Marcia Carvalho Mallozi

Sensibilização a alérgenos inalantes e alimentares em crianças brasileiras atópicas, pela determinação in vitro de IgE total e específica: Projeto Alergia (PROAL)

OBJECTIVE To determine the frequency of sensitization to inhalant and food allergens in children seen at Brazilian allergy services. PATIENTS AND METHODS Total and specific IgE serum levels to inhalant and food allergens (RAST, UniCAP - Pharmacia) were measured in 457 children accompanied in pediatric allergy services and in 62 control children age matched. RAST equal or higher than class 1 was considered as positive (R+). RESULTS Frequency of R+ was significantly higher among atopics (361/457, 79%) when compared to controls (16/62, 25.8%). There were no differences according to gender. The frequency of R+ to all allergens evaluated was higher among atopics when compared to controls. Significantly higher total IgE serum levels were observed among the atopics with R+ in comparison to those with R-. The frequency of R+ to main inhalant allergens were: D. pteronyssinus = 66.7% x 14.5% (p < 0.05), D. farinae = 64.5% x 17.8% (p < 0.05), B. tropicalis = 55.2% x 19.4% (p < 0.05), cockroach = 32.8% x 9.7% (p < 0.05), and cat = 12% x 8.1%. In relation to food allergens we observed: fish = 29.5% x 11.3% (p < 0.05), egg = 24.4% x 4.8% (p < 0.05), cows milk = 23.1% x 3.2% (p < 0.05), wheat = 20% x 8.1% (p < 0.05), peanuts = 14% x 4.8% (p < 0.05), soy = 11.8% x 4.8% (p < 0.05), and corn = 10.6% x 4.8% (p < 0.05). With respect of age, food allergen sensitization predominates in young children whereas the inverse occurs with inhalant allergens. CONCLUSIONS There was a predominant frequency of sensitization to inhalant allergens, mainly house dust mites in the evaluated patients. Food allergens were also responsible for a significant proportion of sensitization, mainly in infants.

Is the prevalence of asthma and related symptoms among Brazilian children related to socioeconomic status

Objective. To evaluate the relationship between socioeconomic status (SES) and the prevalence of asthma and related symptoms among Brazilian children. Methods. The International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire was applied to 23,457 six- to seven- year-old schoolchildren (SC) and 58,144 thirteen- to fourteen-year-old adolescents (AD) from 20 Brazilian cities. SES was evaluated by infant mortality index, poverty index, and average nominal income for people older than 10 years of age. Results. Current asthma ranged from 16.5% to 31.2% among SC and from 11.8% to 30.5% among AD and severe asthma from 2.9% to 8.5% (SC) and 2.6% to 9.1% (AD). Higher values were observed in Brazilian-Northern, -Northeastern and -Southeastern centers. No significant association between SES and prevalence of asthma and related symptoms was observed. Conclusions. In Brazil, the prevalence of asthma and related symptoms is quite variable and independent of SES.

Asthma in children and adolescents in Brazil: contribution of the International Study of Asthma and Allergies in Childhood (ISAAC)

Objective: To assess asthma among Brazilian pediatric population applying the International Study of Asthma and Allergies in Childhood (ISAAC), an internationally standardized and validated protocol. Data sources: ISAAC was conceived to maximize the value of epidemiologic studies on asthma and allergic diseases, establishing a standardized method (self-applicable written questionnaire and/or video questionnaire) capable to facilitate the international collaboration. Designed to be carried out in three successive and dependent phases, the ISAAC gathered a casuistic hitherto unimaginable in the world and in Brazil. This review included data gathered from ISAAC official Brazilian centers and others who used this method. Data synthesis: At the end of the first phase, it has been documented that the prevalence of asthma among Brazilian schoolchildren was the eighth among all centers participating all over the world. Few centers participated in the second phase and investigated possible etiological factors, especially those suggested by the first phase, and brought forth many conjectures. The third phase, repeated seven years later, assessed the evolutionary trend of asthma and allergic diseases prevalence in centers that participated simultaneously in phases I and III and in other centers not involved in phase I. Conclusions: In Brazil, the ISAAC study showed that asthma is a disease of high prevalence and impact in children and adolescents and should be seen as a Public Health problem. Important regional variations, not well understood yet, and several risk factors were found, which makes us wonder: is there only one or many asthmas in Brazil?

Primary Immunodeficiency May Be Misdiagnosed as Cow’s Milk Allergy: Seven Cases Referred to a Tertiary Pediatric Hospital

Introduction. The presence of eczema and gastrointestinal manifestations are often observed in cows milk allergy (CMA) and also in some primary immunodeficiency diseases (PID). Objective. To describe 7 patients referred to a tertiary allergy/immunology Center with a proposed diagnosis of CMA, who were ultimately diagnosed with PID. Methods. This was a retrospective study based on clinical and laboratory data from medical records. Results. Seven patients (6 males) aged between 3 mo and 6 y were referred to our clinic with a proposed diagnosis of CMA. They presented with eczema and/or gastrointestinal symptoms. Five were receiving replacement formula. All patients presented with other clinical features, including severe/recurrent infections unrelated to CMA, and two of them had a positive family history of PID. Laboratory tests showed immune system dysfunctions in all patients. Hyper-IgE and Wiskott-Aldrich syndromes, CD40L deficiency, severe combined immunodeficiency, X-linked agammaglobulinemia, transient hypogammaglobulinemia of infancy, and chronic granulomatous disease were diagnosed in these children. In conclusion, allergic diseases and immunodeficiency are a result of a different spectrum of abnormalities in the immune system and may be misdiagnosed. Educational programs on PID among clinical physicians and pediatricians can reduce the occurrence of this misdiagnosis.

