Herberto José Chong-Neto

Pediatric allergy and immunology in Brazil

The subspecialty of pediatric allergy and immunology in Brazil is in its early years and progressing steadily. This review highlights the research developed in the past years aiming to show the characteristics of allergic and immunologic diseases in this vast country. Epidemiologic studies demonstrated the high prevalence of asthma in infants, children, and adolescents. Mortality rates and average annual variation of asthma hospitalization have reduced in all pediatric age groups. Indoor aeroallergen exposure is excessively high and contributes to the high rates of allergy sensitization. Prevalence of food allergy has increased to epidemic levels. Foods (35%), insect stings (30%), and drugs (23%) are the main etiological agents of anaphylaxis in children and adolescents. Molecular diagnosis of primary immunodeficiencies (PID) showed a high incidence of fungal infections including paracoccidioidomycosis in X‐linked hyper‐IgM syndrome, and the occurrence of BCG adverse reactions or other mycobacterial infections in patients with chronic granulomatous disease. Education in pediatric allergy and immunology is deficient for medical students, but residency programs are effective in training internists and pediatricians for the practice of allergy. The field of PID requires further training. Last, this review is a tribute to Prof. Dr. Charles Naspitz, one of the pioneers of our specialty in Brazil.

Early weight gain and the development of asthma and atopy in children.

Purpose of reviewTo provide perspective to the most recent evidence regarding the association between early weight gain in infancy and the development of asthma and atopy during childhood, and highlight the potential mechanisms involved. Recent findingsRecently, several birth cohort studies involving more than 25 000 children have found a consistent association between early weight gain in the first 2 years of life and incident asthma during school age. Methodology differs substantially between the studies and complicates the establishment of definite conclusions. Specific mechanisms for this association have been proposed, including impairment in lung development and elevated levels of growth factors and cytokines associated with airway inflammation and remodeling. A limited number of studies indicate that early weight gain in infancy is also associated with recurrent wheezing during preschool age but not with the development of atopy. SummaryA consistent association between early weight gain in infancy and incident asthma during school age has been observed in several cohort studies. The identification of this modifiable risk factor for the development of asthma opens the possibility of preventive intervention. Additional studies are necessary to clarify the involved mechanisms and some pending questions, such as the influence of early weight gain in asthma phenotypes and severity.

MUTAÇÕES DO GENE DO RECEPTOR DE VITAMINA D E NÍVEIS SÉRICOS DE VITAMINA D EM CRIANÇAS COM ASMA

ABSTRACT Objective: To verify the relationship between polymorphisms of the vitamin D receptor gene (VDR), clinical findings, and serum vitamin D (VD) levels in asthmatics. Methods: A cross sectional study of 77 children aged 7 to 14 years old, who were attended at a specialized clinic. The children were divided into 3 groups: asthmatics who had been using inhaled corticosteroids (ICS) for more than one year; asthmatics who had not been using ICS; non-asthmatics, and children without allergies (according to the International Study of Asthma and Allergies in Childhood - ISAAC). Spirometry, skin prick tests, the presence of a VDR promoter CDX2 polymorphism from an allele-specific polimerase chain reaction (PCR), exons 2 and 3 polymorphisms genotyping by PCR-SSCA (single-strand conformational analysis), total immunoglobulin E (IgE) and specific IgE to mites and grass were evaluated in these three groups. Levels of 25-hydroxyvitamin D were determined in asthmatics only. Results: The mean age of the children was 10.8±2.0 years old, 57% were male, 38 were asthmatic and using ICS, 22 were asthmatic and not using ICS, and 17 were non-asthmatic. Allergic rhinitis was present in 90% of asthmatics. Homozygous CDX2 was detected in 23% of the patients and absent in the control group (p=0.03). Lower forced expiratory volume in 1 second (FEV1%) values were observed in CDX2 homozygous asthmatics (p=0.001). Variations in the exon 2 and 3 sequences were not related to asthma or the other tests. VD deficiency or insufficiency was detected in 98% of asthmatics. There was no association between VD levels and genetic polymorphisms from exons 2 and 3. Conclusions: There was a positive association between homozygous CDX2 polymorphism, asthma and lower FEV1% values. CDX2 is capable of modifying cell interaction between VDR and VD, and it could be associated with the prevalence of asthma, and the difficulty in controlling the disease.

