Effectiveness and safety of Omalizumab in the treatment of chronic spontaneous urticaria: Systematic review and meta-analysis.

INTRODUCTION: Chronic spontaneous urticaria (CSU) affects approximately 1% of the population, affecting both children and adults. Omalizumab (Oma) is a therapeutic option for patients with refractory forms of CSU. OBJECTIVES: To determine the effectiveness and safety of Oma in the treatment of CSU. METHODS: Systematic review (Cochrane Collaboration methodology) of randomized clinical trials comparing Oma to placebo in refractory CSU treatment. The search is based on MEDLINE; EMBASE, Central Cochrane Library, and LILACS. The outcomes evaluated were: control of the illness, adverse events, and quality of life. RESULTS: Of the 848 identified studies 13 were selected for further review and six were included in the meta-analysis. For all outcomes, high-quality evidence has confirmed that Oma is effective in the treatment of CSU. The dosage of 300mg/month achieved better results; namely a significant reduction in pruritus, papules, and urticaria activity, as well as an increase in the number of patients with a controlled condition, improvement in the quality of life and no differences in adverse events compared to the placebo. CONCLUSIONS: High-quality evidence demonstrates that Oma is effective and safe in the treatment of CSU refractory to therapy with H1 antihistamines.

[HIV/AIDS infection. The Brazilian view. AIDS in Brazil]. / Infecção HIV/AIDS. Visão brasileira. AIDS in Brazil.

The Ministry of Health coordinates and orients in Brazil all the activities concerning the acquired immunodeficiency syndrome which is officially designated as AIDS. The first AIDS' case registered in Brazil was, by retrospective diagnosis, in 1981 but it was in 1982 that the first two diagnosis in live patients were made. The incidence is very high in this country that is among the ones where the higher number of cases are being registered. The great majority of the Brazilian cases occurs in the cities and in direct proportion to the population index. The groups of risk are the same universally known and a comparative increase of heterosexual transmission is noted, chiefly due to the use of injectable drugs and bisexuality of the male partners. Another problem that is being increased is pediatric AIDS, with raising importance of perinatal transmission as well as the use of injectable drugs and precocious prostitution in adolescence. The transfusional and haemophilic AIDS have proportionally decreased due to the control of blood products. The control and the orientation activity of the Ministry of Health is directed to varied points such as: compulsory cases notification, cooperation between public and private sectors, preventive and sexual orientation, freely delivered medication and laboratory tests including sigilous tests, lay and technical personnel preparation, diversified informative and educational campaigns. Trial tests with anti-HIV vaccines have begun to be performed. Multiple Reference Centers were officially established by the administration. Among them is to be quoted the Hospital Universitário Gaffrée Guinle of Rio de Janeiro where the authors work. It is credited for its intensive activity and pioneerism. In this Institution special attention was due against discrimination of HIV-infected patients, to diagnosis, to anonymous and sigilous tests, to medical and psychological assistance, to myocardium involvement, to the virologic study of the Brazilian HIV samples, to research on HIV immunogenicity and pathogenicity, to post-mortem diagnosis control through necropsies.

Immune complex-dissociated p24 antigenemia in the diagnosis of human immunodeficiency virus infection in vertically infected Brazilian children.

PIP: A retrospective cohort study evaluated the presence of immune complex-dissociated (ICD) p24 antigen in frozen plasma samples of 40 children born to HIV-seropositive mothers and followed in the outpatient clinic of Gaffree-Guinle University Hospital. ICD has been helpful in the early diagnosis of infants born of HIV-seropositive mothers within the first 2 months of life. After testing all charts were reviewed for evidence of HIV-related clinical findings and determination of HIV serology until the child reached 24 months of age. The children were all born to HIV-infected Brazilian women between 1984 and 1992. 17 boys (mean age at first evaluation for HIV infection, 17.3 months) and 23 girls (mean age at first evaluation, 16.8 months) were included. Of the 17 boys, 9 were Caucasian and 8 were African-Brazilian; 11 girls were Caucasian and 12 were African-Brazilian. An immune complex disruption procedure was performed at the Universidade do Rio de Janeiro on 100-mcl aliquots of serial plasma samples from the 40 patients enrolled. 200 mcl of treated plasma were then assayed for the presence of p24 antigen through a quantitative enzyme immunoassay. 21 of 40 (52%) infants were identified as HIV-infected through persistent HIV seropositivity after 18 months of age. ICD p24 antigen was detected in at least 1 plasma specimen from 15 of 21 (71.4%) of HIV-infected children, whereas p24 antigen was present in 11 of 21 (52.4%) children infected with HIV. The sensitivity of ICD p24 antigen in diagnosing HIV infection in this cohort of children was 71.4%, whereas that of p24 antigen was 52.4%. The highest mean titers of HIV ICD p24 antigen were observed between 7 and 12 months of life. A history of breast-feeding was present in 18 of 21 (86%) of the HIV-infected infants and in only 5 of 19 (26%) of the uninfected children (p 0.001). In 21 HIV-infected children, 12 (57%) were asymptomatic and 9 (43%) were symptomatic at the time the first ICD p24 antigen test was obtained.^ieng