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.

EFICACIA Y SEGURIDAD DE LA INMUNOTERAPIA CON EXTRACTOS DE ÁCAROS EN RINOCONJUNTIVITIS ALÉRGICA Y EN ASMA BRONQUIAL / Effi cacy and safety of immunotherapy with mite extract in patients with allergic rhinoconjuctivitis and asthma

Para evaluar la efi cacia y seguridad de la inmunoterapia subcutánea (ITSC) con extractos de ácaros, se realizó un ensayo clínico doble ciego controlado con placebo en 154 pacientes mayores de 18 años con rinoconjuntivitis alérgica y/o asma bronquial. La ITSC se administró en una fase de incremento de dosis durante 13 semanas y una fase de mantenimiento con inyecciones mensuales. Como placebo se dieron inyecciones de solución diluyente. Se evaluó la efi cacia según calidad de vida, consumo de medicamentos y frecuencia de las crisis. Se aplicaron los cuestionarios de calidad de vida para rinoconjuntivitis (RQLQ) y cuestionario de calidad de vida para asma (AQLQ). La seguridad se midió según eventos adversos locales y sistémicos. Concluyeron el estudio 136 pacientes (77 con tratamiento y 59 controles). En ambos grupos hubo incremento de la puntuación de los cuestionarios de calidad de vida, mayores en el grupo de estudio (p=0,010). El consumo de medicamentos descendió en rinoconjuntivitis y asma, tanto en el grupo de estudio como en el grupo placebo, sin diferencias signifi cativas entre ambos (p=0,083). La frecuencia de las crisis de rinitis y asma disminuyeron en la muestra, con más reducción en el grupo de tratamiento (p= 0,027). Se reportaron reacciones locales y sistémicas ligeras en ITSC, no así en el grupo placebo, p=0,0003. Los resultados revelan que la inmunoterapia subcutánea con ácaros es efi caz y segura en pacientes con rinoconjuntivitis alérgica y asma(AU)

To evaluate the effi cacy and safety of subcutaneous immunotherapy (SCIT) a double-blind placebo controlled clinical trial was performed with mite extracts in 154 patient's 18-years elders, with allergic rhinoconjunctivitis and/or bronchial asthma. The SCIT was administered in an increased dosage phase for a 13 week period followed by a maintenance phase with monthly injections. Diluted solution injections were given as placebo. Effi cacy was evaluated according to quality of life, medication use, and frequency of crisis. Rhinoconjunctivitis quality of life questionnaire (RQLQ) and asthma quality of life questionnaire (AQLQ) were applied. Safety was measured according to local and systemic adverse events. 136 patients completed the study (77 with SCIT and 59 with placebo). In both groups there was an increase in the score of quality of life questionnaires, score was higher in SCIT (p = 0.010). Medication use declined in both rhinitis and asthma in the SCIT group as in the placebo group with no signifi - cant difference between them (p=0,083). The frequency of rhinoconjunctivitis and asthma crisis decreased in the study group, with a greater reduction in the treatment group (p=0.027). Slight local and systemic reactions were reported in SCIT, none in the placebo group, p=0.0003. The results indicate that subcutaneous immunotherapy with mites is effective and safe in patients with allergic rhinoconjunctivitis and asthma(AU)

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...

Redução da inflamação das vias aéreas e da produção de anticorpos IgEatravés do uso de células dendríticas tolerogênicas pulsadas com extrato solúvel de Blomia tropicalis / Reduction in airway inflammation and the production of IgE antibodies through the use of tolerogenic dendritic cells pulsed with soluble extracts of Blomia tropicalis

As alergias afetam cerca de 20 a 30% da população mundial e sua prevalência, bem como a gravidade dos sintomas, tem aumentado nas últimas décadas. As terapias existentes para as desordens do trato respiratório ocorrem por períodos prolongados, apresentam efeitos colaterais, muitas vezes não são efetivas para pacientes graves e dependem do afastamento do alérgeno. Uma alternativa para esses pacientes seria a indução de tolerância imunológica, através da terapia celular com células dendríticas pulsadas com o alérgeno. O presente trabalho objetivou avaliar o efeito de células dendríticas mielóides sensibilizadas in vitro com extrato de B. tropicalis em modelo murino de alergia respiratória. Em modelos experimentais de alergia respiratória, células T auxiliares (Th2)...

