M.Branco Ferreira

Turbutest™ in the training of asthmatic Turbuhaler™ users

Background: Correct utilization of inhalation devices is a key factor in asthma management. Objective assessment of the ability to use inhaler devices is therefore fundamental.

Specific immunotherapy with hymenoptera venom

Abstract Venom immunotherapy (VIT) is an effective treatment for most subjects who are allergic to hymenoptera venom. We have studied 22 patients (16 honey bee venom allergic and 6 vespula sp. venom allergic) subjected to immunotherapy with aqueous extract of pure venom from Allbay, Dome-Hollister-Stier. In one group of 12 patients, VIT was performed according to a rush protocol and we measured specific IgE and IgG4 during a 4-year follow-up period. We observed a decrease in specific IgE and an increase in specific IgG4 in all patients. In order to determine the safety of ultra-rush protocols (3.5 h) we have recently selected one other group of 10 patients in whom we measured tryptase release during the 24 h (at 2, 3, 4, 6, 8, 10, 12 and 24 h) after the beginning of the ultra-rush schedule. We observed no increase in adverse reactions during the induction or maintenance phase relative to rush protocols. Regarding tryptase levels, we observed no significant differences between basal and the several measurements performed during the ultra-rush VIT schedule. These results suggest that an increase in specific IgG4 is correlated with the protective effect of immunotherapy and that ultra-rush VIT is not associated with significant mast cell activation. Ultra-rush protocols are clinically safe, with a rate of systemic reactions similar to rush protocols and with less local reactions. There is no evidence of ultra-rush VIT induced mast-cell degranulation, and serum tryptase levels have not shown significant variations during ultra-rush VIT.

Effect of specific immunotherapy in eosinophil cationic protein release after specific nasal provocation

Abstract Specific immunotherapy (SIT) is effective in the treatment of allergic rhinitis but its mechanisms of action are still not completely understood, particularly in regard to eosinophil activation mechanisms. The purpose of this research was to study if the inhibition of eosinophil activation, demonstrated through the reduction of eosinophil cationic protein [ECP] release, is involved in the therapeutic actions of specific immunotherapy. We analyzed ECP concentrations in nasal lavage fluid of 21 patients with allergic rhinitis, before and after specific nasal provocation. These results were compared to controls, treated without specific immunotherapy. ECP concentrations in nasal lavage fluid were significantly reduced after two years of specific injectable immunotherapy. These reductions were demonstrated both in pre-provocation [basal] values and after specific nasal provocation. Specific immunotherapy can reduce ECP in nasal lavage fluid of in house dust mite allergic rhinitis patients, both before and after allergen nasal challenge, with significant changes in the kinetic of ECP release, a fact which suggests that specific immunotherapy can influence eosinophil activation or its releasability.

Hereditary angioedema - retrospective of the last 20 years

Abstract Rationale We characterized a group of patients with Hereditary Angioedema (HA) and evaluated different options for prevention, prophylaxis and therapy of crises. Methods Clinical review of patients with HA followed at Immunoallergology Unit (HSM) or in CAIC since 1980. Results Among 28 patients (18F/10M, mean age 39,5 ± 16,9 years), belonging to 12 families, only 2 had no family history. Mean age at first symptoms was 11,7 ± 7,4 years and mean age at diagnosis 14,5 ± 15,5 years. Clinical manifestations at presentation were cutaneous-50%, gastrointestinal (GI)-25%, cutaneous and GI-11%, respiratory-7%, cutaneous and respiratory-4%. Almost all patients, 92%, had already had cutaneous symptoms, 71% GI and 68% respiratory symptoms. During an attack, 3 patients had been submitted to exploratory laparotomy and 4 patients to endotracheal entubation. Most frequent triggering factors were stress and trauma. HA was classified as type I or type II in 18 and 10 patients, respectively. Only 7 patients were not on preventive therapy, the others being medicated with androgens (AD)-13, antifibrinolitics (AF)-3 or with both-5. Therapeutic of acute episodes had been AD+AF-8 patients, AF-6, AD-4, AD+AF+plasma-4, AF+plasma-3 or other approaches-2. Prophylactic terapy was prescribed to 11 patients AD-8, AD+AF-2, plasma or C1 inhibitor-1 with good efficacy. Conclusion Clinical features of this group were similar to those described in the literature concerning prevalence, sex distribution, age at first symptoms and type of clinical manifestations. Mean time between age at first symptoms and diagnosis was quite variable and on average higher than in other studies. Many different therapeutic options have been adopted in severe attacks.