Caracterización de la conjuntivitis alérgica en el niño / Characterization of allergic conjunctivitis in the child

Introducción: la alergia ocular es una entidad de presentación muy frecuente en la práctica clínica de la Oftalmología. Objetivo: caracterizar los pacientes pediátricos con conjuntivitis alérgica del Servicio de Oftalmología del Hospital William Soler. Métodos: se realizó un estudio observacional, descriptivo y prospectivo, durante el bienio 2010-2011, cuyo universo de estudio estuvo constituido por los pacientes con diagnóstico presuntivo de conjuntivitis alérgica, y la muestra, aplicados los criterios de inclusión y exclusión, quedó conformada por 80 pacientes. Se analizaron las variables: edad, sexo, color de la piel, presentación clínica y factores de riesgo asociados. Se utilizó la estadística descriptiva (frecuencias absolutas y porcentaje). Resultados: predominaron los niños entre 8 y 13 años (68,8 por ciento), seguidos por aquellos entre 3 y 7 (12,5 por ciento) y entre 14 y 18 años (1,9 por ciento), los varones (72,5 por ciento) y el color blanco de la piel (71,2 por ciento). El tipo clínico de conjuntivitis alérgica más frecuente resultó la estacional y perenne (38,8 por ciento), seguido de la aguda (31,3 por ciento), y, el de menor presentación, la dermatoconjuntivitis de contacto (5,0 por ciento). La exposición al polvo se refirió por el 100 por ciento de los pacientes. Conclusiones: predominaron los niños entre 8 y 13 años, los varones y el color blanco de la piel. El tipo clínico de conjuntivitis alérgica más frecuente resultó la estacional y perenne, y el factor de riesgo asociado, la exposición al polvo

Introduction: ocular allergy is a disease that frequently presents in clinical practice in ophthalmology. Objectives: to characterize the pediatric patients with allergic conjunctivitis of the ophthalmological service of William Soler hospital. Methods: a prospective, observational and descriptive study was conducted in 2010 and 2011; the universe of study was the patients with presumptive diagnosis of allergic conjunctivitis and the sample was made up of 80 patients after the application of inclusion and exclusion criteria. The analyzed variables were age, sex, race, clinical presentation and associated risk factors. Descriptive statistics (absolute frequencies and percentages) were used. Results: children aged 8 to 13 years (68.8 percent) were predominant, followed by those of 3 to 7 years (12.5 percent) and 14 to 18 years (1.9 percent), males (72.5 percent) and Caucasians (71.2 percent). The most common clinical type of allergic conjunctivitis was the seasonal and permanent one (38.8 percent), followed by the acute one (31.3 percent) and the least observed was contact dermatoconjunctivitis (5 percent). Exposure to dust was mentioned in 100 percent of patients. Conclusions: children aged 8 to 13 years, males and Caucasians prevailed. The most frequent clinical type of allergic conjunctivitis was the seasonal and perennial one and the associated risk factor was exposure to dust

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.

Common allergens of atopic dermatitis in dogs: comparative findings based on intradermal tests

Intradermal tests were performed on 58 dogs diagnosed with atopic dermatitis from 2004~2008 at the Veterinary Medical Teaching Hospital of Konkuk University, Korea. To compare the allergen distribution observed in the present investigation to the results from other studies conducted in Korea and elsewhere, the allergens were grouped according to their kinds. There was no significant difference in gender distribution among the dogs. The most common breeds among the 58 dogs were Maltese (n = 11) and Shih-tzu (n = 11). The average age was 4.8 years. The most frequently produced a positive reaction on the intradermal tests was mold (67.3%) followed by house dust (54.5%) and house dust mites (49.1%). The present study found a low distribution of dogs allergic to various outdoor allergens compared to studies performed in other countries; this may reflect differences in living conditions for dogs living in Korea.

