Anaphylaxis: A Decade of a Nationwide Allergy Society Registry

Background: Anaphylaxis is an acute, life-threatening, multiorgan hypersensitivity reaction.Objective: The aim of this study was to identify the causes of anaphylaxis in Portugal in order to improve our knowledge of epidemiology and management.Methods: We implemented a nationwide notification system for anaphylaxis over a 10-year period, with voluntary reporting by allergists. Data on 1783 patients with anaphylaxis were included. Etiopathogenesis, manifestations, and clinical management were characterized in detail for both children and adults.Results: The mean age was 32.7 (20.3) years, and 30% were under 18 years of age; 58% were female. The mean age at the first anaphylaxis episode was 27.5 (20.4) years (ranging from 1 month to 88 years). The main culprits of anaphylaxis were foods (48%), drugs (37%) (main trigger in adults, 48%), and hymenoptera venom (7%). The main culprit foods were shellfish (27%), fresh fruit (17%), cow’s milk (16%), tree nuts (15%), fish (8%), egg (7%), and peanut (7%). The main drugs were nonsteroidal anti-inflammatory drugs (43%), antibiotics (39%), and anesthetic agents (6%). Other causes included exercise (3%), latex (2%), cold-induced anaphylaxis (2%), and idiopathic anaphylaxis (2%). Most patients (80%) were admitted to the emergency department; only 43% received adrenaline. Anaphylaxis recurred in 41% of patients (21% with ≥3 anaphylactic episodes); 7% used an adrenaline autoinjector device.Conclusions: Food is the leading cause of anaphylaxis in Portugal, while drugs were the main elicitors in adults. We emphasize undertreatment with adrenaline and recurrent episodes, highlighting the need to improve diagnostic and therapeutic approaches to anaphylaxis (AU)

Antecedentes: La anafilaxia es una reacción de hipersensibilidad sistémica potencialmente mortal.Objetivo: El objetivo de este estudio fue el identificar las causas de la anafilaxia en Portugal para mejorar el conocimiento de la epidemiologíay del manejo de la enfermedad.Métodos: Durante un período de 10 años, se implementó un sistema nacional de notificación de anafilaxia, por parte de los alergólogos,mediante la emisión de informes voluntarios. Se recogieron datos de 1.783 pacientes con anafilaxia, pediátricos y adultos, relativos a laetiopatogenia, las manifestaciones clínicas y el manejo clínico de la misma.Resultados: La edad media fue de 32,7 ± 20,3 años, siendo el 30% de los pacientes menores de 18 años. El 58% fueron mujeres. Laedad media del primer episodio de anafilaxia fue de 27,5 ± 20,4 años (desde 1 mes hasta 88 años). Los principales agentes responsablesde anafilaxia fueron los alimentos (48%), los medicamentos (37%), que fue el principal desencadenante en los pacientes adultos, y losvenenos de himenópteros (7%). Los principales alimentos responsables fueron: mariscos (27%), frutas frescas (17%), leche de vaca (16%),nueces (15%), pescado (8%), huevo (7%) y cacahuete (7%). Los principales fármacos, fueron los antiinflamatorios no esteroideos (43%),antibióticos (39%) y anestésicos (6%). Entre otras causas implicadas se incluyó: ejercicio físico (3%), látex (2%), frío (2%) e idiopática (2%). La mayoría de los pacientes fueron atendidos en el servicio de urgencias (80%), y solo el 43% recibió tratamiento con adrenalina.La recurrencia de la anafilaxia ocurrió en el 41% de los pacientes (21% con ≥3 episodios anafilácticos). El 7% utilizó un dispositivoautoinyector de adrenalina.Conclusiones: Los alimentos son la principal causa de anafilaxia en Portugal y en el subgrupo de pacientes adultos, lo son los medicamentos

Asthma app use and interest among patients with asthma: a multicenter study

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Nivel de ruido en unidades de cuidado intensivo de un hospital público universitario en Santa Marta (Colombia) / Noise level in intensive care units of a public university hospital in Santa Marta (Colombia)

