The international survey on the management of allergic rhinitis by physicians and patients (ISMAR).

Epidemiologic studies suggest that the prevalence of allergic rhinitis (AR) is rising worldwide. Several reports, in fact, indicate increasing trends in the prevalence of AR especially in developing countries, likely related to the environment and climate changes and the adoption of an urbanized Western lifestyle. The primary objective of the present study was to collect information about management in real-life settings, including a characterization of typical patients' profile referring to physicians, the disease features, the common approaches to diagnostic assessments and therapeutic decisions. This was an international, multicenter, cross-sectional study conducted in adults or children (≥6 years) suffering from rhinitis confirmed by physician's diagnosis for at least one year. The 234 physicians who participated in the study included a total of 2778 patients in Egypt, Mexico, Brazil, Colombia, Guatemala, Iran, Venezuela, Argentina, Israel, Kuwait and United Arab Emirates. It was found that clinical history was the selected tool to diagnose and categorize AR patients (97.1%), with less than half of patients undergoing allergy testing, may be explaining the scarce use of immunotherapy on management of disease. Out of 2776 patients, 93.4% had somehow received a recommendation to avoid allergens and irritant agent exposure. Notably, 91.4% were receiving at least one treatment at the time of the survey, mostly oral antihistamines (79.7%) and intranasal corticosteroids (66.3%). Oral antihistamines, intranasal steroids and decongestants were considered both safe and effective by patients and physicians, preferring oral and nasal route of administration. The ISMAR registry was designed according to the most accepted epidemiological recommendations, and provides interesting information regarding the management of rhinitis from a patient and physician points of view, with many similarities between the participating countries. Further efforts are required to better manage AR and its comorbidities.

Measurement of IgE antibodies to shrimp tropomyosin is superior to skin prick testing with commercial extract and measurement of IgE to shrimp for predicting clinically relevant allergic reactions after shrimp ingestion.

BACKGROUND: Shrimp is a frequent cause of food allergy. Tropomyosin is the major allergen in shrimp, and it shares homology to tropomyosins from other crustaceans, dust mites, cockroach, and parasites. OBJECTIVE: The aim of this study was to determine the value of detection of IgE to shrimp tropomyosin in the diagnosis of shrimp allergy. METHODS: We have studied 35 patients with asthma, rhinitis, or both who were sensitized to Dermatophagoides pteronyssinus. All subjects underwent skin prick testing in addition to double-blind, placebo-controlled food challenges (DBPCFC); oral open challenges; or both with shrimp. Measurements of IgE to shrimp and shrimp tropomyosin were carried out by means of CAP and chimeric ELISA, respectively. RESULTS: Oral challenges confirmed the diagnosis of shrimp allergy in 7 patients. IgE measurement to shrimp tropomyosin was positive in 71.4% of the patients with shrimp allergy. Of the 28 patients without shrimp allergy, only 7.1% (2/28) had IgE to shrimp tropomyosin compared with 25% (7/28) who had IgE to shrimp and 35.7% (10/28) who had positive skin prick test responses to shrimp. Sensitivity was similar for all 3 methods (71.4%); in contrast, specificity of IgE to shrimp tropomyosin (92.8%) was greater than that of IgE to shrimp (75%) and skin prick testing (64.2%). With regard to diagnostic efficiency, measurement of IgE to shrimp tropomyosin was superior to measurement of IgE to shrimp and skin prick testing (88.5%, 74.2%, and 65.7%, respectively). CONCLUSION: Use of measurements of IgE to shrimp tropomyosin provided added value to the diagnosis of shrimp allergy.

Exposição alergênica e sintomas respiratórios em ambientes climatizados / Allergen exposure and respiratory symptoms in air conditioned environments

Objetivos: Analisar a prevalência de sintomas respiratórios em funcionários de escritórios e avaliar aassociação desses sintomas com a exposição a alérgenose com as características do sistema de ventilação. Métodos: os funcionários foram agrupados deacordo com as características do sistema de condicionamento do ar no local de trabalho, sendo: o sistema 1 (S-1) com maquinário e tubulações do sistema com mais de 20 anos de uso, o sistema 2 (S-2) com maquinário com mais de 20 anos, e as tubulações com menosde dois anos de uso e o sistema 3 (S-3) com maquinárioe tubulações com menos de dois anos de uso. Foi realizado um estudo de prevalência de sintomas alérgicos ocupacionais e antecedentes atópicos entre 286 funcionários. Os alérgenos de fungos, ácaros, pêlosde animais e de baratas, foram quantificados. Comoseguimento, foi realizada a intervenção em S-1 e o estudo de prevalência foi refeito após um ano. Resultados: Foi identificada associação de sintomas naso-oculares (p=0,01 e OR=8,49) e piora dos sintomas com a ocupação de S-1 (p=0,004 e OR= 8,53). Neste mesmo local, foram encontradas umidade relativa do ar mais baixa (p=0,05) e taxas de filtração mais variáveis. O número total de esporos de fungos viáveis foi maior no ambiente externo do que no interno (n=45 p=0,017). Níveis detectáveis de alérgenos de animais domésticos foram verificados. A intervenção foi capaz de reduzir significativamente os riscos encontrados em S-1. Conclusão: O uso prolongado de sistemas de ar-condicionado sem manutenção preventiva apresentouassociação positiva com sintomas respiratórios, passíveisde serem revertidos com intervenções apropriadas.

