Sensitization to cat allergen and its association with respiratory allergies: cross-sectional study

ABSTRACT Cats are a significant source of allergens that contribute towards worsening of allergic diseases. The aim of this study was to investigate the association between sensitization to cat allergens and allergic respiratory diseases.This was an observational retrospective study based on the skin pricktests results of patients at a tertiary-level hospital in São Paulo. A total of 1,985 test results were assessed. The prevalence of sensitization to cat allergen was 20% (399 patients). Our data indicated that in this population of atopic patients, a positive skin prick test result for cat allergen was not associated significantly with a diagnosis of respiratory allergy.

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...

[Contribution of serum total immunoglobulin E measurement in the diagnosis of respiratory allergic diseases]

Serum total IgE measurement is one of the first allergic inflammation marker test. It has been currently used for the diagnosis of allergy. However, when it has been widely used in clinical practice, we discover its limit in the diagnosis of allergic disease. We carried a retrospective study about 1111 consecutive patients, seen in the Allergology Unit of the Home Ministry Hospital with suspicion of atopic disease. The aim of our study is to evaluate the contribution of serum total IgE measurement in the diagnosis of respiratory allergic diseases. Our population was divided into three groups. Group A: 771 allergic symptomatic subjects [371 children with mean age of 7.8 +/- 3.4 years and 467 adults with mean age of 30.1 +/- 6.6 years]. Group B: 117 controls [70 children with mean age of 6.6 +/- 3 years, and 47 adults with mean age of 30.7 +/- 6 years]. 221 patients with doubtful diagnosis of allergy were excluded [group C]. If we consider the cut-off I of 150 UI [for adults], 75% of allergic subjects have elevated serum total IgE, 62% of adults and 77.6% of children. When doubling the cut-off [cut-off II], 49% of allergic subjects have serum total IgE over 300 UI/ml, 36% of adults and 57% of children. In the control group: 35.8% of patients have total IgE over the cut-off value I and 17% over the cut-off value II. The variation of serum total IgE was related in allergic subjects to the type and the number of symptoms. The levels of total IgE were higher in asthma than in rhinitis and more elevated if the patient has several symptoms. With cut-off I we found a quite good sensibility of the test of 75% [62% in adults and 77.6% in children] and a poor specificity of 64% [68% in adults and 61% in children], with a negative predictive value of 28% and a positive predictive value of 93%. When doubling the cut-off, the sensibility falls to 49% and the specificity was improved at 82%. The serum total IgE measurement was in agreement with prick-tests in 80% of cases and with Phadiatop in 56% of cases if we consider cut-off I. Our results showed a large overlapping of serum total IgE in both allergic and control populations. The measurement of serum total IgE is not helpful for the diagnosis of allergic respiratory diseases because it has a quite good sensibility, a poor specificity and a poor negative predictive value. The test was more sensible and less specific in children

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.

Detection of fungi spectrum in industrial and home bakeries and determinated fungal allergy with skin prick test.

Airborne fungal pathogens such as Penicillium, Aspergillus, Cladosporium, Trichophyton, and Alternaria may cause health problems. In this research, the fungal flora at different bakeries and their potential allergenic effects on the workers were investigated. We investigated 148 workers at 17 industrial type bakeries and 62 workers at 17 home type bakeries in Afyon. Our study was performed in two different seasons and climates, between January 2004 and June 2004. Fungal flora was detected by using Petri-dish method. In the winter, Penicillium was the dominant genus, while Cladosporium was the dominant genus during the summer, in both types of bakeries. The allergenic properties of dominant culturable fungi on workers involved in the bakeries were determined with the skin-prick test. It was found that with workers in the industrial type bakeries, the most common skin test positivity was caused by Penicillium. In the other hand, the skin test positivity, performed on workers in the home type bakeries, was equally caused by Penicillium, Trichophyton and Aspergillus.

