José Luiz Rios

Clinical and immunologic profile of children and adolescents submitted to cow milk oral immunotheray (OIT)

Results The mean age was 8.73 years (min: 4, Max: 19), and 9 were females. The symptoms started before 1 year old in 93% of the sample and in 50% before 6 months. Urticaria was the most frequent manifestation in the 1st contact (60%), some progressing to anaphylaxis: the initial event in 40% of cases. Half of the patients responded to minimal amounts of LV, mainly (60%) in raw state. Symptoms appeared in less than 1 hour in 96%. Until the beginning of treatment 73% have had 1-5 episodes of anaphylaxis. About 75% of patients have associated respiratory allergy and 33% had some anaphylactic event in the last 12 months. The specific IgE levels were elevated in 93% of the sample: For full LV the mean level was 50.2 KU/L and the median 41 KU/L (Min: 1.4 KU/l and Max: >100 KU/L); for casein, the mean was 40 KU/L, and the median 28.4 KU/L (0.8 >100). For a-lacto albumin and b-lacto globulin, these values were respectively: 23.1 KU/L, 12.1 KU/L (0.4 82) and 9.94 KU/L, 4:46 KU/L (0.7 31.4).

Immunologic shifts occurring during cow milk (CM) oral immunotheray (OIT)

Methods Series of cases involving 15 children over 4 years and adolescents who still had anaphylaxis to cow’s milk. Specific IgE levels were evaluated in three steps of OIT: at baseline, pre-treatment session (step 1); When the patient reached the concentration 1:1 (step 2); and when reaching the final volume to 150 ml of milk a day (step 3). The differences between the levels of specific IgE were analyzed by Student’s t test. The adopted level of significance was <0.05

Epidemiological survey on the practice of allergen immunotherapy in Brazil

Background Allergen immunotherapy (IT) is widely used to treat patients with allergic diseases, proven effective and recommended by national and international guidelines. Its efficacy and safety depend on the correct indication, use of relevant allergens and good quality extracts, as well as prescription and supervision by a trained professional. Our aims were to evaluate the frequency of use of IT in Brazil and to investigate whether this practice meets recommendations of the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Medical Association.

360 Effects of Omalizumab in Children with Atopic Keratocojunctivitis: A New Treatment for Severe Ocular Allergies?—Report of Two Cases.

Background Keratoconjunctivitis is a severe form of ocular allergy, difficult to control and with poor prognosis. The purpose of this study was to verify the clinical efficacy of humanized monoclonal antibody omalizumab treatment in children with this condition. Methods Report of 2 cases of children with severe vernal keratoconjunctivitis poorly controlled by the conventional therapeutic scheme that were submitted to treatment with Omalizumab. The disease was scored according to the severity by ophthalmologic evaluation (amount of viscous mucus, giant papillae >1 mm, aspect of cornea/keratitis) and graduation of allergic symptons (itching, tearing, photophobia), before and after the last subcutaneous administration of Omalizumab. Evaluation by Parents/ guardians using the same score, regarding to itchy eyes, runny eyes and photophobia, after Omalizumab application, was also requested. Results Case 1: MPOS (7 years) with vernal keratoconjunctivitis and atopic dermatitis since childhood, both with progressive severity. Recalcitrant ocular itching and photophobia, in addition had other atopic conditions such as mild asthma, rhinitis and egg allergy. Total IgE = 1323 IU/mL. Ocular manifestations poorly controlled with topical use of antihistamines, cromolyn, tacrolimus and cyclosporine. The use of topical corticosteroids was frequent, but resulted in brief improvement. Case 2: HCS (6 years) with vernal keratoconjunctivitis since 3 years age, and mild asthma and moderate persistent rhinitis. Continued use of topical tacrolimus 0.03% showed an initial improvement, but subsequent relapses resulted in frequent use of systemic prednisolone and eye drops antibiotics to control symptoms. Total IgE = 1530 IU/mL. After the second Omalizumab application, good or excellent improvement in ocular symptoms of both children was observed by allergists and parents. Ophthalmologic evaluation showed moderate improvement in the amount of slime and little or no improvement in the structural changes of the eye (cornea and appearance of giant papillae). Conclusions There are few reports about the use of Omalizumab in allergic keratoconjunctivitis. Our work points to the need for further research in this area as the Anti-IgE may become a promising therapy for this difficult to control condition.