Allergies affect about 20-30% of world population and its prevalence and severity of symptoms has increased in recent decades. Existing therapies to respiratory tract disorders are extense, with side effects, not effective for severe patients and depending on the allergen removal. An alternative for these patients is the induction of immune tolerance by cell therapy with dendritic cells pulsed with the allergen. This study aimed to evaluate the effect of myeloid dendritic cells sensitized in vitro with B. tropicalis extract in a murine model of respiratory allergy. In experimental models of respiratory allergy, T helper cells (Th2)...

Efficacy of the d-phenothrin/pyriproxyfen association against mites in naturally co-infested rabbits / Eficácia da associação de d-fenotrina e piriproxifen no controle de ácaros em coelhos naturalmente co-infestados

The aim of the present study was to evaluate the efficacy of the d-phenothrin/pyriproxyfen association against Psoroptes ovis, Cheyletiella parasitivorax, and Leporacarus gibbus infestations in naturally co-infested rabbits. Twenty crossbreed (New Zealand White x California) rabbits concurrently infested by the three mite species were randomly divided in two groups. All rabbits presented with hyperemia, erythema and formation of crusts in the ear canals caused by P. ovis. Infestations by both C. parasitivorax and L. gibbus were considered asymptomatic in all animals.Ten animals were treated with a 4.4% d-phenothrin and 0.148% pyriproxyfen spray formulation until have their body surface uniformly sprayed, including external ear canals. The other ten rabbits remained untreated, serving as control group. Observations were done on days +7, +14, +21, +28, and +35 post-treatment. The d-phenothrin/pyriproxyfen association showed 100% efficacy against the three mite species and was responsible for the remission of psoroptic mange lesions on treated animals. No signs of intoxication were observed. The results indicate that d-phenothrin/pyriproxyfen spray formulation in a single application is an effective and clinically safe option for the control of different mite infestations in rabbits.

O objetivo do presente estudo foi avaliar a eficácia da associação de d-fenotrina e piriproxifen no controle de infestações simultâneas por Psoroptes ovis, Cheyletiella parasitivorax e Leporacarus gibbus em coelhos naturalmente co-infestados. Vinte coelhos mestiços (Nova Zelândia Branco x Califórnia) infestados simultaneamente pelas três espécies de ácaros foram divididos aleatoriamente em dois grupos. Todos os coelhos infestados por apresentavam eritema, hiperemia e formação de crostas nas orelhas, causados por P. ovis. Infestações simultâneas por C. parasitivorax e L. gibbus foram considerados assintomáticas em todos os animais. Dez animais foram tratados com uma formulação spray contendo d-fenotrina a 4,4% e piriproxifen a 0,148%, pulverizando toda a superfície corporal de forma uniforme, incluindo a face interna das orelhas. Os outros 10 coelhos não foram t ratados, sendo mantidos como grupo controle. Os animais foram avaliados nos dias 7, 14, 21, 28 e 35 pós-tratamento. A associação de d-fenotrina e piriproxifen foi 100% eficaz no controle das três espécies de ácaros e foi responsável pela remissão das lesões de sarna psoróptica nos animais tratados. Não foram observados sinais de intoxicação. Os resultados indicam que a formulação spray de d-fenotrina e piriproxifen em uma única aplicação é uma opção clinicamente segura e eficaz no controle de infestações por ácaros em coelhos.