Phadiatop® no diagnóstico de alergia respiratória em crianças: Projeto Alergia (PROAL) / Phadiatop® in the diagnosis of respiratory allergy in children: Allergy Project - PROAL

OBJETIVO: Avaliar a positividade do Phadiatop® em crianças acompanhadas em serviços brasileiros de alergologia e compará-la aos resultados de IgE sérica específica a alérgenos inalantes e alimentares. CASUíSTICA E MÉTODO: Em 457 crianças acompanhadas em serviços de alergia pediátrica e um grupo de crianças controle não-alérgicas (n = 62), distribuídas em cinco faixas etárias, foram determinados em amostra de soro: Phadiatop® e IgE específica (RAST) a alérgenos inalantes e alimentares (UniCAP - Pharmacia®). RESULTADOS: O Phadiatop® foi positivo em 305 crianças atópicas (67,6 por cento) e em 25,8 por cento das controles (p < 0,001). Entre as crianças atópicas, a distribuição de positividade variou de acordo com a faixa etária: 7,9 por cento (24/305) entre as abaixo de 2 anos, 15,4 por cento (47/305) nas de 2 a 3 anos, 22,0 por cento (67/305) nas de 3 a 4 anos, 19,3 por cento (59/305) nas de 4 a 5 anos e 35,4 por cento (108/305) nas de 5 a 12 anos. Não houve concordância entre os alérgenos alimentares e a presença de Phadiatop® positivo. O estudo da relação entre os RAST positivos para alérgenos inalados e o Phadiatop® positivo mostrou melhores índices com os ácaros domiciliares (D. pteronyssinus, D. farinae e Blomia tropicalis). CONCLUSÕES: O Phadiatop®é método útil no diagnóstico de alergia aos ácaros domiciliares.

Airway Inflammation and Allergen Specific IgE Production May Persist Longer Than Airway Hyperresponsiveness in Mice

During the preclinical study of new therapeutic modality, we evaluate whether the treatment can reverse the established asthma phenotypes in animal model. However, few have reported on the long term persistence of asthma phenotypes upon re-challenge with allergen (secondary challenge) in animal model. We evaluated the persistence of asthma phenotypes by secondary challenge at different times in previously challenged murine asthma model. BALB/c mice sensitized by intraperitoneal injections of 20 microgram of ovalbumin and 1 mg of alum on days 1 and 14 were challenged initially by the inhalation of 1% ovalbumin for 30 min on days 21, 22, and 23. Each group of mice was rechallenged at 5, 7, 9, or 12 weeks after the initial challenge. Airway hyperresponsiveness, BAL fluid, airway histology and serum ovalbumin-specific IgE level were evaluated. Airway eosinophilia, airway inflammation and serum ovalbumin-specific IgE production persisted upon secondary allergen challenges at least 12 weeks after the initial challenge. However, airway hyperresponsiveness persisted only until mice were rechallenged 7 weeks after the initial challenge. Airway inflammation and allergen specific IgE production may persist longer than airway hyperresponsiveness in a mouse asthma model of secondary allergen challenge.

Comparative study of platelet histamine and serotonin with their corresponding plasma oxidases in asthmatics with normals.

OBJECTIVE: Asthma is well controllable but non-curable disease. Exact pathophysiology involved is unresolved till today. Role of allergic hypersensitivity reaction in asthmatic on-set is well established. Present work is an effort to elucidate some basic points of unresolved pathophysiology of asthma taking platelets as marker. MATERIAL AND METHODS: A group of 52 normal human subjects in the age group of 20-60 years were studied for platelet histamine and serotonin levels and also for their plasma metabolising enzymes diamine oxidase (DAO) and monoamine oxidase (MAO). The data was collected for 79 asthmatic patients at different stages of asthma and accordingly were studied as four different groups of seventy nine asthmatics those were on regular treatment and were comfortable with drugs and were free from symptomatic attack formed gr. I; these (79) patients were followed-up during their symptomatic phase (gr. II) and same (79) patients immediately after their recovery from symptomatic stage studied as gr. III members. All the 79 asthmatic patients fall in gr. I, II and III in a serial manner i.e. all (n = 79) in each group. A separate group of thirty seven patients with known history of asthma but were symptom free and also off drugs for last 2-4 years formed gr. IV. RESULTS: Results showed mean platelet count in asthmatics at all four stages were in the normal range but were slightly low in comparison with normals. Both the enzymatic levels (DAO and MAO) in gr. I, II and III were significantly higher than normals but were same in the case of gr. IV patients. Low levels of platelet biogenic amines were observed in asthmatics (gr. I to gr. IV) than normals. CONCLUSIONS: Thus, study parameters showed significant difference in asthmatics and normals. Findings of the study have been utilized to understand unanswered hypersensitivity shown by the asthmatics over normal individuals (non-asthmatics).