OBJETIVO: Evaluar el nivel de ruido en las unidades de cuidado intensivo adulto, pediátrico y neonatal de un hospital universitario de la ciudad de Santa Marta (Colombia). DISEÑO: Estudio descriptivo, observacional no intervencionista y con seguimiento a lo largo del tiempo. MATERIALES Y MÉTODOS: Se realizó un muestreo continuo durante 20 días por cada unidad utilizando un sonómetro tipo I, con filtro de ponderación frecuencial A y temporal Fast. Se registraron los valores máximos, el percentil 90 como ruido de fondo y el nivel continuo de ruido. RESULTADOS: Los niveles medios horarios variaron entre 57,40 ± 1,14-63,47 ± 2,13 dBA para la unidad de adultos, con un máximo entre 71,55 ± 2,32-77,22 ± 1,94dBA y un ruido de fondo entre 53,51 ± 1,16-60,26 ± 2,10 dBA; para la unidad pediátrica la media horaria se establece entre 57,07 ± 3,07-65,72 ± 2,46dBA, con un máximo de 68,69 ± 3,57-79,06 ± 2,34dBA, y de 53,33 ± 3,54-61,96 ± 2,85dBA de ruido de fondo; finalmente, la unidad neonatal reporta entre 59,54 ± 2,41-65,33 ± 1,77dBA la media horaria, los máximos entre 67,20 ± 2,13-77,65 ± 3,74dBA, y fondo de 55,02 ± 2,03-58,70 ± 1,95dBA. El ANOVA evidenció una diferencia significativa entre los valores horarios y entre las unidades de cuidado intensivo, mostrando una mayor influencia la hora del día. CONCLUSIONES: Los niveles de ruido en las unidades de cuidado intensivo se ven afectados por el tipo de unidad; se presentaron los valores más altos en la unidad pediátrica y los más bajos en la de adultos. No obstante, el parámetro que más influye en el nivel es la hora del día, con mayores niveles en la mañana y la tarde, y menores en la noche y la madrugada

OBJECTIVE: To evaluate the noise level in adult, pediatric and neonatal intensive care units of a university hospital in the city of Santa Marta (Colombia). DESIGN: A descriptive, observational, non-interventional study with follow-up over time was carried out. MATERIALS AND METHODS: Continuous sampling was conducted for 20 days for each unit using a type I sound level meter, filter frequency in A weighting and Fast mode. We recorded the maximum values, the 90th percentile as background noise, and the continuous noise level. RESULTS: The mean hourly levels in the adult unit varied between 57.40 ± 1.14-63.47 ± 2.13dBA, with a maximum between 71.55 ± 2.32-77.22 ± 1.94dBA, and a background noise between 53.51 ± 1.16-60.26 ± 2.10dBA; in the pediatric unit the mean hourly levels varied between 57.07 ± 3.07-65.72 ± 2.46dBA, with a maximum of 68.69 ± 3.57-79.06 ± 2.34dBA, and a background noise between 53.33 ± 3.54-61.96 ± 2.85dBA; the neonatal unit in turn presented mean hourly values between 59.54 ± 2.41-65.33 ± 1.77dBA, with a maximum value between 67.20 ± 2.13-77.65 ± 3.74 dBA, and a background noise between 55.02 ± 2.03-58.70 ± 1.95dBA. Analysis of variance revealed a significant difference between the hourly values and between the different units, with the time of day exhibiting a greater influence. CONCLUSIONS: The type of unit affects the noise levels in intensive care units, the pediatric unit showing the highest values and the adult unit the lowest values. However, the parameter exerting the greatest influence upon noise level is the time of day, with higher levels in the morning and evening, and lower levels at night and in the early morning

Nivel continuo equivalente de ruido en la unidad de cuidado intensivo neonatal asociado al síndrome de burnout / Equivalent continuous noise level in neonatal intensive care unit associated to burnout syndrome