Serological identification of house dust mite allergens in dogs with atopic dermatitis / Identificação sorológica de alérgenos de ácaros da poeira domiciliar em cães com dermatite atópica

House dust mite antigens have been used for decades to diagnose allergic diseases in humans and animals. The objective of this study was to identify allergens in commercial Dermatophagoides farinae and Blomia tropicalis extracts by immunoblotting using sera from allergic dogs and anti-dog IgE conjugate. The analysis of antigens present in the D. farinae extract (FDA Allergenic) using sera from 10 dogs allergic to D. farinae showed that eight sera recognized a band of approximately 102 kDa, eight recognized two bands of 52 to 76 kDa, five recognized one band of approximately 76 kDa, four recognized one band of 31 to 38 kDa, and two recognized one band of 12 to 17 kDa. Immunoblot assays of the B. tropicalis extract (FDA Allergenic) using sera from 10 animals allergic to B. tropicalis showed that five sera recognized two bands of 52 to 76 kDa. These results demonstrate the importance of the two house dust mite species for the pathogenesis of canine atopic dermatitis in Brazil. In addition, the results indicate which allergens should be present in allergenic extracts used for diagnosis and allergen-specific immunotherapy.

Antígenos de ácaros da poeira domiciliar são utilizados por décadas para diagnóstico de doenças alérgicas em seres humanos e animais. O objetivo do presente trabalho foi identificar proteínas alergênicas presentes em extratos de Dermatophagoides farinae e Blomia tropicalis através de "immunoblotting" utilizando-se soros de animais alérgicos e conjugado anti-IgE canina. A análise por "immunoblotting" dos antígenos presentes no extrato de D. farinae (FDA Allergenic), utilizando soros de dez animais alérgicos, mostrou que oito soros reconhecem uma banda com peso molecular de aproximadamente 102 kDa; oito soros duas bandas entre 52 e 76 kDa; cinco soros uma banda com aproximadamente 76 kDa; quatro soros uma banda entre 31 e 38 kDa; e dois soros uma banda entre 12 e 17 kDa. A análise por "immunoblotting" dos antígenos do extrato de B. tropicalis (FDA Allergenic) mostrou que cinco soros reconhecem duas bandas com pesos moleculares entre 52 e 76 kDa. Esses resultados demonstram a importância dessas duas espécies de ácaros da poeira domiciliar na patogênese da dermatite atópica canina no Brasil, assim como indicam alérgenos que devem estar presentes nos extratos alergênicos utilizados para diagnóstico e imunoterapia alérgeno-específica.

Atopy in children with eczema.

Objective. To explore the prevalence of common food and aeroallergens sensitization in early childhood skin diseases and to compare the pattern of common food and aeroallergens sensitization before and after 6 months among infants with atopic dermatitis (AD). Methods. All skin prick tests (SPTs) performed on children =< 18 months of age managed at the pediatric dermatology clinic of an university-affiliated teaching hospital over a 16-month period were examined. Results. There was generally no difference in the pattern of sensitization to common food and aeroallergens between AD patients and non-AD young children with miscellaneous dermatological or gastrointestinal conditions. Dust mites were the only common aeroallergens in these patients; whereas egg and peanuts were the common sensitizing food allergens. Cat and dog fur as aeroallergens, soy bean, orange and beef as food allergens were relatively uncommon among the studied subjects. In AD, infants =< 6 months were generally naive to aeroallergens but became sensitized to the D. Pteronyssinus in the next 12 months of age. 80% of these infants were not sensitized to cow’s milk and none sensitized to soybean. Conclusions. Atopic sensitization to common allergens was common in early childhood with or without AD. Majority of young infants were not sensitized to milk, and develop eczema before they show atopy to the milk or soy allergens.

Sensitization of Children to Storage Mites in Kutahya, Turkey

Specific IgE against Acarus siro, Glycphagus domesticus, Tyrophagus putrescentiae, and Lepidoglyphus destructor have been investigated by ELISA in sera of 92 children. Of them, 41 were found to be specific IgE positive (> or = 0.35 IU/ml) against at least one of house dust mite species, Dermatophagoides pteronyssinus and Dermatophagoides farinae, by an immunoblot. In 65.9% of the dust mite-sensitized children, specific IgE against at least one of these mite species was found. Sensitization levels, including co-sensitization cases were found to be 35.7% against A. siro, 24.4% against T. putrescentiae, 31.7% against L. destructor, and 26.8% against G. domesticus. In non-sensitized children, dust mite sensitization level was found to be 25.5%. Breakdown of sensitization by individual species in this group was; against A. siro and T. putrescentiae at 7.8%, against L. destructor at 13.7%, and against G. domesticus at 9.8%. When all children were reckoned, 43.5% was found to be sensitized against at least one storage mite species, with sensitizations against A. siro at 18.5%, T. putrescentiae at 26.1%, L. destructor at 21.7%, and G. domesticus at 17.4%. In dust samples collected from the dwellings of children, distribution of species was found to be A. siro (17%), G. domesticus (23%), T. putrescentiae (29%), L. destructor (25%), and unidentified (6%). In Fisher's chi-square test on SPSS program, there was a relationship between dust mite sensitization and storage mite sensitization (P < 0.05), but no meaningful relationship was found on the basis of individual mite species.