The hammock: a reservoir of allergens

INTRODUCTION: Asthma affects approximately 10 percent of the world's population. Sensitization to allergens is an important risk factor, and exposure to allergens is associated with disease severity. METHODS: We performed skin tests to evaluate allergen sensitization to mites, cockroaches, cats, dogs, and molds in 73 asthmatic patients. Enzyme Linked Immunosorbent Assay was used to assay the mite and cockroach allergens found in dust from the bedding, hammocks, bedroom floors, living rooms, and kitchens of 29 patients and 14 controls. RESULTS: Fifty patients (68.5 percent) had positive skin test responses. There were positive responses to D. pteronyssinus (52.0 percent), B. tropicalis (53.4 percent), T. putrescentiae (15.0 percent), E. maynei (12.3 percent), L. destructor (8.2 percent), B. germanica (20.5 percent), P. americana (21.9 percent), Felis catus (10.9 percent), C. herbarium (2.7 percent), A. alternata (4.1 percent), and P. notatun (1.3 percent). The exposure to mite and cockroach allergens was similar in the patients and the controls. The Dermatophagoides pteronyssinus Group 1 levels were highest in the beds and hammocks. The Blattella germanica Group 1 levels were highest in the kitchens, living rooms and hammocks. DISCUSSION: The positive skin tests to mites, cockroaches and cats were consistent with previous studies. D pteronyssinus was the most prevalent home dust mite, and hammocks were a source of allergens. To improve asthma prophylaxis, it is important to determine its association with mite allergen exposure in hammocks.

Are cutaneous hypersensitivity tests to inhalant allergens a severity marker for vernal keratoconjunctivitis?

PURPOSE: The purpose of this study was to analyze the cutaneous sensitivity to a variety of allergens in patients with vernal keratoconjunctivitis (VKC) and to demonstrate the relation between skin response and clinical aspects of the disease. METHODS: Twenty patients with vernal keratoconjunctivitis were randomly chosen from the External Disease and Cornea Sector. They were clinically evaluated, and a score ranging from 0 to 20 was applied based on signs and symptoms on ophthalmic examination. All subjects underwent a skin prick test against standardized allergens, such as house dust mites D. pteronyssinus, D. farinae, and Blomia tropicalis, as well as allergens from cat, dog, fungi and feather. RESULTS: Seventy-five per cent of patients were positive for at least one of the allergens tested. House dust mites were responsible for the majority of the cases (75 percent). There was a poor correlation between the clinical score and sensitivity to allergens (r= - 0.119 for fungi; r= - 0.174 for dog; r= - 0.243 for house dust mites; r= - 0.090 for feather). A significant correlation was found only for cat allergen extract (r = - 0.510; p=0.024). CONCLUSIONS: Our study demonstrated poor correlation between cutaneous hypersensitivity tests and clinical findings in patients with vernal keratoconjuntivitis. We concluded that skin response to inhalant allergens is not a useful test to identify clinical severity and chronicity of inflammatory process in this disease.

OBJETIVO: Avaliar o papel da sensibilização cutânea a diferentes aeroalérgenos em pacientes com ceratoconjuntivite vernal e a correlação entre esta e os aspectos clínicos da doença. MÉTODOS: Vinte pacientes do setor de doenças externas e córnea foram aleatoriamente convidados para participar deste estudo. Os pacientes foram avaliados e a eles foi atribuído um escore clínico variando de 0 a 20 de acordo com sinais e sintomas presentes no exame oftalmológico. Todos os pacientes foram submetidos a testes cutâneos de hipersensibilidade imediata contra aeroalérgenos padronizados como os ácaros domiciliares D. pteronyssinus, D. farinae e Blomia tropicalis, assim como também a alérgenos de epitélio de gato, epitélio de cão, mistura de fungos e mistura de penas. RESULTADOS: Setenta e cinco por cento dos pacientes tiveram teste de hipersensibilidade imediata positivo contra pelo menos um dos antígenos testados. Os ácaros domiciliares foram responsáveis pela maioria destes casos (75 por cento). Houve uma pobre correlação entre o escore clínico e a hipersensibilidade cutânea aos alérgenos (r= -0,119 para fungos; r= -0,174 para epitélio de cão; r= -0,243 para ácaros domiciliares; r= -0,090 para mistura de penas). Houve correlação significativa apenas contra epitélio de gatos (r= -0,510; p=0,024). CONCLUSÃO: O estudo demonstrou uma pobre correlação entre os testes cutâneos de hipersensibilidade imediata e os achados clínicos nos pacientes com ceratoconjuntivite vernal. Os testes cutâneos de hipersensibilidade imediata contra aeroalérgenos não foi parâmetro eficaz na identificação dos casos de maior gravidade e cronicidade de ceratoconjuntivite vernal.

