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Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):465-466, 2021.
Article in English | EMBASE | ID: covidwho-1570398


Background: Dupilumab has been recently approved for treatment in patients with severe AD in Portugal-until now there is no published data regarding Portuguese experience in Allergy centers. Method: Cross sectional clinical and laboratory assessment of 33 patients (pts) with moderate to severe AD treated with dupilumab (dupi) for at least 16 weeks (W): prospective evaluation of severity scores (SCORAD-Scoring Atopic Dermatitis, EASI-Eczema Area and Severity Index, P-VAS-Pruritus Visual Analogic Scale), report of adverse events up to 52 weeks of treatment. SCORAD and EASI were assessed in 23 pts at W52, P-VAS in 21 pts at W52. Results: Of the 33 pts, 18 were female (55%) with a mean age (SD, range) of 35.3 years (13.2, 15-60). In 16 pts the age of onset was before 2 years old, mean (SD) disease duration 28.1 years (12);94% patients had a diffuse pattern of skin lesions;97% of pts had allergic rhinitis, 82% asthma, 52% conjunctivitis and 30% food allergy. Median total IgE at baseline was of 6313 U/ml (P25-P75: 2842-12491) with a 76% reduction at W52 in 16 pts. Median eosinophil count at baseline was 520 eosinophils/mm3 (P25-P75: 270-740). Before starting dupi 29 pts had been treated with cyclosporine. At the beginning, 15 pts were under oral corticosteroids, 14 under oral systemic immunosuppressive drugs (all pts but two stopped both until W12 of dupi) and 5 switched from omalizumab. At baseline, median SCORAD and EASI were 69.3 and 24.2 points. At W16, W36 and W52, median SCORAD was 27.4, 22.3 and 21.5, and median EASI 5.3, 4.1 and 2.1. At W16, the EASI-50, EASI-75 and EASI-90 were achieved by 91%, 61% and 18% pts, and at W52, by 87%, 70% and 52% pts. The mean percentage of SCORAD reduction at W16 and W52 was 55% and 73%;and of EASI was 76% and 82%. At W16 and W52, an improvement of ≥4 points in P-VAS was achieved by 77% and 95% pts. There was a mean reduction of P-VAS at W2, W4, W16 and W52 of 2.6;3.6;4.7 and 6.3 points, respectively. Conjunctivitis was reported in 10 (30%) pts, two of them with keratoconjunctivitis and blepharitis, without needing to interrupt treatment;two pts also had facial erythema. One patient had COVID, and dupilumab scheme treatment was maintained. Conclusion: The majority of AD patients had a significant and consistent improvement in all the severity scores, after one year of treatment with dupilumab. No relevant adverse events were reported.

Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):356, 2021.
Article in English | EMBASE | ID: covidwho-1570360


Case Report: With the growing trend of incorporating seeds in diet, hypersensitivity reactions have been progressively occurring but are rarely suspected. Linseed is a plant from the Linaceae family, and its seeds are increasingly used in bread. Despite being identified as an allergen capable of causing anaphylaxis, case reports are scarce. Female infant, 11 months old, with atopic dermatitis (AD), has been under cow's milk (CM) avoidance diet in the last 3 months due to CM allergy. At 10 months old, 15 minutes after ingesting a maze and sweet potato's bread, a perioral, axillar, and ear's pruriginous erythema developed, as well as nasal, palpebral, and malleolar angioedema. It was medicated with second-generation H1 antihistamine with symptom resolution after 6 hours. She avoided that bread and tolerated wheat bread. Prick to prick tests were positive for the suspected bread but negative for maze flour and raw and cooked sweet potato. After a detailed analysis of the bread's composition, linseed was identified, and prick to prick tests were positive with it. Due to COVID-19 restrictions, the patient has not yet performed oral challenge. A linseed allergy was the most likely diagnosis. Thus, we recommended avoiding this seed or any food that can contain it. Crossreactivity with other foods (wheat, peanut, rapeseed) and rape pollen is poorly understood, and its clinical relevance has not yet been determined. Hence, we did not perform any further investigation. This was a rare finding, and we did not find any report on infancy. This case should raise awareness for a growing trend of seed hypersensitivity. Therefore, this group of foods should be taken into account while we're investigating suspected allergic reactions to cereals and other grains.

Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):207, 2021.
Article in English | EMBASE | ID: covidwho-1570352


Background: According to current evidence, the lungs are the most affected organ in SARS-CoV-2 infection. Recent data shows impairment of carbon monoxide diffusing capacity, decreased total lung capacity, and restrictive ventilatory defect in COVID-19 adult patients. Data in children are lacking. Our goal was to characterize clinically and demographically the pediatric population with asthma that tested positive for SARS-CoV-2 in our hospital during 2020 and evaluate the pulmonary function after the infection. Method: Cross-sectional study performed in Hospital Dona Estefânia, from March 2nd to December 31st, 2020. All pediatric asthmatic patients (<18 years) who tested positive for SARS-CoV-2 (RT-PCR test) were included. Asthma diagnosis was based on a previous physician's diagnosis or parent-reported history. A convenience sample of the asthmatic patients performed spirometry and carbon monoxide diffusing capacity (DLCO). Results: We were able to identify 20 asthmatic patients [50% male;median age: 10.5 years old (P25- 75: 9- 14.5)]. Atopic comorbidities were present in 75% ( n = 15) (rhinitis the most frequent). According to GINA, 11 (55%) had mild and 9 (45%) moderate asthma. Five patients (25%) needed hospital admission because of COVID-19 infection, 3 had asthma exacerbation, and 3 had COVID-19 pneumonia. Nine of the 20 patients performed spirometry and DLCO after COVID-19 infection. Respiratory function was performed few months after the infection [median=3 months (P25- 75: 2- 6.5)]. In our sample, we found 2 patients with obstructive ventilation impairment and small airway dysfunction. We didn't find any statistically significant difference between de FVC, FEV1, FEV1/FVC ratio, FEF25- 75, and peak expiratory flow (PEF) before and after COVID-19 infection. There were 2 asthmatics with impaired DLCO (65.1% and 64.7%). Conclusion: Two patients showed obstructive ventilation, but it could be due to the variable airflow limitation of asthma, and 2 had DLCO impairment. We didn't find any statistically significant difference between respiratory function before and after COVID-19 infection. However, this is a small sample, and further evaluations with larger populations are needed.