Humoral and cellular immune responses to Blomia tropicalis and concanavalin A-binding fractions in atopic patients

Blomia tropicalis, Dermatophagoides pteronyssinus and D. farinae are prevalent house dust mites. Concanavalin A-binding components derived from B. tropicalis (Bt-ConA extract) are highly immunogenic in allergic diseases. The aim of the present study was to evaluate the humoral and cellular immune responses to B. tropicalis in mite-sensitized patients. A total of 137 patients with allergic rhinitis with/without asthma and 109 non-atopic subjects were selected and analyzed by the skin prick test, and for total serum IgE and specific IgE levels to both Bt-total and Bt-ConA extracts, their proliferative response and cytokine (IFN-ã and IL-5) production by peripheral blood mononuclear cells (PBMC) stimulated with both extracts. Skin prick test showed that 70 percent of the patients were sensitized to Bt (Bt+) and similar levels of specific IgE to Bt-total and Bt-ConA extracts were demonstrable in Bt+ patients. Significant PBMC proliferation was observed in response to Bt-total extract in Bt+, but not in Bt- patients and non-atopic subjects (P < 0.001). Bt-ConA extract induced increased proliferative responses in all patient groups compared to medium alone (P < 0.05), but these responses were significantly decreased in the presence of the mannopyranoside ConA inhibitor (P < 0.05). Significant IFN-ã production was observed after Bt-ConA stimulation of Bt+ patients (P < 0.05), while Bt-total extract had no effect. IL-5 production was consistently detected in Bt+ patients after allergen-specific stimulation or with no stimulus, indicating that PBMC from allergic patients are prone to produce Th2 profile cytokines, spontaneously or inductively by allergen restimulation. These data showed that ConA-binding components isolated from B. tropicalis may contain relevant antigens that are involved in both humoral and cellular immune responses. However, without an additional purification procedure to eliminate the residual contamination with...

Cloning, sequence analysis, and expression of cDNA coding for the major house dust mite allergen, Der f 1, in Escherichia coli

Our objective was to clone, express and characterize adult Dermatophagoides farinae group 1 (Der f 1) allergens to further produce recombinant allergens for future clinical applications in order to eliminate side reactions from crude extracts of mites. Based on GenBank data, we designed primers and amplified the cDNA fragment coding for Der f 1 by nested-PCR. After purification and recovery, the cDNA fragment was cloned into the pMD19-T vector. The fragment was then sequenced, subcloned into the plasmid pET28a(+), expressed in Escherichia coli BL21 and identified by Western blotting. The cDNA coding for Der f 1 was cloned, sequenced and expressed successfully. Sequence analysis showed the presence of an open reading frame containing 966 bp that encodes a protein of 321 amino acids. Interestingly, homology analysis showed that the Der p 1 shared more than 87 percent identity in amino acid sequence with Eur m 1 but only 80 percent with Der f 1. Furthermore, phylogenetic analyses suggested that D. pteronyssinus was evolutionarily closer to Euroglyphus maynei than to D. farinae, even though D. pteronyssinus and D. farinae belong to the same Dermatophagoides genus. A total of three cysteine peptidase active sites were found in the predicted amino acid sequence, including 127-138 (QGGCGSCWAFSG), 267-277 (NYHAVNIVGYG) and 284-303 (YWIVRNSWDTTWGDSGYGYF). Moreover, secondary structure analysis revealed that Der f 1 contained an a helix (33.96 percent), an extended strand (17.13 percent), a ß turn (5.61 percent), and a random coil (43.30 percent). A simple three-dimensional model of this protein was constructed using a Swiss-model server. The cDNA coding for Der f 1 was cloned, sequenced and expressed successfully. Alignment and phylogenetic analysis suggests that D. pteronyssinus is evolutionarily more similar to E. maynei than to D. farinae.