Los niveles de ruido en las unidades de cuidado intensivo neonatal facilitan la aparición de síntomas asociados al síndrome de burnout como estrés, irritabilidad, fatiga e inestabilidad emocional sobre el equipo asistencial. El objetivo del presente trabajo fue evaluar los niveles continuos equivalentes de ruido en la unidad de cuidado intensivo neonatal y comparar los resultados con los niveles de ruido asociados a la aparición del síndrome de burnout sobre el personal asistencial. Se realizó un muestreo continuo durante 20 días utilizando un sonómetro tipo I en la unidad. Se registraron los valores máximos, el percentil noventa y el nivel continuo equivalente de ruido (Leq). El nivel de ruido se reporta en un rango de 51,4-77,6 decibelios A (dBA) con un promedio de 64 dBA, un máximo de 100,6 dBA, y un ruido de fondo promedio de 57,9 dBA. Los niveles de ruido sobrepasan los estándares sugeridos para unidades de cuidado intensivo neonatal, se encuentran cercanos a los valores máximos de exposición a ruido contemplados en la normativa ocupacional y a los niveles de ruido asociados a la aparición de burnout; lo que permite inferir la alta probabilidad de incidencia de los niveles de ruido presentes en la unidad sobre el desarrollo del síndrome de burnout en el personal asistencial

Noise levels in neonatal intensive care units allow the appearance of symptoms associated with burnout such as stress, irritability, fatigue and emotional instability on health care personnel. The aim of this study was to evaluate the equivalent continuous noise levels in the neonatal intensive care unit and compare the results with noise levels associated with the occurrence of burnout syndrome on the care team. Continuous sampling was conducted for 20 days using a type I sound level meter on the unit. The maximum, the ninetieth percentile and the equivalent continuous noise level (Leq) values were recorded. Noise level is reported in the range of 51.4-77.6 decibels A (dBA) with an average of 64 dBA, 100.6 dBA maximum, and average background noise from 57.9 dBA. Noise levels exceed the standards suggested for neonatal intensive care units, are close to maximum values referred for noise exposure in the occupational standards and to noise levels associated with the onset of burnout; thus allowing to infer the probability of occurrence of high levels of noise present in the unit on the development of burnout in caregivers

Characterisation of systemic reactions to subcutaneous immunotherapy with airborne allergens and classification according to WAO 2010

BACKGROUND: Systemic reactions (SR) to subcutaneous immunotherapy (SCIT) are rare but potentially severe. The use of different definitions and classifications hampered comparability between studies. AIMS: To determine the frequency of SR to SCIT with airborne allergens, and to characterise and classify them according to the WAO 2010 recommendations. METHODS: Cross-sectional, retrospective study. Data on patients, immunotherapy and SR to SCIT were collected from the SCIT record forms. During the study period, 22,332 SCIT injections were administered (3732 patients). RESULTS: A total of 26 SR (0.1% of administrations) were recorded in 16 (0.6%) patients (median age 22 years, nine males, all with rhinitis and nine with asthma). Twenty-one (81%) SR occurred during the induction phase; eight (31%) in the first hour after administration. According to the WAO 2010 classification, 12 (46%) were grade 1 and 14 (54%) were grade 2. Most grade 2 reactions occurred in asthmatics, presented as mild asthma symptoms and resolved without need for medical observation. Only two individuals without asthma presented grade 2 reactions, both with concurrent cutaneous and low respiratory symptoms; both required medical observation and treatment despite late onset; 82% (n = 12) of grade 2 reactions were late. No grade 3---5 reactions were registered and only one patient needed adrenaline treatment. No risk factors for SR to SCIT were identified in this study. CONCLUSIONS: SCIT is a safe treatment when administered by trained staff. The WAO 2010 classification might be useful for retrospectively classifying the severity of reactions, although its usefulness in treatment decision needs further research

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Validation of Total and Specific IgE Measurements in Induced Sputum