Perfil clínico e laboratorial de crianças com alergia respiratória atendidas em ambulatório geral de pediatria / Clinical and laboratory profile of children affected by respiratory allergy at a pediatric clinic

Foi realizado um estudo retrospectivo com 53 crianças portadoras de alergia respiratória (asma e rinite alérgica) aconpanhadas em ambulatório. Avaliando o perfil clínico e laboratorial desse grupo verificamos que sexo masculino e a presença de familiares diretos atópicos (especialmente a mãe) constituiram fatores de risco para o aparecimento da doença alérgica. O ambiente físico teve influência determinante na fisiopatologia da asma e da rinite na maior parte dos casos. Verificou-se o aumento do nível sérico da IgE na totalidade do grupo e eosinofilia em 66 (per cent) dos caos. Entre as crianças com teste cutâneo positivo, os alérgenos predominantes foram o "Dermatophagoides pteronyssinus" e o "Dermatophagoides farinae". A história clínica e o exame físico dos pacientes permitiu o diagnóstico e o estabelecimento do plano terapêutico, ficando reservado um papel secundário aos testes laboratoriais. Os autores puderam observar também nesta casuística que o acompanhamento dos pacientes alérgicos deve priorizar medidas preventivas dirigidas à higiene do ambiente físico para exclusào dos fatores desencadeantes reconhecidos (au)

Associação clínica e reatividade dos testes cutâneos em crianças com alergias respiratórias / Clinical association and reactivity of cutaneous tests in children with respiratory allergy

Os autores analisaram, através de estudo de prevalência, 66 crianças portadoras de alergia respiratória atendidas no Hospital Universitário Lauro Wanderley - UFPB, no período de agosto/97 a janeiro/98, objetivando estudar a associação entre o quadro clínico e a reatividade dos testes cutâneos aos alérgenos inalantes. A prevalência de alergia respiratória, neste período foi de 20,59 por cento, sendo 2,80 por cento dos pacientes portadores de rinite alérgica; 9,06 por cento de asma brônquica e 8,73 por cento da associação rinite/asma. O diagnóstico clínico evidenciou sintomas leves em 40,9 por cento e 65,2 por cento das crianças selecionadas portadores de rinite e asma brônquica, respectivamente. O estudo da associação entre o quadro clínico e a reatividade dos testes cutâneos aos principais alérgenos testados não demonstrou associação, exceto o estudo entre asma e reatividade cutânea à mistura de flores (× = 3,97; p=0,46). Da análise dos resultados, os autores concluíram que a ocorrência de reatividade ao teste cutâneo a um determinado alérgeno não significa que o paciente, necessariamente, terá sintomas clínicos de alergia respiratória quando exposto a este alérgeno

Diagnóstico de la rinosinusitis crónica / Chronic rhinosinusitis diagnosis

Ningún estudio ancilar, de laboratorio o gabinete ha podido desplazar a la historia y examen clínicos como la piedra angular en el diagnóstico de las enfermedades alérgicas, lo que hace en el imperiosa la necesidad de conocer adecuadamente la diversidad de manifestaciones clínicas que orientan hacia dichas enfermedades, lo que permitirá una mejor evaluación diagnóstica y, por ende, un mejor enfoque terapéutico

Methacholine inhalation challenge in patients with post-Mycoplasma pneumoniae pneumonia.

We studied methacholine bronchial inhalation challenge in 12 patients at 4th week and 12th week after recovered from Mycoplasma pneumoniae pneumonia, compared with 12 healthy subjects as controls. The aerosolized methacholine was produced by an atomized nebulizer of the Provocationtest I, Pari-Starnberg, Germany and the aerosol was kept into a reservoir bag. Then, it was inhaled slowly by a subject. Increasing concentration of methacholine solutions (0, 0.5, 1, 5, 10, and 25 mg/ml) were used. The results revealed that 67% of the patients had bronchial reactivity to methacholine at the first time of challenge with a mean concentration of methacholine producing a fall in FEV1 of 20% from baseline (PC20) of 12.3 +/- 6.44 mg/ml. Fifty percent of the patients were still positive to the test on the second time of challenge with a mean PC20 of 20.1 +/- 6.89 mg/ml. None of the healthy subjects had bronchial hyperreactivity (PC20 > 25 mg/ml). Two patients experienced wheezing and asthmatic attacks requiring bronchodilator therapy during acute phase pneumonia. They were also diagnosed as having bronchial asthma for the first time. Many patients had prolonged coughing during the recovery phase lasting more than 4 weeks. This prolonged coughing seemed to have a correlation with the development of bronchial hyperresponsiveness (BHR). We concluded that M. pneumoniae could induce BHR which may be transient or persistent. The effect of mycoplasma respiratory tract infection may result in airway inflammations and asthmatic attacks.