Sensibilidad de la IgE vs. IgE específica en contra alérgenos de ácaros y hongos para el despistaje de alergias tipo I en una población de trabajadores / Total IgE sensitivity against specific IgE against mites and molds in Workers for the screening of type I allergy

Las alergias mediadas por IgE (tipo 1) son enfermedades crónicas que afectan a más del 20% de la población en algunos países. Se analizaron muestras de un grupo de 55 trabajadores del IUPOLC, Caracas, Venezuela, que manifestaron presentar síntomas relacionados con Alergias tipo I, mediante el uso de un cuestionario especialmente diseñado para tal fin. En ichas muestras se determinó la IgE Total Sérica por ELISA (Dr. Fooke Laboratorien, Alemania) y simultaneamente se ensayó un panel de IgE específica compuesto por ácaros y hongos de conocida prevalencia local por la técnica de Allergy Screen® (r-biopharm, Alemania), en aras de calcular la sensibilidad diagnósticada de la IgE Total sérica como marcador para el diagnóstico de Alergias Tipo I ante el hallazgo de valores significativos de IgE Específica para los alergenos seleccionados. Se escogieron los valores de referencia de IgE Total utilizados en la mayoría de los laboratorios clínicos de Venezuela. El valor de sensibilidad diagnóstica obtenido en el estudio para la IgE Total sérica fue de 66,67%, con una especificada de 100%. Valor Predictivo VPP de 100%. Valor Predicitivo Negativo 61,29%. Se discutió la posibilidad de que este valor de sensibilidad pudiese ser incluso menor con la inclusión de mayor número de alergenos y/o pruebas de piel. En conclusión, la utilización de la IgE Total sérica como herramienta diagnóstica de primera instancia (tamizaje y/o screening) de alergia tipo I, debe estar acompañada de la historia clínica del paciente y la prescripción de otros ensayos como la IgE específica. Los laboratorios clínicos locales deben procurar la utilización de mejores esquemas de interpretación (valores de referencia) de la IgE Total sérica que contribuyan a un mejor diagnóstico de esta patología.

IgE mediated allergies (Type I)are chronic diseases that effect more than 20% the population in some countries. We analyzed 55 blood samples from workers of Universitary Institute of Scientific Police, IUPOLC Caracas, Venezuela, that presented Allergies related symptyoms at the moment ofthe study. We used a specially designed survey to register that information. We tested serum Total IgE by ELISA method and a specific IgE using an immunoblott nitrocellulose paner composed with mites and molds allergens of well know local prevalence, in order to calculate the diagnostic sensitivity of serum Total IgE as a marker for screening Type I Allergies compared with allergen sensitivities detected on the individuals. We selected the most common reference values for serum Total IgE used in Venezuela. The sensitivity obtained for serum Total IgE was 66,67% specificity 100%, Positive Predictive Value 100%, and Negative Predictive Value 61,29%. We discussed the possibility that the sensitivity obtained for Total IgE could be oven lower if more number of allergens and skin tests were included on the study. We conclude that the use of Total IgE as screening diagnostic tool for allergies must be used together with clinical history of the patient and other assays like i.e. Specific IgE. Local Clinical Laboratories should promote of better interpretation schemes (reference values) for Total IgE that actually helps to a better diagnosis of this disease.