Decreased respiratory symptoms after intervention in artificially ventilated offices in São Paulo, Brazil.

BACKGROUND: The increase in work-related respiratory complaints in artificially ventilated buildings have multiple causes, and intervention studies are a valuable approach to understanding possible mechanisms. STUDY OBJECTIVES: To analyze the effects of an intervention in a ventilation system with > 20 years of continuous use, and with a high rate of building-related respiratory complains. DESIGN: An epidemiologic study was done among individuals working in places with ventilation machinery and ducts with > 20 years of use, before and after intervention. Analysis of symptoms and logistic regression were performed to check the associations between air-conditioning intervention and reported symptoms. RESULTS: The air-conditioning intervention showed a protective effect on building-related worsening of respiratory symptoms (odds ratio, 0.132; 95% confidence interval, 0.030 to 0.575), naso-ocular symptoms (odds ratio, 0.231; 95% confidence interval, 0.058 to 0.915), and persistent cough (odds ratio, 0.071; 95% confidence interval, 0.014 to 0.356). CONCLUSION: Intervention in high-risk occupational locations can be effective in improving perceived indoor air quality.

Upper respiratory symptoms associated with aging of the ventilation system in artificially ventilated offices in São Paulo, Brazil.

BACKGROUND: The increase of work-related respiratory complaints in artificially ventilated buildings has multiple causes, and the role of allergen exposure and symptoms is still controversial. STUDY OBJECTIVES: To analyze the risk factors and the association of work-related symptoms with allergen exposure and different conditions of the same air conditioning system in São Paulo, Brazil. DESIGN: Workers were classified according to characteristics of the air conditioning system: the first group (group 1) with ventilation machinery and ducts with > 20 years of use, the second group (group 2) with ventilation machinery with > 20 years of use and ventilation ducts with < 2 years of use, and the third group (group 3) with ventilation machinery and ducts with < 2 years of use. Logistic regression was performed to check the associations between air conditioning groups, allergen exposure (fungi, mites, animal dander, and cockroach), and symptoms. RESULTS: There was a higher prevalence of building-related worsening of respiratory symptoms (p = 0.004; odds ratio [OR], 8.53) and symptoms of rhinoconjunctivitis (p = 0.01; OR, 8.49) in group 1. There was a lower relative humidity (p = 0.05) and nonsignificant lower temperature in group 1, when compared to the other groups. The viable mold spores totals were higher outdoors than in the indoor samples (n = 45, p = 0.017). There were higher levels of Der p 1 in group 2 (p = 0.032). All allergen levels were considered low. CONCLUSION: There was a strong association of building-related upper-airway symptoms with places having ventilation systems with > 20 years of use.

Transporte passivo de alérgenos de cão e gato em edifícios de escritórios / Passive transport of dog and cat allergens in office buildings

Objetivos: Verificar a prevalência de sintomas alérgicos e a exposição alergênica em população alocada em edifícios de escritórios. Métodos: Um estudo de prevalência foi realizado entre 330 funcionários, por meio de questionário padronizado e revalidado sobre sintomas respiratórios alérgicos, antecedentes atópicos e tabagismo. Amostras de poeira foram coletadas (n=18) e analisadas mediante a técnica de ELISA quanto aos níveis dos alérgenos Der p 1, Der p 2, Der f 1, Blo t 5, Can f 1, Fel d 1, Bla g 1 e Bla g 2. Resultados: Foram encontradas prevalências de 33,2 per cent de sintomas de rinoconjuntivite, 35,9 per cent de sintomas de sinusite, 33,5 per cent de tosse produtiva persistente e 31,1 per cent de piora ocupacional dos sintomas respiratórios. Além disso, 14,7 per cent da população estudada relatou episódios de sibilos recorrentes. Os níveis de Der p 1 variaram de 0,06 até 1,96 mg/g de poeira, Fel d 1 de 0,1 até 0,71mg/g e Can f 1 de 0,18 a 6,6 mg/g. Os níveis de Bla g 1, Bla g 2 e Blo t 5 foram indetectáveis. Discussão: Foi relatada alta prevalência de sintomas respiratórios relacionados ao local de trabalho sugestivos de processos alérgicos neste grupo de indivíduos trabalhando sob condicionamento central do ar, com a presença de alérgenos domiciliares no local de trabalho. Conclusões: Os locais estudados foram caracterizados por alta prevalência de sintomas respiratórios sugestivos de alergias respiratórias nos seus ocupantes, níveis totais de alérgenos baixos, mas com evidências de transporte passivo de alérgenos.

Fístula liquórica como diagnóstico diferencial de rinite / Cerebrospinal fluid fistula as differential diagnosis from rhinitis

A rinite alérgica representa uma das doenças mais freqüentes na prática diária do alergologista, otorrinolaringologista e do clínico, caracterizando-se clinicamente por espirros mültiplos, coriza hialina, prurido e obstruçäo nasais. A fístula liquórica, mesmo sendo pouco freqüente, é diagnóstico diferencial importante das rinites. Nesta revisäo procuramos abordar, de forma sucinta, características clínicas, fisiopatologia, diagnóstico laboratorial e tratamento da entidade.