Flujo espiratorio máximo en niños asmáticos: Casos y controles / Peak expiratory flow rate in asthmatic children: Case/control study

Con el fin de determinar las variaciones del Flujo Expiratorio Máximo (PEF), se estudiaron a 38 niños asmáticos (CASOS) en período intercrítico de la enfermedad y a 38 niños sanos (CONTROLES) de ambos sexos comprendidos entre los 5 y 15 años de edad. Los niños asmáticos fueron clasificados por parámetros clínicos en determinado grado de severidad de asma bronquial, determinando el PEF de cada niño objeto de estudio con el mini-Wright Peak Flow Meter, en dos registros diarios a las 06 y 18 horas, durante 7 días consecutivos, obteniendo la variabilidad del mismo. Se encuentra diferencia en la variabilidad global de niños asmáticos de todos los grados de severidad de la enfermedad comparada con la de los niños normales, con diferencia estadística altamente significativa (p<0.000001). Las variaciones diurnas del PEF ayudan en el diagnóstico del asma bronquial y también son útiles para realizar la catalogación de severidad de la enfermedad. El PEF correlaciona bien con los síntomas presentados por los pacientes y por lo tanto guarda correpondencia con la Hiperreactividad bronquial (HRB) del niño asmático. Postulamos que un niño con historia clínica sugestiva, una variabilidad global mayor del 8 por ciento indica que el diagnóstico de asma es altamente probable

Confiabilidade do multi-test no diagnóstico da alergia respiratória / Multi-test skin testing in the diagnosis of respiratory allergy

O multi-test é uma modalidade moderna e confiável de teste alérgico epicutâneo (puntura modificada). É um teste sensível, comparável ao teste intradérmico 1:1000, rápido (resultados em 15 minutos), com boa correlaçäo com o RAST, e de grande aceitaçäo e tolerabilidade pelos pacientes (independente de sua faixa etária). Acumulamos uma experiência pessoal que ultrapassa 1.200 casos com mais de 9.600 resultados de testes alérgicos diferenciados.

Riesgo de patología respiratoria en pacientes expuestos al polvo de cereal / Risk of respiratory pathology in exposed patients to the cereal dust

Se estudiaron ciento sesenta y tres (163) pacientes adultos, trabajadores de la Junta Nacional de Granos de la ciudad de Santa Fe, con diferentes grados de exposición al polvo de cereal según la función laboral, clasificándolos en: operarios de alta exposición (grupo A) y de baja exposición (grupo B). Nuestra hipótesis de trabajo consistió en averiguar la incidencia de la enfermedad respiratoria producida por la inhalación de polvo de cereal. Para ello se realizó una historia clínica con examen físico-respiratorio de rutina, antecedentes personales y familiares de patología respiratoria, historia de tabaquismo, test cutáneo por Prick al polvo de cereal y DFG Pteronisinus y Farina con control Negativo y Positivo, Rx de Toráx, prueba funcional respiratoria y dosaje de IgE total. Se comprobó en el grupo A una mayor sintomatología respiratoria (rinitis, tos y expectoración) con deterioro de la función pulmonar, principalmente en el FMF de predominio obstructivo fijo, acompañado de imágenes radiológicas características de lesión interticial peribronquial y parenquimatoso. Los trabajadores con asma fueron encontrados en el grupo B, en mayor número y significación estadística con respecto a los del grupo A. El hábito tabáquico facilitó la inflamación de las vías aéreas por polutantes ambientales, produciéndose un mayor número de trabajadores en el grupo de alta exposición (grupo A) con tos y expectoración. La predisposición atópica no fue un factor de relevancia en la etiología de los síntomas, no pudiendo demostrarse en el grupo A diferencias estadísticas significativas con los tests cutáneos, no con el dosaje de IgE mayor de 100. Por el contrario, existieron diferencias significativas con los valores IgE en el grupo B, considerando que ésto se debe al cambio precoz del lugar de trabajo de aquellos operarios sensibles al polvo de cereal y polutantes que reaccionaban con crisis de asma. Conclusión: teniendo en cuenta lo manifestado, donde la alta exposición al polvo de cereal produce mayor sintomatología respiratoria, que se cuantificó espirometricamente y radiológicamente, consideramos necesario que se mejoren las condiciones de trabajo en silos, a través de máscaras con filtros eficaces y mediadores de partículas respirables por área y por persona, que garanticen un umbral de polución que haga disminuir el alto grado de morbilidad respiratoria de estos pacientes

Dermatoglyphics in nasobronchial allergic disorders.