Prebióticos, probióticos e simbióticos na prevenção e tratamento das doenças alérgicas

OBJECTIVE: To review current evidence about the effects of probiotics, prebiotics and symbiotics on the immune development as well as on the prevention of allergic diseases in children. DATA SOURCES: Randomized, double-blind clinical trials in humans published in the last five years, in the Medline database, containing the following keywords: prebiotics (oligosaccharides), probiotics, symbiotics and hypersensitivity. DATA SYNTHESIS: For this review three papers with prebiotics were included, all of them using a mixture of GOS:FOS (9:1) in infant formula for the first months of life; 24 papers with probiotics, where L. rhamnosus GG, B. lactis, L. casei, L. paracasei, L. reuteri, L. acidophilus, B. longum, B. breve and P. freudenreichii sp. were the tested bacterial strains; and two papers about symbiotics. CONCLUSIONS: Although there are some evidence of benefits of early supplementation with some specific probiotic strains, prebiotics and symbiotics for the prevention of atopic eczema in children with high risk of allergy development, and probiotic use for the treatment of IgE-mediated moderate and severe atopic dermatitis, further research is needed in order to extended the evaluation of supplemented individuals, safety aspects and long term effectsOBJETIVO: Avaliar o papel dos probioticos, prebioticos e simbioticos no equilibrio do sistema imunologico do lactente, bem como seu efeito preventivo no desenvolvimento de doencas alergicas na crianca. FONTE DE DADOS: A partir do levantamento de todos os ensaios clinicos duplo-cegos e randomicos em seres humanos, publicados nos ultimos cinco anos na base de dados Medline e que contivessem unitermos relacionados a prebioticos (oligossacarideos), probioticos e simbioticos versus hipersensibilidade, analisou-se seu papel quanto a utilizacao em doencas alergicas. SINTESE DE DADOS: Foram incluidos nesta revisao tres trabalhos com prebioticos, os quais utilizaram a mistura GOS:FOS (9:1) em formulas infantis em lactentes nos primeiros meses de vida; 24 trabalhos com probioticos, sendo os micro-organismos utilizados na suplementacao L. rhamnosus GG, B. lactis, L. casei, L. paracasei, L. reuteri, L. acidophilus, B. longum, B. breve e P. freudenreichii sp., e dois estudos com simbioticos. CONCLUSOES: Apesar das evidencias de beneficios da suplementacao precoce de probioticos com algumas cepas especificas, prebioticos e simbioticos na prevencao da dermatite atopica, em criancas de alto risco para alergias, e do uso de probioticos no tratamento das dermatites atopicas moderadas e graves mediadas por IgE, ha necessidade de ampliar os estudos quanto ao tempo de observacao dos individuos suplementados, quanto a seguranca e aos efeitos em longo prazo

Oral food challenges in a specialized allergy outpatient clinic in São Paulo, Brazil

Methods A retrospective study of chart analysis of 171 patients undergone to 220 OFC, between June/2007 and Feb/ 2014. Food tests comprised CM, egg, soy, peanuts, nuts, seafood, meat, chicken, tartrazine, chocolate, wheat and coconut. Patients were evaluated according to the type of CM’s challenge (open or double-blind placebocontrolled), aim of the procedure (diagnosis or follow up tolerance), symptoms, body mass index, time of breastfeeding, age at first reaction, family history of food allergy, presence of other atopic diseases (asthma, allergic rhinitis and atopic dermatitis) and skin prick test.

Polymorphisms in inflammasome genes and risk of asthma in Brazilian children

HighlightsIndividuals with gain‐of‐function SNPs in NLRP1 could be more prone in activating inflammasome in the presence of asthma‐related cell stressors (i.e. ER stress or ROS).Gain‐of‐function IL1A rs17561 lead to a constitutive increased alarmin level that could easier induce lung inflammation and damage.Low IL‐18 serum level could be related to a worse ability to pulmonary epithelial regeneration. Abstract Considering its role in inflammation and recently described “alternative” roles in epithelial homeostasis and Th1/Th2 balance, we hypothesize that inflammasome genetics could contribute to the development of asthma. Selected functional polymorphisms in inflammasome genes are evaluated in a cohort of asthmatic children and their families. Gain‐of‐function NLRP1 variants rs11651270, rs12150220 and rs2670660 resulted significantly associated to asthma in trios (TDT) analysis; and rs11651270 and rs2670660 also with asthma severity and total IgE level in asthmatic children. NLRP1 activators in humans are still unknown, however we hypothesized that individuals with gain‐of‐function SNPs in NLRP1 could be more prone in activating inflammasome in the presence of asthma‐related cell stressors (i.e. ER stress or ROS), and this activation contribute to exacerbate inflammatory response and asthma development. Gain‐of‐function IL1A rs17561 resulted significantly associated with a reduced pulmonary capacity in asthmatic children. IL18 rs5744256 which lead to lower serum level of IL‐18 appeared to be associated to a worse response to bronchodilators. Concluding, this work provides evidences about the contribution of inflammasome genetics in the development of paediatric asthma, both considering its inflammatory role in alveolar macrophages (i.e.: NLRP1) or its homeostatic role in lung epithelial cells (i.e.: IL1A, IL18).

