Evaluation of atopy in patients with COPD / Avaliação de atopia em portadores de DPOC

OBJECTIVE: To determine the prevalence of atopy and to evaluate clinical, laboratory, and radiological profiles in patients with COPD. METHODS: This was a cross-sectional study involving outpatients with stable COPD (defined by the clinical history and a post-bronchodilator FEV1/FVC < 70% of the predicted value). The patients completed a questionnaire regarding clinical characteristics and atopy, after which they underwent nasal lavage cytology, skin prick testing, chest X-rays, arterial blood gas analyses, and determination of total serum IgE. RESULTS: Of the 149 subjects studied, 53 (35.6%), 49 (32.8%), and 88 (59.1%) presented with nasal eosinophilia, a positive skin prick test result, and symptoms of allergic rhinitis, respectively. Correspondence analysis confirmed these findings, showing two distinct patterns of disease expression: atopy in patients with COPD that was less severe; and no evidence of atopy in those with COPD that was more severe (reduced FEV1 and hyperinflation). There was a statistically significant association between nasal eosinophilia and a positive bronchodilator response. CONCLUSIONS: Using simple and reproducible methods, we were able to show that there is a high frequency of atopy in patients with COPD. Monitoring inflammation in the upper airways can be a useful tool for evaluating respiratory diseases in the elderly and in those with concomitant asthma and COPD, a clinical entity not yet fully understood. .

OBJETIVO: Determinar a prevalência de atopia e avaliar o perfil clínico, laboratorial e radiológico de pacientes com DPOC. MÉTODOS: Estudo de corte transversal com pacientes ambulatoriais portadores de DPOC estável (definida pela história clínica e relação VEF1/CVF < 70% do previsto após broncodilatador). Os pacientes responderam um questionário clínico e de atopia e foram submetidos a citologia de lavado nasal, teste cutâneo de alergia, radiografia de tórax, hemogasometria arterial e dosagem de IgE total. RESULTADOS: Dos 149 indivíduos avaliados, 53 (35,6%), 49 (32,8%) e 88 (59,1%), respectivamente, apresentavam eosinofilia no lavado nasal, teste cutâneo positivo e sintomas de rinite alérgica. A análise de correspondência confirmou esses achados, evidenciando dois perfis distintos de doença: a presença de atopia em pacientes com estágios mais leves de DPOC, e a ausência de características de atopia em pacientes com aspectos de doença mais grave (VEF1 reduzido e hiperinsuflação). Houve uma associação estatisticamente significante entre eosinofilia no lavado nasal e prova farmacodinâmica positiva. CONCLUSÕES: Este estudo identificou uma alta frequência de atopia em pacientes com DPOC, utilizando ferramentas simples e reprodutíveis. A monitorização inflamatória de vias aéreas parece ser uma ferramenta útil para avaliar as doenças respiratórias em idosos, assim como em pacientes com sobreposição de asma e DPOC, entidade clínica ainda pouco compreendida. .

Influence of linolenic [omega 3] and linoleic [omega 6] poly unsaturated fatty acid containing oils on an experimentally induced model of atopy

Atopy or atopic syndrome is an allergic hypersensitivity reaction affecting nose, eyes, skin, and lungs. In the typical Western diet, 20-25-fold more omega-6 [linoleic acid] than omega-3 [linolenic] polyunsaturated fats are consumed. The Mediterranean-style diet high in alpha linolenic acid [ALA] has been shown to markedly reduce the recurrence rate after a first myocardial infarction. Epidemiologic studies have also shown that a higher intake of ALA protects against fatal ischemic heart disease and is associated with a reduced prevalence of coronary artery disease in both men and women. The aim of this work is to study the effect of short term daily oral feeding with diet containing linseed oil [omega-3, alpha linolenic acid] or sunflower [omega-6, linoleic acid] on the experimentally induced model of atopy in rats. 60 male Sprague Dawlley rats were divided into three equal groups. The first group is the control group where the animals were fed with normal diet, the second group was fed with diet containing 5% linseed oil for 28 days and the third group was fed with diet contains 5% sunflower oil for 28 days. Blood samples were taken at the day for the determination of the total number of oesinophils. While the animals were under the same condition of diet feeding, animals of each group were vaccinated by i.p. injection with 0.1 ml sterile saline solution containing 150 ng of Haemophilus influenza type b vaccine five times! week for another 28 days. Blood samples were withdrawn two times per week from each group of animals to follow up the changes in the eosinophils number. The results showed that linseed containing diet sharply decreased the peripheral number of circulating eosinophils, while sunflower containing diet significantly increased this number. Also the observed changes in the eosinophils number, due to repeated allergen challenge by Hiberix vaccine in the linseed group of animals, were always below the free fat diet control values, and in some cases the decrease was significant while sunflower oil containing diet can increase their numbers. This work showed that manipulation of dietary fat can modulate the clinical response of atopic disorders

