Augusto Tiaqui Abe

Atopy patch test (APT) in the diagnosis of food allergy in children with atopic dermatitis

BACKGROUND Atopic Dermatitis is a chronic inflammatory skin disease. Food allergens are important in the pathogenesis in 1/3 of the cases. Several mechanisms are involved in the pathogenesis of Atopic Dermatitis. Immediate reactions are identified by both measurement of specific IgE and skin prick test. Atopy Patch Test seems to be relevant in the investigation of patients with suspected delayed-type reactions. OBJECTIVES To evaluate the standardization of this method concerning allergen concentration, occlusion time and interpretation, and determine the specificity and sensitivity of the Atopy Patch Test according to the skin prick test and specific IgE levels in food allergy diagnosis in children with Atopic Dermatitis. METHODS Seventy-two children, aged 2-12 years were selected and followed at the allergy clinic of the Hospital São Zacharias. Skin prick test, specific IgE and food Atopy Patch Test (cows milk, egg, soy and wheat) were carried out. Three groups were submitted to the Atopy Patch Test: (1) Atopic Dermatitis with or without Rhinitis and Asthma; (2) Rhinitis and or Asthma without AD; (3) Healthy individuals. RESULTS In group 1, 40% of the patients presented positive reactions. The longer the exposure time (48h and 72h), the higher the sensitivity. In group 2, the test was more specific than sensitive for all the extracts, with increased sensitivity the longer the time of exposure (72h). In group 3, 8.3% presented positive tests. CONCLUSION APT evidenced a great diagnostic value in late-phase reactions to food, with high specificity. It showed to be a specific and reliable tool in comparison with the healthy groups results.FUNDAMENTOS: A Dermatite Atopica e uma doenca inflamatoria cronica da pele. Os alimentos sao importantes na patogenese da doenca em 1/3 dos casos. Diversos mecanismos estao envolvidos na fisiopatogenia da dermatite Atopica. As reacoes imediatas sao identificadas pela dosagem de IgE especifica e teste de puntura. O teste de contato atopico parece ter relevância na investigacao de pacientes com suspeita de reacao tardia. OBJETIVOS: Avaliar a padronizacao do metodo com relacao a concentracao do alergeno, tempo de oclusao e de interpretacao; e determinar a especificidade e a sensibilidade do teste de contato atopico em relacao ao teste de puntura e a dosagem de IgE especifica, no diagnostico de alergia alimentar em criancas com dermatite Atopica. METODOS: Setenta e duas criancas com 2 a 12 anos foram submetidas a teste de puntura e dosagem de IgE especificas para alimentos (leite de vaca, ovo, soja, trigo). O teste de contato atopico foi aplicado em 3 grupos: (1) Dermatite Atopica com ou sem Rinite e Asma; (2) Rinite e ou Asma sem Dermatite Atopica; (3) Saudaveis. RESULTADOS: No grupo 1, 40% dos pacientes apresentaram reacao positiva. Quanto maior o tempo de exposicao, maior foi a sensibilidade. No grupo 2, o teste foi mais especifico que sensivel para todos os extratos; com aumento da sensibilidade com maior tempo de exposicao (72h). No grupo 3, 8.3% apresentaram testes positivos. CONCLUSAO: O teste de contato atopico mostrou ter valor diagnostico em relacao as reacoes de fase tardia a alimentos, com elevada especificidade. Mostrou-se um teste especifico e confiavel ao comparar com os resultados do grupo controle.

Clinical and laboratorial factors and their relation to asthma severity

Patients and methods We have studied 142 patients with asthma, diagnosed by clinical spirometric findings, attended at the Clinical Immunology outpatient service of an University Hospital. They were divided into two groups according to their asthma severity: group 1 (n=72), mild intermittent or mild persistent asthma, and group 2 (n=70) with moderate or severe asthma. They were submitted to medical history, physical examination and laboratorial routine tests, x-rays, spirometry and aeroallergens skin prick tests, and their findings were compared between both groups.

Drug rash induced by levothyroxine and oral desensitization

Methods We report a case of drug rash induced by levothyroxine and currently oral desensitization. A 31 year-old woman had been diagnosed as Hashimoto’s Thyroiditis. She was having levothyroxine for 9 years when she begun to present bilateral eyelids maculopapular rash. Blood exams and physical examination were normal except for the eyelids rash. As she stopped using levothyroxine, the rash has disappeared. Her endocrinologist prescribed her other brands of levothyroxine, and the patient reported the same reaction.