Frequency of rhinitis and orofacial disorders in patients with dental malocclusion

Abstract Objective: To describe the frequency and etiology of rhinitis, oral breathing, types of malocclusion and orofacial disorders in patients treated for dental malocclusion. Methods: Patients with poor dental occlusion (n=89, 8-15 years) undergoing orthodontic treatment at the Postgraduate Orthodontics Center (São Paulo, Brazil) participated in the study. Rhinitis and oral breathing were diagnosed by anamnesis, clinical assessment and allergic etiology of rhinitis through immediate hypersensitivity skin prick test with airborne allergens. The association between types of breathing (oral or nasal), rhinitis and types of dental malocclusion, bruxism and cephalometric alterations (increased Y axis of facial growth) compared to standard cephalometric tracing (Escola de Odontologia da Universidade de São Paulo) were assessed. Results: The frequency of rhinitis in patients with dental malocclusion was 76.4% (68), and, of these, 81.7% were allergic (49/60 positive skin prick test), whereas the frequency of oral breathing was 62.9%. There was a significant association between an increased Y axis of facial growth and oral breathing (p<0.001), as well as between oral breathing and rhinitis (p=0.009). There was no association between rhinitis and bruxism. Conclusions: The frequency of rhinitis in children with dental malocclusion is higher than that in the general population, which is approximately 30%. Patients with oral breathing have a tendency to a dolichofacial growth pattern (increased Y axis of facial growth). In patients with rhinitis, regardless of the presence of oral breathing, the dolichofacial growth tendency was not observed.

Gene polymorphisms as susceptibility factors in Brazilian asthmatic children and adolescents

Background Asthma is a complex disease due to the contribution of both genetic and environmental factors. Several genes and polymorphisms have been associated to asthma susceptibility and development, leading to distinct clinical patterns. The aim of this study was to analyze sixteen genetic polymorphisms in eleven genes previously associated to asthma in a Brazilian family-based population study.

Effects of a pulmonary rehabilitation program on physical capacity, peripheral muscle function and inflammatory markers in asthmatic children and adolescents: study protocol for a randomized controlled trial

BackgroundIndividuals with chronic lung disease are more susceptible to present reduction in exercise tolerance and muscles strength not only due to pulmonary limitations but also due systemic repercussions of the pulmonary disease.The aim of this study is to assess the physical capacity, peripheral muscle function, physical activity in daily life, and the inflammatory markers in children and adolescents with asthma after pulmonary rehabilitation program.MethodThis is a study protocol of randomized controlled trial in asthmatic patients between 6 to 18 years old. The assessments will be conducted in three different days and will be performed at the beginning and at the end of the protocol. First visit: quality of life questionnaire, asthma control questionnaire, pre- and post-bronchodilator spirometry (400 μcg salbutamol), inflammatory assessment (blood collection), and cardiopulmonary exercise test on a cycle ergometer to determine aerobic capacity. Second visit: assessment of strength and endurance of the quadriceps femoris and biceps brachii muscles with concomitant electromyography to assess peripheral muscle strength. Third visit: incremental shuttle walk test (ISWT) and accelerometer to evaluate functional capacity and physical activity in daily life during 7 days. Then, the volunteers will be randomized to receive pulmonary rehabilitation program (intervention group) or chest physiotherapy + stretching exercises (control group). Both groups will have a supervised session, twice a week, each session will have 60 minutes duration, with minimum interval of 24 hours, for a period of 8 weeks. Intervention group: aerobic training (35 minutes) intensity between 60 to 80 % of the maximum workload of cardiopulmonary exercise testing or of ISWT; strength muscle training will be applied to the quadriceps femoris, biceps brachii and deltoid muscles (intensity: 40 to 70 % of maximal repetition, 3 x 8 repetition); finally the oral high-frequency oscillation device (Flutter®) will be used for 5 minutes. The control group: oral high-frequency oscillation device (Flutter®) for 10 minutes followed by the stretching of upper and lower limbs for 40 minutes. It is expected to observe the improvement in aerobic capacity, physical activity in daily life, muscle strength and quality of life of patients in the intervention group, and reduction in inflammatory markers.Trial registrationClinical Trial Number: NCT02383069. Data of registration: 03/03/2015