Durante los últimos años, se están analizando de forma exhaustiva los componentes solubles del esputo inducido, no obstante pocos estudios analizan la IgE total y específica y ninguno de ellos ha intentado validar la técnica. El objetivo de este estudio fue validar la cuantificación de IgE total y específica en el sobrenadante del esputo inducido y evaluar la influencia del procesamiento del mismo con dithiothreitol (DTT). La IgE total y específica fueron determinadas mediante el fluoroenzymoinmunoensayo ImmunoCAP (Phadia ThermoFisher Scientific). Para el proceso de validación utilizamos experimentos de adición de células del esputo con IgE total y específica (frente a Dermatophagoides pteronyssinus y Phleum pratense) en un rango de concentraciones de acuerdo a las recomendaciones de la ATS/ERS. Para las comparaciones intragrupo se utilizó el test de Wilcoxon y el coeficiente de correlación intraclase para evaluar el grado de acuerdo entre ambas mediciones. Fueron considerados como significativos valores de p <0.05. En cuanto a los resultados obtenidos en las muestras de esputo procedentes de 18 pacientes (13 con enfermedad pulmonar intersticial, 2 con asma alérgica y 3 controles sanos), 12 varones, con una edad media de 45.6 ± SD 15.8 años, se obtuvo una media de IgE total de 5.4 (P25-754.0-6.0) kU/L. La IgE específica frente a Dermatophagoides pteronyssinus y Phleum pratense fueron inferiores a 0.35 kUA/L en todas las muestras. Las cifras de recuperación de la IgE total y específica estaba por encima del 80% con un amplio rango de valores. No se hallaron diferencias significativas entre la cuantificación de IgE total y específica con PBS o con DTT, con un buen coeficiente de correlación intraclase (0.81; p=0.01). En conclusión, la cuantificación de IgE total y específica en esputo inducido utilizando un imnunoensayo comercializado es válido y presenta una alta dispersión de rangos de niveles de IgE (AU)

Background and objectives: Soluble components are increasingly analyzed in induced sputum supernatant. However, only a few studies have measured total or specific immunoglobulin (Ig) E in sputum and none have attempted to validate it. We aim to validate laboratory measurements of total and specific IgE in induced sputum supernatant and to evaluate the influence of sputum processing with dithiothreitol (DTT) on IgE measurements. Methods: Total and specific IgE were measured by ImmunoCAP and the process was validated using sputum spiking experiments with total and specific IgE (to Dermatophagoides pteronyssinus and Phleum pratense) over a range of concentrations according to international recommendations. The Wilcoxon signed-ranks test was used for within-group comparisons and intraclass correlation coefficients were used to evaluate agreement between measurements. Two-tailed P values lower than .05 were considered significant. Results: Samples from 18 patients (13 with interstitial lung disease, 2 with allergic asthma, and 3 healthy controls; 12 men; mean [SD] age, 45.6 [15.8] years) were evaluated. Median total IgE was 5.4 kU/L (interquartile range, 4.0-6.0 kU/L). Specific IgE levels to D pteronyssinus and P pratense were below 0.35 kUA/L in all samples. Recovery rates were above 80% for total and specific IgE over a wide range of values. No differences were found in total IgE measurements of sputum dispersed with DTT or phosphate-buffered saline, with a good intraclass correlation coefficient between both measurements (0.81, P=.01). Conclusions: Total and specific IgE measurements performed in induced sputum with a commercially available immunoassay are valid over a wide range of IgE levels (AU)

Maternal serum progesterone, estradiol and estriol levels in successful dinoprostone-induced labor

