uncommon. It still constitutes a concern fi health professionals and for patients. The drug provocation te (DPT) is a determinant method to provide a safe alternative these patients. Other allergic hypersensitive causes (eg. lats allergy) can mimic LA reactions and must be investigated. VI suggest a practical approach based on DPT to be used when LA allergic hypersensitivity is suspected. Pacients and Methods: We stud ied 33 patients with SUSI: cion of local anesthetic hypersensitivity evaluated in our clin between July 2003 and July 2006. Ali of them underwent DP which was performed based on European Network for OrL Allergy (EN DA) orientations and the choice of the drug to t tested was based on the clinical history. Ali patients we avallied (clinical history and in vivo and in vitro tests) in ord to investigate latex allergy before the drug provocation. VI proceeded phone contact to ali these patients in April 2007 order to check if the medication we tested was used and if thr had reactions with it. Results: We proceeded 33 drug provocation tests in pai ents with suggestive history of local anesthetic reaction (: with Bupivacaine and 15 with Lidocaine), ali negative. Two these patients, who underwent DPT with Bupivacaine and wi Lidocaine, had positive evaluation to latex allergy. We conta ted ali patients and verified that the tested drug was used I ali of them with no problems. Conclusion: We demonstrated that DPT is an importa method to provide a safe alternative drug to patients with su picion of allergic hypersensitivity to LA and latex allergy Inve tigation has always to be proceeded. Therefore, the practic approach we use helps us to provide a correct, safe and inc vidualized orientation to each patient.

Curso de atualização em emergências médicas. Aula 10: faringoamigdalite e sinusites / Updating in medical emergencies course. Class 10: pharyngoamigdalitis and sinusites

As infecções das vias aéreas superiores constituem problema comum de Saúde Pública Mundial. Sua identificação adequada e o uso criterioso de antimicrobianos nestas situações evitam co-morbidades, como febre reumática e glomerunefrite, e diminuem consideravelmente o absenteísmo ao trabalho. Atualizamos "Faringoamigdalite e sinusite" na visão do clínico prático.

The infections of the upper airways constitute a common problem of the World's Public Health. Their adequate identification and the criterial usage of antimicrobial drugs in these situations avoid comorbities, such as rheumatic fever and glomerulonefritis and considerably diminishes absenteeism in the workplace. We update here "Pharyngoamigdalitis and sinusitis in the view of the general practitioner.

Alergia al venono de himenópteros / Hymenoptera venom allergy

La alergia al veneno de himenópteros es un hecho epidemiológicamente significativo. Alrededor del 0.15% al 3% de la población general tiene historia de reacciones sistémicas causada por picaduras de insectos. Entre los himenópteros más comunes que provocan este tipo de reacciones se encuentran: abejas, abejorros, avispas y hormigas. Las manifestaciones clínicas varian desde reacciones locales (eritema, edema, prurito o dolor) hasta reacciones sitémicas, e incluso shock anafilçactico con riesgo vital. El manejo inmediato depende de la intensidad de la reacción y abarca desde la aplicaión de frío local y el uso de antihistamínicos orales y corticoides tópicos y orales hasta, en los casos más severos, la administración de adrenaina inyectable. En relación con el tratamiento a largo plazo, la inmunoterapia específica ha demostrado ser muy efectiva en la reducción del riesgo de reacción severa frente a la posterior picadura de insecto.

pattern of sensitisation to inhalant allergens in Omani patients with asthma, allergic rhinitis and rhinoconjunctivitis

Identification of relevant allergens that are prevalent in each environment which may have diagnostic and therapeutic implications in allergic diseases. This study aimed to identify the pattern of sensitisation to inhalant allergens in Omani patients with asthma, allergic rhinitis and rhinoconjunctivitis. The study was carried out during three consecutive years [2004-2006] at the allergy skin test laboratory of Sultan Qaboos University Hospital, Oman. Records of patients who had undergone an allergy skin prick test with a referring diagnosis of asthma, allergic rhinitis or rhinoconjunctivitis were reviewed. Two panels were used during the 3 years period. The frequencies of positive skin tests were analysed. Results: 689 patients were tested, 384 for the first panel and 305 for the second panel. In the first panel, the commonest positive allergens were: house dust mites [37.8%], hay dust [35.4%], feathers [33.3%], sheep wool [26.6%], mixed threshing dust [25.8%], cat fur [24.2%], cockroach [22.7%], straw dust [22.7%], horse hair [17.4%], maize [16.?%], grasses [11.5%], cotton flock [10.7%], trees [10.4%], cow hair [7.8%], Alternaria alternata [3.6%], Aspergillus Niger [3.4%], and Aspergillus fumigatus [?.3%]. In the second panel, the commonest positive allergens were also house dust mites: Dermatophagoides pteronyssinus [50.8%], Dermatophagoides farinae [47.9%]; Mesquite [Prosopis glandulosa] [35.7%], Russian thistle [Salsola kali] [34.4%], cockroach [32.1%], Bermuda grass [Cynodon dactylon] [19.7%], grass mix-five standard [18.0%], wheat cultivate [14.1%], cats [13.8%], Penicillium notatum [4.3%], Alternaria tenius [3.9%], Aspergillus Niger [3.3%], feather mix [3.0%], dog [2.6%], horse hair and dander [2.6%], and Aspergillus fumigatus [1.6%]. The pattern of sensitisation to environmental allergens in Oman seems to be similar to other reports from the Arabian Peninsula. Methods to identify and characterise environment specific allergens like a pollen survey may help in the management of patients with allergic asthma, allergic rhinitis and rhinoconjunctivitis