ABSTRACT
We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.
Subject(s)
Asthma , Adolescent , Asthma/diagnosis , Asthma/epidemiology , Female , Humans , Male , Phenotype , Portugal/epidemiology , Prospective Studies , Spain/epidemiologyABSTRACT
We report a 10-year-old patient with haemophilia A developing anaphylaxis to recombinant factor VIII (octocog alfa). Allergic reactions, and especially anaphylactic events, are rare in patients with haemophilia A. The nature of these reactions is not fully understood. Here, we demonstrate a type I hypersensitivity reaction using sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting assay. This test revealed itself as an essential diagnostic tool, as it allowed us to choose an alternative treatment (moroctocog alfa). Its safety was later confirmed by an uneventful challenge test.
Subject(s)
Anaphylaxis/chemically induced , Factor VIII/adverse effects , Finger Injuries/drug therapy , Hemophilia A/drug therapy , Child , Factor VIII/administration & dosage , Factor VIII/therapeutic use , Hematoma , Humans , Male , Treatment OutcomeABSTRACT
Objetivos: A alergia a veneno de himenópteros pode condicionar a vida da criança de forma significativa. Pretende-se, com a exposição de dois casos clínicos e uma breve revisão do tema, salientar a importância da referenciação dessas crianças a consultas especializadas, para início de dessensibilização.Descrição dos casos: Duas crianças, aos três e aos seis anos, tiveram anafilaxia a picada de vespa e abelha, respectivamente. Em ambas, após a determinação de IgE específica e confirmação alergológica, iniciou-se dessen-sibilização com veneno de himenópteros em esquema ultra-rush, sem intercorrências relevantes, apenas edema no local da injeção. Após doze meses de injeções a cada quatro semanas, recebem agora manutenção com injeções a cada seis semanas. No primeiro caso, a criança foi picada por vespa aos dez meses de imunoterapia, desencadeando apenas reação local diminuta.Conclusões: Em ambos os casos, a imunoterapia específica subcutânea com veneno em esquema ultra-rush foisegura e eficaz, oferecendo o conforto de um menor número de injeções e de deslocamentos ao hospital na fasede indução. A manutenção da terapêutica já demonstrou efeito protetor na reexposição ao veneno em uma dascrianças.
clinical cases and a brief review on the topic, emphasizing the importance of referral of these children to specialized care for early desensitization.Cases description: Two children, at three and six years, had anaphylactic reaction to wasp and bee stings, respectively. In both cases, after the determination of specific IgE and allergologic confirmation, desensitization with hymenoptera venom in ultra-rush regimen was done, without relevant side effect apart from swelling at the injection site. After twelve months of injections every four weeks, the children are now receiving maintenance injections every six weeks. In the first case, the child was stung by wasp at ten months of immunotherapy, triggering only small localreaction.Conclusions: In both cases, the subcutaneous venom immunotherapy with ultra-rush regimen was safe and effective, providing the comfort of a smaller number of injections and hospital visits during the induction phase. Maintenance therapy has demonstrated a protective effect on re-exposure to the poison in one child.