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

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

Management of the patient reporting an allergy to penicillin

Recent emphasis on the prevention of surgical wound infection has highlighted the role of the anesthesiologist as the physician responsible for administering appropriate antibiotic prophylaxis. Patients often report a distant or unclear history of penicillin allergy. Administering an antibiotic to which the patient has a true allergy can provoke a life threatening reaction. The anesthesiologist should be aware of the prevalence, severity, and manifestations of allergies to antibiotics, as well as the available alternatives. Unnecessary administration of more powerful broad-spectrum antibiotics leads to the development of antimicrobial resistance and should be avoided. It is the anesthesiologists' duty to balance these issues when selecting appropriate antibiosis

Inmunoterapia alergeno específica: causas de abandono durante el primer año de inicio, en el Hospital Universitario de Puebla / Allergen-specific immunotherapy: causes of abandon during the first year after inicialization at the Universitary Hospital of Puebla

Se estudiaron 36 pacientes con enfermedad alérgica, menores de 15 años de edad, que por primera vez les fue implementada inmunoterapia alergeno específica y que abandonaron permanentemente el procedimiento durante el transcurso del primer año. Se aplicó un cuestionario en el hogar de los pacientes para investigar las causas de abandono. Se evaluaron los resultados mediante análisis estadístico descriptivo. Se incluyó a un total de 36 pacientes. El fenómeno de abandono se dio más en el primer trimestre de implementada la inmunoterapia, 17 pacientes (44 por ciento). La causa más frecuente de deserción fue por mejoría clínica del cuadro alérgico en 13 pacientes (36 por ciento), siguiendo en orden descendente de frecuencia la dificultad para cudir a consulta, el incrmento de la sintomatología alérgica, dolor e incredulidad al procedimiento. Se concluye que es alta la frecuencia de abandono debido a mejoría del cuadro alérgico en los primeros meses de iniciado el procedimiento

La reacción anafiláctica / The anaphylactic reaction

Una persona alérgica a la penicilina, al veneno de insectos o determinado alimento generalmente no es consciente de su problema hasta el momento en que se presentan los síntomas. Un médico con experiencia puede reconocer la reacción y darle tratamiento antes que la situaciónes torne peligrosa para la vida. Este artículo revisa las características de la reacción anafiláctica, el diagnóstico diferencial y el tratamiento del episodio agudo. Y el tratamiento del episodio agudo. Se hace énfasis en la prevención de la exposición repetida al agente desencadenante, ya que el paciente presenta un mayor riesgo de anafilaxia después de la primera reacción.

Broncoprovocaçäo com histamina e metacolina em crianças com asma brónquica e em controles normais / Bronchoprovocation with histmine and methacholine in Brazilian asthmatic and normal children

Submetemos 31 crianças asmáticas e 20 crianças controles "normais" a testes de broncoprovocaçäo com histamina e metacolina. A histamina e a metacolina foram diluídas em soluçäo salina e administradas por via inalatória, através de um nebulizador de De Vilbiss 645, com obturador nasal. Foram usadas concentraçöes crescentes de ambas as drogas: 0,025; 0,125; 0,25; 1,0; 2,0; 8,0; 16,0; 32,0 e 64,0 mg/ml para histamina e 0,025; 0,25; 1,0; 2,5; 10,0; 25,0 e 50,0 mg/ml para metacolina. Medidas do VEF1 foram realizadas um e dois minutos após inalaçäo da soluçäo salina e após inalaçäo de cada uma das concentraçöes em ambas as provas. Queda do VEF1 em 20% ou mais em relaçäo ao VEF1 basal (após soluçäo salina) interrompeu a prova. Com os dados obtidos foi construída uma curva log dose-resposta e por interpolaçäo linear dos dois últimos pontos desta curva foi encontrada a concentraçäo cumulativa capaz de produzir queda de 20% do VEF1 (PC20VEF1). A média da PC20 VEF1 obtida para crianças asmáticas foi significantemente menor que a média do grupo controle, tanto para a histamina como para a metacolina. Näo houve diferença estadística entre os tempos estudados (um a dois minutos). Para a metacolina houve uma evidente diferenciaçäo nas doses capazes de induzir a PC20VEF1 entre asmáticos e controles, ou seja, todos os asmáticos apresentaram uma PC20VEF1 com concentraçäo de metacolina igual ou inferior a 2 mg/ml. Com a histamina, houve certa interposiçäo entre os grupos. O TBP com histamina apresentou especificidade de 100% e sensibilidade de 80%, enquanto a metacolina apresentou especificidade e sensibilidade de 100%