Evaluation of atopy among mouth-breathing pediatric patients referred for treatment to a tertiary care center

OBJETIVO: Respirador bucal é o indivíduo que utiliza a cavidade oral como principal via aérea durante a respiração. Trata-se de síndrome de múltiplas etiologias, dentre as quais a rinite alérgica merece destaque por sua alta prevalência. Este trabalho teve como objetivo avaliar a presença de atopia entre respiradores bucais encaminhados a serviço de referência da região metropolitana de Belo Horizonte. MÉTODOS: Estudo transversal e descritivo, realizado no Hospital das Clínicas da Universidade Federal de Minas Gerais. Foram incluídos pacientes de 2 a 12 anos de idade, com período de admissão entre novembro de 2002 e abril de 2004. Os responsáveis responderam a um questionário completo, e os pacientes foram submetidos a teste alérgico cutâneo para inalantes. Houve 140 participantes do estudo. Foram classificados como atópicos aqueles que apresentaram teste positivo para, no mínimo, um alérgeno. As análises estatísticas foram feitas no programa SPSS, usando análises univariadas seguidas pela regressão logística. RESULTADOS: Entre os 140 pacientes, 44,3 por cento (62/140) tiveram teste alérgico positivo. Acaros foram os alérgenos predominantes, apresentando positividade em 100 por cento dos atópicos. Em análise multivariada, atopia esteve significativamente associada ao sexo masculino (p = 0,05), presença de asma (p = 0,014), menor número de pessoas dormindo no mesmo cômodo que o paciente (p = 0,005), ausência de tabagismo passivo (p = 0,005) e ausência de apnéia noturna (p = 0,003). CONCLUSÃO: A alta prevalência de positividade no teste alérgico enfatiza a importância da investigação alergológica em respiradores bucais, pois a alergia tem formas específicas de tratamento que podem reduzir a morbidade desses pacientes quando adequadamente utilizadas.

OBJECTIVE: A mouth breather is someone who uses his/her oral cavity as main airway during breathing. This is a syndrome with several etiologies, but allergic rhinitis plays a key role due to its high prevalence. The aim of this study was to assess the presence of atopy among mouth-breathing patients referred to a tertiary care center in the metropolitan region of Belo Horizonte, Brazil. METHODS: Cross-sectional, descriptive study carried out at Hospital das Clínicas of Universidade Federal de Minas Gerais. Patients aged 2 to 12 years, admitted between November 2002 and April 2004, were included. Parents or surrogates completed a comprehensive questionnaire, and patients were submitted to a skin test for inhalant allergens. A total of 140 patients participated in the study. Those with a positive result for at least one allergen were regarded as atopic. The statistical analyses were made using SPSS, with univariate analyses followed by logistic regression. RESULTS: Of 140 patients, 44.3 percent (62/140) obtained positive results on the allergic test. Mites were the most predominant allergens, with a positive rate of 100 percent among atopic patients. In the multivariate analysis, atopy was significantly associated with the male sex (p = 0.05), presence of asthma (p = 0.014), lower number of people sleeping in the same room with the patient (p = 0.005), absence of passive smoking (p = 0.005) and absence of sleep apnea (p = 0.003). CONCLUSION:The high prevalence of positive results on the allergic test highlights the importance of allergologic investigation in mouth-breathers, since allergy has specific treatments that may reduce morbidity in these patients when properly used.

Incidence of atopic stigmata and prick test results in patients with asthma, allergic rhinitis and conjunctivitis.

Allergic diseases are part of the 'modern lifestyle' and their incidence is still increasing. Cutaneous markers (stigmata) usually provide valuable clues for the diagnosis of atopic diseases. This study evaluated the prevalence of the four major and twenty-one minor criteria of Hanifin and Rajka in a total of 246 patients with mucosal allergies (99 asthma, 108 allergic rhinitis, and 39 allergic conjunctivitis). The two most prevalent major criteria were history of atopic diseases and pruritus. The most prevalent three minor criteria were periorbital darkening, influence of environmental factors and xerosis. The most common prick test-positive allergens were grass and mite allergens. Despite evidence for a high co-morbidity between atopic diseases, in daily clinical practise diagnostic and therapeutic procedures generally focus on the most predominant disease. We concluded that it may be important to screen subjects with mucosal allergies for the presence of major and minor cutaneous stigmata. Screening for cutaneous manifestations and subsequent treatment might further enhance the quality of life of these patients.