Development of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy.

It has been hypothesized that specific immunotherapy (SIT) significantly decreases the development of new allergen sensitizations in mono-sensitized patients. In this study, we evaluated the effect of SIT on the development of new allergen sensitizations in 129 asthmatic children mono-sensitized to house dust mite. SIT was accepted by only 70 of them (SIT group). The remaining 59 children were treated only with medication (control group). At the end of the study we found that 33% of all patients developed new sensitizations. Surprisingly, the prevalence of new sensitizations was significantly higher in the SIT group (45.5%) than in the control group (18.1 %). Ash tree (Fraxinus excelsior), Olive and Meadow fescue (Festuca elatior) were the most common allergens responsible for the new sensitizations. We conclude that SIT did not prevent the onset of new sensitizations in asthmatic children mono-sensitized to house dust mite.

Prevalence of mouse allergen (Mus m 1) in homes of New Zealand rural children.

Mouse allergen has emerged as an under recognized indoor allergen associated with sensitization and contributing to asthma severity. As part of a study of farm residence, exposures, and risk of allergic diseases in children in New Zealand, 216 living room floor dust samples were analysed for the mouse allergen, Mus m 1. Associations between Mus m 1 and allergic diseases, farm residence, and presence of cats were analysed. Significantly higher levels of Mus m 1 were found in farm dwellings, while the presence of cats was associated with significantly lower Mus m 1 levels. Levels of Mus m 1 in New Zealand were considerably lower than those reported overseas. No significant associations were found between Mus m 1 levels and atopic status or allergic diseases. Mouse allergen is unlikely to be an important indoor allergen for rural New Zealand children.

Ácaros em amostras de poeira de tapetes na cidade de Campinas / Mites in dust samplings from rugs in the city of Campinas

Objetivo: investigar a fauna acarina presente em amostras de poeira de tapetes de resid6encias na cidade de Campinas, Brasil. Métodos: um total de 92 amostras (47 amostras de tapetes presentes em quartos e 45 de tapetes em salas de estar), coletadas em 58 residências foram incluídas no estudo. As amostras foram analisadas por microscópio óptico utilizando o meio de Hoyer com fixador. Resultados: Os resultados demostraram um total de 483 corpos de ácaros (média +/- DP:5,2 +/- 4,9 ácaros/lâmina; variação de 0 a 25 ácaros/lâmina). Desse total, 280 e 203 destes presentes nas amostras dos quartos e da sala, respectivamente. As famílias mais prevalentes foram: Pyroglyphidae (n=392; 81,2% do total)- sobretudo Dermatophagoides pteronyssinus, Glycyphagidae (n=45; 9,3%) - Blomia tropicalis, e Cheyletidae (n=19; 3,9%) - Cheyletus spp. Não se observou diferença significativa na concentração acarina nas amostras da sala de estar e do quarto. Conclusões: as amostras de poeira de tapetes da sala de estar e do quarto de dormir apresentaram fauna e concentração acarinas, sendo o ácaro D.pteronyssinus o mais prevalente.

The levels of cockroach allergen in relation to cockroach species and allergic diseases in Thai patients.