Hormone-mediated quiescence involves the maintenance of a decreased inflammatory responsiveness. However, no study has investigated whether labor induction with prostanoids is associated with changes in the levels of maternal serum hormones. The objective of this study was to determine whether labor induction with dinoprostone is associated with changes in maternal serum progesterone, estradiol, and estriol levels. Blood samples were obtained from 81 pregnant women at term. Sixteen patients had vaginal birth after spontaneous labor, 12 required cesarean section after spontaneous labor and 16 underwent elective cesarean. Thirty-seven patients had labor induction with dinoprostone. Eligible patients received a vaginal insert of dinoprostone (10 mg) and were followed until delivery. Serum progesterone (P4), estradiol (E2) and estriol (E3) levels and changes in P4/E2, P4/E3 and E3/E2 ratios were monitored from admission to immediately before birth, and the association of these measures with the resulting clinical classification outcome (route of delivery and induction responsiveness) was assessed. Progesterone levels decreased from admission to birth in patients who underwent successful labor induction with dinoprostone [vaginal and cesarean birth after induced labor: 23% (P < 0.001) and 18% (P < 0.025) decrease, respectively], but not in those whose induction failed (6.4% decrease, P > 0.05). Estriol and estradiol levels, P4/E2, P4/E3 and E3/E2 ratios did not differ between groups. Successful dinoprostone-induced labor was associated with reduced maternal progesterone levels from induction to birth. While a causal relationship between progesterone decrease and effective dinoprostone-induced labor cannot be established, it is tempting to propose that dinoprostone may contribute to progesterone withdrawal and favor labor induction in humans.

Microarray based IgE detection in poly-sensitized allergic patients with suspected food allergy - an approach in four clinical cases

Background: Component-resolved diagnosis and microarray technology have been recently introduced into clinical allergy practice, and may be particularly useful in poly-sensitized allergic patients. Methods: We compare the clinical usefulness of a microarray-based IgE detection assay (ISAC®) with skin tests and specific IgE with standard allergens (sIgE) or their monocomponents in four case reports of patients poly-sensitized to aeroallergens and food. Results: Case 1: a woman with rhinitis, oral allergy syndrome to several fruits and anaphylaxis to cherry. Diagnostic tests supported non-specific lipid transfer proteins (nsLTPs) primary sensitization. Case 2: a woman with exercise-induced asthma, rhino-conjunctivitis and oral allergy syndrome to fresh fruits of different families. A diagnosis of primary grass and weed pollen allergy with profilin and pathogenesis-related protein family 10 (PR-10) cross-reactive food allergy was proposed. Case 3: a man with atopic eczema, asthma, rhinitis, and multiple anaphylactic episodes with cashew nuts and oral allergy syndrome to fruits. The diagnostic workup supported a primary birch pollen allergy with PR-10 and nsLTPs cross-reactive food allergy. Case 4: a woman with rhino-conjunctivitis, per-operative anaphylaxis due to latex and recent pharyngeal angio-oedema episodes. The diagnosis was a primary grass and weed pollen allergy with equivocal profilin sensitization and no obvious cross-reactivity mediated by nsLTPs sensitization. Conclusions: The possibility to carry out multiple sIgE measurements with single protein allergens, in particular with the microarray technique, is a useful, simple and non-invasive diagnostic tool in complex poly-sensitized allergic patients(AU)

Influência de diferentes meios de cultura sobre o crescimento de Pfaffia glomerata (Spreng. ) Pedersen (Amaranthaceae) para conservação in vitro / Influence of different culture media on the growth of Pfaffia glomerata (Spreng. ) Pendersen (Amaranthaceae) for conservation in vitro