Brazilian Guidelines for Hereditary Angioedema Management - 2017 Update Part 1: Definition, Classification and Diagnosis

Hereditary angioedema is an autosomal dominant disease characterized by recurrent angioedema attacks with the involvement of multiple organs. The disease is unknown to many health professionals and is therefore underdiagnosed. Patients who are not adequately diagnosed and treated have an estimated mortality rate ranging from 25% to 40% due to asphyxiation by laryngeal angioedema. Intestinal angioedema is another important and incapacitating presentation that may be the main or only manifestation during an attack. In this article, a group of experts from the “Associação Brasileira de Alergia e Imunologia (ASBAI)” and the “Grupo de Estudos Brasileiro em Angioedema Hereditário (GEBRAEH)” has updated the Brazilian guidelines for the diagnosis and treatment of hereditary angioedema.

Anafilaxia na sala de emergência: tão longe do desejado!

RESUMO 1. Mestranda em Saúde Coletiva, Universidade Federal do Paraná (UFPR), Curitiba, PR. 2. Acadêmico(a) de Medicina, UFPR, Curitiba, PR. 3. Professor Titular de Pediatria, UFPR, Curitiba, PR. 4. Professor Adjunto de Pediatria, UFPR, Curitiba, PR. 217 Objetivo: Anafilaxia é a mais dramática condição clínica da emergência em alergia. O objetivo deste estudo foi verificar o conhecimento de médicos em serviços de urgência e emergência sobre o manejo da anafilaxia. Métodos: Estudo transversal, onde foi aplicado questionário escrito para 119 médicos em oito hospitais (grupo Hospital) e 210 médicos de nove Unidades de Pronto Atendimento/Serviço de Atendimento Móvel de Urgência (grupo UPA/SAMU) entre abril e setembro/2016. Resultados: Entre os convidados, responderam ao questionário 79 (66,4%) médicos que atuavam em Hospital, e 78 (37,1%) em UPA/SAMU. Cento e vinte e dois participantes (78,7%) se formaram há até 10 anos. Sessenta e nove médicos (43,9%) acertaram o diagnóstico de anafilaxia, e apenas 29 (18,5%) identificaram os sistemas que podem ser acometidos na reação anafilática. A adrenalina intramuscular foi referida como primeira opção de tratamento da anafilaxia por 64 (40,7%), e o glucagon foi escolhido como opção em pacientes que utilizam ß-bloqueadores por 19 (12,1%) dos médicos. A orientação quanto aos autoinjetores foi referida por 71 (45,3%) dos médicos. Conclusão: O nível de conhecimento médico em serviços de urgência e emergência sobre o manejo da anafilaxia é baixo. As diretrizes não são seguidas e podem resultar em desfecho desfavorável ao paciente com reação anafilática. Descritores: Anafilaxia, adrenalina, conhecimento, serviços médicos de emergência. Objective: Anaphylaxis is the most dramatic clinical presentation of allergy in the emergency setting. The aim of this study was to assess knowledge on anaphylaxis management among physicians working at emergency services. Methods: A cross-sectional study was carried out and a written questionnaire was applied to 119 physicians working at eight hospitals (Hospital group) and to 210 physicians working at nine emergency services/mobile emergency services (UPA/SAMU group) between April and September 2016. Results: Among the respondents, 79 (66.4%) physicians worked at hospitals and 78 (37.1%) at emergency services. One hundred twenty-two participants (78.7%) had graduated less than ten years earlier. Sixty-nine physicians (43.9%) correctly diagnosed anaphylaxis, and only 29 (18.5%) identified the systems that could be affected in an anaphylactic reaction. Intramuscular adrenaline was reported as the first treatment option for anaphylaxis by 64 physicians (40.7%), and glucagon was chosen as an option in patients using ß-blockers by 19 (12.1%). The use of auto-injectors was referred by 71 (45.3%) of the physicians. Conclusion: The level of medical knowledge on anaphylaxis management in emergency departments is low. Guidelines are not followed and may result in an unfavorable outcome for patients presenting with an anaphylactic reaction.

United airway disease: a reality in early life?

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