Nelson Augusto Rosário Filho

Sub-Lingual Immunotherapy: World Allergy Organization Position Paper 2009

Chair: G. Walter Canonica Co-Chairs Jean Bousquet, Thomas Casale, Richard F. Lockey, Carlos E. Baena-Cagnani, Ruby Pawankar, Paul C. Potter Authors Philippe J. Bousquet, Linda S. Cox, Stephen R. Durham, Harold S. Nelson, Giovanni Passalacqua, Dermot P. Ryan, Jan L. Brozek, Enrico Compalati, Ronald Dahl, Luis Delgado, Roy Gerth van Wijk, Richard G. Gower, Dennis K. Ledford, Nelson Rosario Filho, Erkka J. Valovirta, Osman M. Yusuf, Torsten Zuberbier Co-Authors Wahiduzzaman Akhanda, Raul Castro Almarales, Ignacio Ansotegui, Floriano Bonifazi, Jan Ceuppens, Tomás Chivato, Darina Dimova, Diana Dumitrascu, Luigi Fontana, Constance H. Katelaris, Ranbir Kaulsay, Piotr Kuna, Désirée Larenas-Linnemann, Manolis Manoussakis, Kristof Nekam, Carlos Nunes, Robyn O’Hehir, José M. Olaguibel, Nerin Bahceciler Onder, Jung Won Park, Alfred Priftanji, Robert Puy, Luis Sarmiento, Glenis Scadding, Peter Schmid-Grendelmeier, Ester Seberova, Revaz Sepiashvili, Dírceu Solé, Alkis Togias, Carlo Tomino, Elina Toskala, Hugo Van Beever, Stefan Vieths

Sub-lingual immunotherapy: World allergy organization position paper 2009

Co-Authors: Wahiduzzaman Akhanda, Raul Castro Almarales, Ignacio Ansotegui, Floriano Bonifazi, Jan Ceuppens, Tomás Chivato, Darina Dimova, Diana Dumitrascu, Luigi Fontana, Constance HKatelaris, Ranbir Kaulsay, Piotr Kuna, Dèsirée Larenas-Linnemann, Manolis Manoussakis, Kristof Nekam, Carlos Nunes, Robyn O’Hehir, José M Olaguibel, Nerin Bahceciler Onder, JungWon Park, Alfred Priftanji, Robert Puy, Luis Sarmiento, Glenis Scadding, Peter Schmid-Grendelmeier, Ester Seberova, Revaz Sepiashvili, Dirceu Solé, Alkis Togias, Carlo Tomino, Elina Toskala, Hugo Van Beever, Stefan Vieths*

The International Study of Wheezing in Infants: Questionnaire Validation

Background: There are no internationally validated questionnaires to investigate the prevalence of infant wheezing. This study was undertaken to validate a questionnaire for the International Study on the Prevalence of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL). Material and Methods: Construct and criterion validity were tested for the question ‘Has your baby had wheezing or whistling in the chest during his/her first 12 months of life?’. Construct validity (i.e. the ability of parents and doctors to refer to the same symptoms with the same words) was tested in a sample of 50 wheezing and 50 non-wheezy infants 12–15 months of age in each of 10 centres from 6 different Spanish- or Portuguese-speaking countries. Criterion validity (i.e. the ability of parents to correctly detect the symptom in the general population) was evaluated in 2 samples (Santiago, Chile and Cartagena, Spain) of 50 wheezing and 50 non-wheezing infants (according to parents) of the same age, randomly selected from the general population, who were later blindly diagnosed by a paediatric pulmonologist. Results: Construct validity was very high (ĸ test: 0.98–1) in all centres. According to Youden’s index, criterion validity was good both in Cartagena (75.5%) and in Santiago (67.0%). Adding questions about asthma medication did not improve diagnosis accuracy. Conclusions: The EISL questionnaire significantly distinguished wheezy infants from healthy ones. This questionnaire has a strong validity and can be employed in large international multicentre studies on wheezing during infancy.

Prevalence of asthma and allergic diseases in adolescents: nine-year follow-up study (2003-2012)

OBJECTIVE To determine the prevalence of symptoms of asthma, rhinitis, and atopic eczema in adolescents (AD; 13-14 years) living in seven Brazilian cities, by applying the standardized written questionnaire (WQ) of the International Study of Asthma and Allergies in Childhood (ISAAC), and to evaluate the time trend nine years after the last assessment of ISAAC phase 3 (ISP3). METHODS The ISAAC-WQ was answered by 20,099 AD from the Northern, Northeastern, Southeastern, and Southern Brazilian regions. Values obtained were compared to those observed in ISP3 using nonparametric (chi-squared or Fisher) tests, and the ratio of annual increment/decrement was established for each of the centers, according to the symptom assessed. RESULTS Considering the national data and comparing to values of ISP3, there was a decrease in the mean prevalence of active asthma (18.5% vs. 17.5%) and an increase in the frequency of severe asthma (4.5% vs. 4.7%) and physician-diagnosed asthma (14.3% vs. 17.6%). An increase in prevalence of rhinitis, rhinoconjunctivitis, and atopic eczema was also observed. CONCLUSIONS The prevalence of asthma, rhinitis, and atopic eczema in Brazil was variable; higher prevalence values, especially of asthma and eczema, were observed in regions located closer to the Equator.