Pfaffia glomerata ocorre em vários estados do Brasil e países limítrofes da região Sul às margens de rios e nas orlas das matas de galerias, é espécie hidrófita e heliófita. As raízes de espécies do gênero Pfaffia são usadas na medicina popular brasileira, especialmente como tônico, afrodisíaco e no controle do diabete. O objetivo deste trabalho foi estabelecer um banco de germoplasma in vitro de Pfaffia glomerata. O experimento em delineamento inteiramente casualizado foi conduzido com seis tratamentos: 1) MS + 2 por cento de sacarose + 4 por cento de sorbitol; 2) MS/2 + 2 por cento de sacarose + 4 por cento de sorbitol; 3) MS + 2 por cento de sacarose + 4 por cento de sorbitol + 2 mg L-1 de pantotenato de cálcio; 4) MS/2 + 2 por cento de sacarose + 4 por cento de sorbitol + 2 mg L-1de pantotenato de cálcio; 5) MS + 2 por cento de sacarose + 3 por cento de manitol + 2 mg L-1de pantotenato de cálcio; 6) MS/2 + 2 por cento de sacarose + 3 por cento de manitol + 2 mg L-1de pantotenato de cálcio. Os resultados obtidos foram submetidos à análise de variância e ao teste de separação de médias de Scott Knott. Os tratamentos um, três e quatro apresentaram, significativamente, o maior número de segmentos nodais por haste, quando comparados com os tratamentos dois, cinco e seis. O tratamento dois foi o mais indicado para a conservação in vitro da espécie por ter promovido menor crescimento das plantas (altura de 3,1±1,9 cm), alto índice de sobrevivência, 100 por cento de explantes com brotação e o maior número de brotos por explante, após seis meses de cultivo. Todas as plântulas produziram raízes e não houve formação de calos, também não ocorreu hiperhidricidade nos tratamentos avaliados. As plantas aclimatizadas apresentaram 100 por cento de sobrevivência no ambiente ex vitro. A manutenção de acessos de P. glomerata no banco de germoplasma in vitro é viável tanto do ponto de vista da conservação quanto economicamente.

Pfaffia glomerata occurs in several states of Brazil and its neighboring countries in the south region at riverbanks and gallery forests. It is a hydrophyte and heliophyte species. The roots of the genus Pfaffia are used in Brazilian folk medicine especially as tonic, aphrodisiac and to control diabetes. The aim of this work was to establish an in vitro germplasm bank for Pfaffia glomerata. The experiment was carried out in completely randomized design with six treatments: 1) DM + 2 percent sucrose + 4 percent sorbitol; 2) DM/2 + 2 percent sucrose + 4 percent sorbitol; 3) DM + 2 percent sucrose + 4 percent sorbitol + 2 mg L-1 calcium pantothenate; 4) DM/2 + 2 percent sucrose + 4 percent sorbitol + 2 mg L-1 calcium pantothenate; 5) DM + 2 percent sucrose + 3 percent mannitol + 2 mg L-1 calcium pantothenate; 6) DM/2 + 2 percent sucrose + 3 percent mannitol + 2 mg L-1 calcium pantothenate. Results were subjected to analysis of variance and Scott Knott test for mean grouping. Treatments 1, 3 and 4 had a significantly larger number of nodal segments per stem, compared to Treatments 2, 5 and 6. Treatment 2 was the most appropriate for the in vitro conservation of this species since it led to the lowest growth (3.1±1.9 cm height), high survival rate, 100 percent explants with sprouting, and the largest number of sprouts per explant after six months of culture. All seedlings produced root and showed no formation of calluses or hyperhydricidity under the evaluated treatments. Acclimatized plants showed 100 percent survival in the ex vitro environment. Maintaining P. glomerata accessions in an in vitro germplasm bank is viable both economically and for conservation.

Genetic organisation of Iris yellow spot virus M RNA: indications for functional homology between the G(C) glycoproteins of tospoviruses and animal-infecting bunyaviruses.

The complete nucleotide sequence (4838 nucleotides) of Iris yellow spot virus (IYSV) M RNA indicates, typical for tospoviruses, the presence of two genes in ambisense arrangement. The vRNA ORF codes for the potential cell-to-cell movement (NSm) protein (34.8 kDa) and the vcRNA ORF for the viral glycoprotein (G1/G2) precursor (128.6 kDa). Multiple sequence alignment of the NSm and G1/G2 precursor proteins of IYSV with those of other tospoviruses, showed highest homologies to Peanut bud necrosis virus (PBNV) and Watermelon silver mottle virus (WSMV). The potential cell-to-cell movement protein of tospoviruses is highly conserved (40-70% identity), with the exception of the first 60 N terminal amino acids, a domain that clearly diverged. For the G1 and G2 viral glycoproteins, blast searches revealed a significant homology between the C-terminally located tospoviral G1 (G(C)) protein with the counterpart of the animal-infecting bunyaviruses, suggesting a functional homology for these proteins.