Recently, cockroaches have been established as the second most Important allergen, producing allergic diseases, especially in low socioeconomic populations. In Thailand, about 44-61% of atopic patients were positive to cockroach extract by a skin-prick test. This study examined cockroach allergen levels in relation to cockroach species and allergic diseases in the houses of cockroach-sensitive patients. Sixty households of allergic patients in the Bangkok metropolitan area were surveyed using open- and closed-ended questionnaires. Cockroaches were collected using commercial cockroach traps, while dust samples were obtained from the bedrooms, kitchens and living rooms of the houses using a vacuum cleaner. The cockroaches were counted and their species Identified. The levels of cockroach allergens were determined by specific monoclonal antibodies using a monoclonal antibody-polyclonal antibody based sandwich ELISA kit. Six cockroach species were Identified: Periplaneta americana (American cockroach, 72.15%), Supella longlpalpa (2.75%, found in only one house), Periplaneta brunnea (0.78%), Periplaneta australaslae (0.78%), Neostylopyga rhombifolla (0.78%), Blattella germanica (German cockroach, 0.39%) and nymphs (22.35%). Allergens of the predominant species, P. americana, were detectable in all homes studied, with the highest levels in the kitchen areas. The range of allergen levels in house dust varied from 0.40-162.00 microg per g of dust. The median and mean allergen levels in kitchen dust were 59.16 microg and 62.80 microg per g of dust, respectively, while the median allergen level in bedroom dust was only 15.90 microg per g of dust. The German cockroach allergen (Bla g 2) was undetectable in any of the houses. IN CONCLUSION: P. americana was the most common cockroach and may be the species causing allergic diseases, especially asthma, in Thailand, which differs from the USA and Europe

Effects of immunotherapy on pulmonary functions and airway hyper-reactivity in patients with allergic asthma to house dust mites

This study was designed to investigate the effects of immunotherapy with an extract of house dust mites on 20 asthmatic palients allergic to house dust mites during 12 months period. The results of this study showed that there is statistically significant improvement in the pulmonary function parameters including FVC, FEV[1], FEV[1]/ FVC% and PEFR, and also there was statistically significant reduction in airway hyperreactivity to methacholine after completion the course of immunotherapy, these finding suggest that in well selected asthmatic patients allergic to house dust mites only, the immunotherapy is effective in improving pulmonary functions and reducing airway hyperreactivity in these patients

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.

Allergic conjunctivitis.

The purpose of this research is to study the clinical features and risk factors of various types of allergic conjunctivitis. Four hundred and forty-five patients with a history of itching, foreign body sensation, lacrimation and red eyes were examined, and a skin test was performed and assessed to grade the severity. The mean age of the subjects was 24.5 +/- 16.3 years with female preponderance, except for vernal keratoconjunctivitis. The majority of the patients had perennial allergic conjunctivitis. Ninety-five percent of the patients had associated allergic diseases, especially allergic rhinitis. Sixty-six percent of the patients had a family history of atopy. Most patients had symptoms at night. Symptoms persisted throughout the year and were generally triggered by exposure to house dust. The allergy skin tests to common aero-allergens were positive in 95% of patients tested. Common allergens causing sensitization were house-dust mites, house dust, cockroaches, and grass pollen. Environmental control and avoidance of these allergens should be stressed in the management of these conditions.

Pattern of sensitization to common environmental allergens amongst atopic Singapore children in the first 3 years of life.

This study was aimed to investigate the sensitization pattern to a range of common allergens in young Singaporean children. A cross-sectional study involving 75 children aged below 3 years was carried out. They presented between December 1995 and April 2000 with symptoms of asthma, rhinitis, eczema, or food allergy. Their levels of allergen-specific serum IgE to a panel of foods (egg white, milk, soy protein, shrimp, wheat and peanut), pet dander, dust mites and cockroaches were measured with Pharmacia CAP System radioallergosorbent test kits. Serum IgE levels greater than 0.35 kU/l represented a positive result. Four children could not be tested with the complete panel because of insufficient serum. The prevalence of sensitization was highest for cow's milk (45.9%) followed by egg white (38.7%), dust mites Dermatophagoides pteronyssinus (31.4%) and Blomia tropicalis (25.5%). Sensitization to ingested allergens was significantly more prevalent in children aged 1 year or younger than in the older children (70.4% of those below 1 year, and 50% of those aged 1-3 years; p < 0.02). Sensitization to inhaled allergens, such as dust mites, was more likely to manifest as respiratory symptoms (allergic rhinitis and asthma), while ingested allergens were associated with gastrointestinal symptoms and eczema (p < 0.001). It was concluded that infants and young children are at high risk of sensitization to common environmental substances. Allergen avoidance is therefore important even in the very young. The prevalence of sensitization to food allergens is higher compared to inhalant allergens in young children.