Jorgete Silva

Risk factors for wheezing in a subtropical environment: Role of respiratory viruses and allergen sensitization

Abstract Background Risk factors for acute wheezing among children in subtropical areas are largely unknown. Objective To investigate the role of viral infections, allergen sensitization, and exposure to indoor allergens as risk factors for acute wheezing in children 0 to 12 years old. Methods One hundred thirty-two children 0 to 12 years of age who sought emergency department care for wheezing and 65 children with no history of wheezing were enrolled in this case-control study. Detection of respiratory syncytial virus antigen, rhinovirus and coronavirus RNA, adenovirus, influenza, and parainfluenza antigens was performed in nasal washes. Total IgE and specific IgE to mites, cockroach, cat, and dog were measured with the CAP system. Major allergens from mites, cockroach, cat, and dog were quantified in dust samples by ELISA. Univariate and multivariate analyses were performed by logistic regression. Results In children under 2 years of age, infection with respiratory viruses and family history of allergy were independently associated with wheezing (odds ratio, 15.5 and 4.2; P = .0001 and P = .008, respectively). Among children 2 to 12 years old, sensitization to inhalant allergens was the major risk factor for wheezing (odds ratio, 2.7; P = .03). High-level allergen exposure, exposure to tobacco smoke, and lack of breast-feeding showed no association with wheezing. Conclusions Some risk factors for wheezing previously identified in temperate climates were present in a subtropical area, including respiratory syncytial virus infection in infants and allergy in children older than 2 years. Rhinovirus was not associated with wheezing and did not appear to be a trigger for asthma exacerbations.

A prospective study of wheezing in young children: The independent effects of cockroach exposure, breast‐feeding and allergic sensitization

The objective of this study was to evaluate risk factors for persistent wheezing in a group of 2–4‐year‐old children after an index‐wheezing episode in infancy. Eighty infants who had been seen at the Emergency Department for an episode of acute wheezing were followed for 2 yr in this prospective study. Caregivers completed a questionnaire, and children underwent clinical evaluation and skin prick testing 2 yr following the index‐wheezing episode. Detection of respiratory viruses and analysis of exposure to major indoor allergens were carried out at enrollment. Immunoglobin E antibodies were measured at the beginning of the study and at the end of follow‐up, using the CAP system. Logistic regression analysis was performed to identify factors associated with persistent wheezing. Seventy‐three children (44 boys) completed the study. After 2 yr, 38 (52%) reported three or more wheezing episodes in the past 12 months (persistent wheezers). Independent risk factors for persistence of wheezing were allergic sensitization and exposure to cockroach allergen in the kitchen. Breast‐feeding for at least 1 month was a protective factor. A strong association between allergic sensitization and persistence of wheezing was found in a group of very young children living in a subtropical area.

A family history of serious complications due to BCG vaccination is a tool for the early diagnosis of severe primary immunodeficiency

Severe Combined Immunodeficiency (SCID) is one of the most severe forms of primary immunodeficiency (PID). Complications of BCG vaccination, especially disseminated infection and its most severe forms, are known to occur in immunodeficient patients, particularly in SCID. A carefully taken family history before BCG injection as well as delaying vaccination if PID is suspected could be a simple and effective method to avoid inappropriate vaccination of an immunodeficient child in some cases until the prospect of newborn screening for SCID has been fully developed. We describe a patient with a very early diagnosis of SCID, which was suspected on the basis of the previous death of two siblings younger than one year due to severe complications secondary to the BCG vaccine. We suggest that a family history of severe or fatal reactions to BCG should be included as a warning sign for an early diagnosis of SCID.

Role of the asthma predictive index (API) in assessing the development of asthma among Brazilian children

Methods Sixty one of 76 children who participated in a previous study (Camara et al JACI 2004;113;551-7) aimed at identifying risk factors for acute wheezing in infancy were re-evaluated at the ages of 2-4 and 8-12 years. They had been seen at the Emergency Room (ER) for an episode of wheezing at the age of 6-24 months. At the age of 8-12 years, parents completed a questionnaire on respiratory symptoms; 52 children underwent skin prick testing with a panel of inhalant and food allergens and 48 performed methacholine challenge tests. Children were considered asthmatic at the age of 8-12 years if they presented previous physician-diagnosed asthma, or at least one of the following symptoms in the past 12 months: wheezing, cough or chest tightness with exercise, or dry cough without colds, accompanied by bronchial hyperresponsiveness, defined by a PC20 <4mg/ml methacholine challenge test. A positive API (at least one major criteria: physician-diagnosed eczema or parental asthma; or 2 of 3 minor criteria: physician-diagnosed allergic rhinitis, wheezing without colds or peripheral eosinophilia ≥4%) was established based on information collected when the children were 2-4 years-old. Sensitivity, specificity, predictive values, likelihood ratios and confidence intervals (CI) of the API for the diagnosis of asthma at 8-12 years-old were calculated. Results Among the 48 children evaluated at school age, 20 (41.7%) were diagnosed with asthma; 13 of them (65%) had a positive API at 2-4 years. Of the 28 children who did not develop asthma, only 9 (32.1%) had a positive API. Sensitivity and specificity of the API were 65% (CI=40.8-84.6) and 67.9% (CI=47.7-84.1), respectively. Positive and negative predictive values were 59.1 (CI=38.7-79.7) and 73.1 (IC=53.9-86.3); and positive and negative likelihood ratios were 2.02 (CI=1.5-2.73) and 0.51 (CI=0.37-0.72), respectively.

A systematic intervention for assistance of patients with asthma in Brazil: partnership between university and public health system

Methods A group of 16 allergists/immunologists developed a capacitating program in 11 Public Health Units in the city of Ribeirao Preto, Brazil. The program comprised lectures on asthma and hands-on training on spirometry and use of inhalation devices; production of didactic material; and development of a protocol on management of asthma. Spacers and spirometry were provided. Each researcher visited one Health Unit 2-4 times a month, to accompany the non-specialist on patients’ visits to the clinic, perform case discussions, and deliver short lectures to the health professionals. Records of asthma medications provided to patients upon physicians’ prescription in the North Region were compared to those from three other Regions with no intervention.

Health outcomes, education, healthcare delivery and quality – 3051. Profiles of diagnosis and treatment of asthma in the public health system in Brazil

Health outcomes, education, healthcare delivery and quality – 3051. Profiles of diagnosis and treatment of asthma in the public health system in Brazil Janaina M Melo, Adriana S Moreno, Virginia PL Ferriani, Elcio Vianna, Marcos Borges, Persio Roxo Jr, Ana Carla S Araujo, Luane M Mello, Rosa Ferreira, Jorgete M Silva, Patricia Stefanelli, Marcos R Goncalves, Larissa P Oliveira, Andrea Cetlin, Luana B Queiroz, Rosangela Villela, Davi C Aragon, L Karla Arruda