Atopy and House Dust Mite Sensitization as Risk Factors for Asthma in Children

Asthma is commonly described as an atopic disease in childhood, but some cases of this disorder do not fit this description. The aim of this study was to evaluate the frequency of atopy, asthma, and sensitization to house dust mites in children with allergic symptoms. This study was performed at the Severance Hospital of Yonsei University with patients who visited the allergy clinic for evaluation of nonspecific upper respiratory symptoms, typical symptoms of asthma, or a general health workup. The patients were divided into three age groups: 0-3 years (group 1), 4-7 years (group 2), and 8-12 years (group 3). Of the 1, 244 children examined, 844 (67.8%) were atopic and 400 (32.2%) were non-atopic. The frequency of atopy and asthma increased with age. Asthma was diagnosed in the same proportion (64%) of atopic and non-atopic children. As risk factors for asthma symptoms, the positive values of house dust mite (HDM) sensitivity were significantly increased in groups 1, 2, and 3 to 53.5%, 68.9%, and 80.2%, respectively. A significant difference between the percentage of asthmatics sensitized to HDM and that of asthmatics not sensitized to HDM was found only in group 3. In conclusion, asthma is related to atopy with increasing age, and house dust mite sensitization seems to be an important determinant of asthma in older children in Korea.

Sensitization to common allergens, especially pollens, among children with respiratory allergy in the Trakya region of Turkey.

Asthma and allergic rhinitis are common problems in children and the causative pollen allergens vary according to the geographical area. The aim of this study was to investigate patterns of sensitization to common inhalant allergens, especially pollens, in Turkish children living in the Trakya region and to determine differences between rural and urban areas. Allergen skin testing was prospectively performed on 539 children aged between 4 and 17 years with respiratory allergy. The reaction was considered to be positive if the mean wheal diameter was at least 3 mm greater than that of the negative controls. We detected positive skin reactions in 420 (77.9%) children. Two hundred and eighty-one (52.1%) mite, 277 (51.4%) pollen, 174 (32.3%) mold, 65 (12.1%) animal dander, 12 (2.2%) cockroach and 6 (1.1%) latex skin sensitivities were detected. Among the pollen allergies 173 were cereal pollen (32.1%), 170 grass pollen (31.5%) and 144 tree pollen allergies (26.7%). The most common positive skin test among the pollens was to cultivated wheat (Titicum vulgare) (n = 116, 21,5%), followed by rye grass (Lolium perenne) and orchard grass (Dactylis glomerata). Positive skin reactions to Alternaria, to Candida albicans, and to all pollens except Ulmus competris, Pinus sylvetris, Platanus vulgaris and Tilia platyphyllos, were higher in children with allergic rhinitis than in those with asthma. In children from rural areas, allergic skin reactivity was found to be more common against Candida albicans, sheep dander and all pollens except Corylus avellana, Fraxinus excelsior, Populus alba, Pinus sylvetris, Platanus vulgaris and Chenopodium album, than in urban children. Although Trakya is close to Greece and other Mediterranean countries, this study suggests that the pollens, which sensitize children, are not similar.

Allergy to house dust mites and asthma

House dust mites have been shown to be important sources of indoor allergens associated with asthma and other allergic conditions. Asthma is a chronic respiratory disease that affects millions of people worldwide, and numerous scientific studies have shown that the prevalence of asthma is increasing. The most common dust mite species around the world include Dermatophagoides pteronyssinus (Dp), Dermatophagoides farinae (Df), Euroglyphus maynei (Em) and Blomia tropicalis (Bt). Over the past three decades, many important allergens from these species have been identified and characterized at the molecular level. The biological function of several house dust mite allergens has been elucidated, with many of them showing enzymatic activity. However, Bt allergens remain the least studied, even though this mite is very common in tropical and subtropical regions of the world, including Puerto Rico. Therefore, it is very important to include Bt in diagnostic and therapeutic strategies for house dust mite induced allergy and asthma, particularly in areas where Bt exposure and sensitization is high. Recombinant DNA technology, as well as other molecular biology and immunological techniques, have played a fundamental role in advances towards a better understanding of the biology of house dust mites and their role in allergic diseases. This kind of study also contributes to the understanding of the complex immunologic mechanisms involved in allergic reactions. The development of effective diagnostic and therapeutic approaches depends on the continuity of research of house dust mite allergens. The objectives of this review are to describe the most important aspects of house dust mite allergy and to acquaint the scientific community with the latest findings pertaining to house dust mite allergens, particularly those derived from Bt.