Teste de contato atópico com aeroalérgenos: uma ferramenta promissora no diagnóstico da dermatite atópica

RESUMO Teste de contato atopico com aeroalergenos: uma ferramenta promissora no diagnostico da dermatite atopica 1 Servico de Alergia, Hospital Sao Zacharias, Rio de Janeiro, RJ. 2 Hospital Geral de Nova Iguacu, Nova Iguacu, RJ. 3 Servico de Imunologia, Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ. 4 FDA Allergenic. Artigo Original Braz J Allergy Immunol. 2013;1(1):65-70. Atopy patch test with aeroallergens: a promising tool in the diagnosis of atopic dermatitis Sergio Duarte Dortas Junior, MD, MSc1,2, Soloni Afra Pires Levy, MD1, Andrea Huguenim Silva Pires, MD, MSc1, Augusto Tiaqui Abe, MD1, Solange Oliveira Rodrigues Valle, MD, PhD1,3, Vilma Perez Coelho, MD1, Ludwig Ruppert Hahnstadt, MSc4, Alfeu Tavares Franca, MD, PhD1,3 Objetivos: Avaliar a padronizacao do metodo com relacao a concentracao do aeroalergeno, tempo de oclusao, de interpretacao; e determinar a especificidade e a sensibilidade do teste de contato alergico (TCA) em relacao ao teste por puntura e a dosagem de IgE especifica, na verificacao da sensibilizacao a acaros em criancas com dermatite atopica (DA). Metodos: Foram selecionadas 72 criancas com idade entre 2 e 12 anos, acompanhadas no ambulatorio de alergia do Hospital Sao Zacharias. Estas foram submetidas a teste de puntura, dosagem de IgEs especificas e TCA para acaros (Dermatophagoides pteronyssinus, Dermatophagoides farinae e Blomia tropicalis). Os testes foram realizados em 3 grupos: (1) DA com ou sem rinite e asma, (2) Rinite e/ou asma sem DA, (3) Saudaveis (controle). Resultados: No grupo 1, 40% dos pacientes apresentaram reacao positiva. A sensibilidade foi maior nos pacientes com maior tempo de exposicao (48 h e 72 h). No grupo 2, o TCA foi mais especifico que sensivel para todos os extratos, com aumento da sensibilidade quanto maior o tempo de exposicao (72 h). No grupo 3, apenas 8,3% apresentaram positividade a algum aeroalergeno do TCA. Conclusao: O TCA mostrou ter valor diagnostico em relacao as reacoes de fase tardia a acaros (D. pteronyssinus, D. farinae e B. tropicalis), com elevada especificidade. Ele demonstrou ser um teste confiavel quando comparado aos resultados do grupo controle. Descritores: Dermatite atopica, teste de contato atopico, acaros. Objectives: To evaluate the standardization of the atopy patch test (APT) with regard to concentration of aeroallergens, occlusion time, and interpretation, and to determine the specificity and sensitivity of the method in relation to prick test and serum specific IgE determination in the investigation of dust mite sensitization in children with atopic dermatitis (AD). Methods: Seventytwo children, ranging from 2 to 12 years of age, were selected among those receiving care at the allergy outpatient clinic of Sao Zacharias Hospital. Children underwent skin prick testing, specific IgE measurements, and APT for mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis). Tests were performed in three groups: (1) AD with or without rhinitis and asthma; (2) rhinitis and/or asthma without AD; (3) healthy individuals (controls). Results: In group 1, 40% of the patients presented positive reactions. Sensitivity was higher in patients with longer exposure times (48 h and 72 h). In group 2, APT was more specific than sensitive for all extracts, with increasing sensitivity associated with longer times of exposure (72 h). In group 3, only 8.3% of the individuals were positive to any aeroallergen on APT. Conclusion: APT seems to have diagnostic value in identifying late phase reactions to mites (D. pteronyssinus, D. farinae, and B. tropicalis), with high specificity, and proved to be a reliable test when compared with the results obtained for controls.

Prevalence of autoantibodies in a group of hereditary angioedema patients

Hereditary Angioedema is a dominantly inherited disease. Routine screening of autoantibodies (AAB) is not recommended for individuals with Hereditary Angioedema; however, prevalence of these antibodies in Hereditary Angioedema patients is not well documented. We aim to determine the prevalence of AAB so that individuals at risk of developing autoimmune diseases can be identified. Fifteen patients with Hereditary Angioedema attended at Clementino Fraga Filho University Hospital accepted to participate in this study. Prevalence of AAB was 40%. Our data indicate high prevalence of AAB in patients with Hereditary Angioedema. Large-scale studies should be considered to determine the significance of these AAB in the follow-up care of patients with Hereditary Angioedema.