Fifty persons having nasobronchial allergy diagnosed by a positive skin test were compared with age and sex matched normal individuals for dermatoglyphic palmer patterns. The palmer prints were obtained on white art paper using Kores duplicating ink. In female patients, total number of whorls was less, more so on digit IV of left hand. Digit V of right hand had low frequency of ulnar loops, the d-t ridge count was low. In male patients, ulnar loops were less frequent on digit III of right hand. Total finger ridge count was less in both sexes. High frequency of arches was observed in female patients and in total. Digit V of left hand in females and in total patients revealed high frequency of arches. a-b ridge count was high in males and in total patients.

Pruebas in vitro e in vivo a ácaros / Test in vitro and in vivo to mites

Se estudiaron 40 niños con una o más enfermedades alérgicas perennes (asma bronquial, rinitis alérgica o dermatitis atópica) con el fin de determinar el valor en nuestro medio de las pruebas in vivo e in vitro más utilizadas para el diagnóstico de alergia, como la IgE total sérica, IgG alergenoespecífica (RAST) y pruebas cutáneas utilizando el método de punción en pacientes sensibles a D.pteronissinus, D. farinae o ambos. Todos los pacientes tuvieron pruebas cutáneas positivas. La IgE total sérica estuvo elevada en 95 porciento de los casos, con un pobre coeficiente de correlación (r) al comparar el grado de reacción cutánea y la concentración de IgE total sérica, no existiendo significancia estadística. Por otro lado, 95 porciento de los pacientes tuvieron RAST positivo con un coeficiente de correlación de 0.31 (p< 0.05). Se concluye que en nuestro país, la historia clínica y las pruebas cutáneas son suficientes en un porcentaje razonable para hacer el diagnóstico de alergia, en pacientes sensibles a ácaros de polvo casero.

Food and chemicals as environmental incitants

La susceptibilidad a provocadores ambientales de componentes presentes en el aire, la comida y el agua constituye un problema de salud conocido. Tales sensibilidades y reacciones pueden dar lugar a múltiples síntomas que afectan el músculo liso, las membranas y la sustancia colágena de los sistemas respiratorio, gastrointestinal y genitourinario. Estas reacciones pueden ser confundidas como hipocondriasis, pero son realmente reacciones a contaminantes y químicos presente en el medio ambiente casero y de trabajo del paciente. La realización de historias clínicas detalladas alertarán al médico y la enfermera de la industria, pudidendo establecer su relación, mediante eliminación y confrontamiento del paciente a las sustancias ofensivas mediante la realización de estudios cuidadosos y controlados

Aplicaçäo de análise multivariável ao estudo do teste de lavagem de nitrogênio com respiraçäo única / Application of multivariate analysis to the study of the single-breath nitrogen washout test

O presente trabalho trata da aplicaçäo de método numérica à análise de testes de funçäo pulmonar. Objetiva-se investigar preliminarmente a utilizaçäo de técnicas de análise de múltiplas variáveis aos dados obtidos no teste de lavagem de nitrogênio com respiraçäo única (TN2-RU). O teste foi realizado com uso de sistema experimental baseado em computador. Parâmetros do TN2-RU foram obtidos em 18 voluntários, classificados de acordo com questionário de sintomas respiratórios. Através de análise discriminante obtiveram-se equaçöes cujas variáveis independentes säo parâmetros do TN2-RU. Essas equaçöes permitiram separar, com significância estatística, grupos de sintomáticos e näo sintomáticos (p < 0,05) e tabagistas e näo tabagistas (p < 0,05). Tais resultados indicam a utilidade de métodos de análise de múltiplas variáveis na análise de dados de testes de funçäo pulmonar, possibilitando a objetivaçäo de condutas e estudos clínicos