Monoclonal antibodies against whole body extract of the dust mite Blomia tropicalis

OBJECTIVE: To produce and characterize monoclonal antibodies (mAbs) against whole body extract of the dust mite Blomia tropicalis (Bt). BACKGROUND: Bt is an important source of allergens causing allergic diseases in tropical and subtropical regions. mAbs are excellent tools for delineating cross-reactivity between Bt and other mites. MATERIALS AND METHODS: Mice were immunized with extracts of Bt. mAbs were produced by standard techniques. Hybridoma screening was performed by ELISA. Ascitic fluids were produced and partially purified by adsorption chromatography. Reactivity of mAbs against extracts of Bt and Dermatophagoides pteronyssinus (Dp) was analyzed by ELISA, immunoblots and ELISA inhibition. Also, reactivity of mAbs against the putative cysteine protease rBlo t 1 from Bt was tested. RESULTS: Three IgG mAbs were obtained and partially purified. The mAbs reacted with Bt by ELISA. In immunoblots, mAbs recognized two protein components of 29 and 35 KD. Also, the mAbs reacted with Dp extracts by ELISA, and the same sized components were detected in immunoblots. In competitive ELISA, Dp extract reduced in 62% the reactivity with Bt antigens, and Bt extract produced a maximum reduction of reactivity against Dp antigens of 83%. The mAbs recognized rBlo t1. The homology between Blo t1 and the proteins recognized by the mAbs was high (90%) as the inhibition assays demonstrated. CONCLUSIONS: The cross-reactivity between Dp and Bp could be related with the presence of proteins as their respective cysteine proteases. The produced mAbs have proven to facilitate the identification of antigens of Bt and to determine the possible cross-reactivity between Bt and other common mites of the acarofauna of tropical and subtropical countries where Bt is commonly found.

Increased circulating CCR3+ type 2 helper T cells in house dust mite-sensitive Chinese patients with allergic diseases.

Chemokine receptor expression has been shown to be associated with the differentiation of T helper cells. The CCR3, CXCR4 and CCR5 expression on circulating T cells were studied in 30 house dust mite sensitive-patients with allergic diseases and in another 30 healthy controls. The expression was analyzed in CD4, CD8 and double negative (DN) T cells by triple fluorescence staining. In addition, intracellular cytokine staining was performed in the CCR3+ CD4+ T cells. Increased circulating portions of CCR3+ CD4+ T cells and CCR3+ DN T cells were found in these patients (p < 0.01). There was no statistically significant difference in the expression of CXCR4 and CCR5 on T cells. The follow-up data of the patients did not show a statistically significant change in the CCR3 expression. IL-4 was expressed within CCR3+ CD4+ T cells upon activation. The IL-4 secreting CCR3+ type 2 T helper cells may play a pathogenetic role in immune responses of house dust mite-sensitive Chinese patients with allergic diseases.

Allergen sensitization to aeroallergens including Blomia tropicalis among adult and childhood asthmatics in Thailand.

To study prevalence of allergen sensitization among asthmatics in Thailand, skin prick tests (SPT) were performed in 84 pediatric, 71 adult asthmatics and 71 adult volunteers. Allergen extracts used for testing included common allergens in Thailand and in Singapore. The incidence of positive SPT to any allergen among the three groups (childhood, adult patients and adult controls) were 64.3%, 43.7% and 35.2%, respectively. Dermatophagoides were the most common allergens sensitized by both pediatric (58.3%) and adult asthmatics (40.8%). Twenty-four children (28.6%) and 8 adult patients (11.3%) were sensitized to storage mites (Blomia tropicalis and/or Austroglyciphagus malaysiensis). All patients sensitized to Blomia tropicalis were sensitized to Dermatophagoides. Twenty-seven percent and 15.5% of childhood and adult asthmatics were sensitized to cockroach allergens. The rates of sensitization to oil palm pollen in childhood and adult asthmatics were 8.3% and 5.6%, respectively. Sensitization to other pollens and spores were less than 5%. This study confirms the importance of Dermatophagoides among Thai asthmatics.