Nebulized budesonide to treat acute asthma in children

OBJECTIVE To investigate the efficacy of a single dose of inhaled budesonide as compared to oral prednisone in patients with acute asthma. METHODS Randomized double-blind, double-dummy and placebo-controlled clinical trial. Forty-nine children aged 2 to 7 years with acute asthma were randomized in three groups after receiving nebulized salbutamol (0.15 mg/kg). Group I received placebo both as tablets and nebulization, group II was treated with a single dose of oral prednisone (1 mg/kg) and inhaled placebo, and group III received a single dose of placebo tablet and nebulized budesonide (2 mg). Patients were evaluated in terms of symptom score and transcutaneous hemoglobin saturation. Nebulized salbutamol was repeated in case of increasing symptom score or lower saturation. RESULTS Progressive clinical improvement was observed in all three groups. However, a significant increase in hemoglobin saturation was observed after 2 hours with prednisone, 4 hours with budesonide, and 24 hours with placebo. CONCLUSION A combination of single-dose nebulized budesonide and salbutamol may be as effective as oral prednisone to improve symptom severity, but the latter increases hemoglobin saturation in exacerbation of asthma.

Efetividade de um modelo fotogramétrico para a análise da mecânica respiratória toracoabdominal na avaliação de manobras de isovolume em crianças

OBJECTIVE To test the applicability of a geometric model, adapted to the supine position, for the analysis of respiratory mechanics regarding changes in lateral thoracoabdominal areas in children with asthma. METHODS Nineteen children (mean age, 11.26 +/- 1.28 years) performed isovolume maneuvers (IVMs) after maximal inspiration, followed by glottal closure and alternation of airflow between the abdominal and thoracic compartments. The maneuvers were recorded in a digital video camera placed perpendicularly to the movement plane, and the images of interest were selected. The geometric model was traced on each image based on surface landmarks of anatomical references. The traced areas were calculated using a computer program, and the results were converted into metric units (cm(2)) using a surface landmark of a known area. Relative contributions (RCs) of the subcompartments in relation to their original compartments and to the chest wall (CW) were calculated. RESULTS The model was based on 55 thoracic IVM images and 55 abdominal IVM images. Areas and subareas were compared between the maneuvers. There were significant differences in all subcompartments (p < 0.001). All of the RCs were significantly different for the CW (p < 0.001) but not for the ratios between the subcompartments and their original compartments. CONCLUSIONS This geometric model, applied in children and adapted to the supine position, was effective in profiling changes in the thoracoabdominal silhouette during the IVMs, and the selected subdivisions were useful for the identification of areas contributing the most and the least to CW composition.

Insulin-Like Growth Factor-1, Leptin, Body Composition, and Clinical Status Interactions in Children with Cystic Fibrosis

Background/Aims: Children with cystic fibrosis (CF) are of increased risk of reduced fat body mass (FBM) and lean body mass (LBM). Serum concentrations of insulin-like growth factor-1 (IGF-1)and leptin could be markers of LBM and/or FBM depletion. To evaluate the relationships between disease activity, body composition, IGF-1and leptin concentrations in CF children. Methods: A cross-sectional study with 26 CF children aged 5.0–15.5 years and 33 healthy controls, mean age 9.4 years. Body composition was evaluated by dual-energy X-ray absorptiometry. Fasting blood samples were analyzed for leptin, IGF-1and IGFBP-3. Results: FBM standard deviation score (SDS; CF boys –0.02 ± 0.88 vs. 0.78 ± 0.65, p < 0.01; CF girls –0.37 ± 1.15 vs. 0.70 ± 0.97, p < 0.05), leptin concentration (CF boys 2.07 ± 0.79 vs. 3.07 ± 1.28 ng/ml, p < 0.05; CF girls 2.71 ± 0.86 vs. 5.00 ± 2.95 ng/ml, p < 0.05) and IGF-1SDS (CF boys –1.43 ± 1.50 vs. –0.32 ± 0.88, p < 0.05; CF girls –0.66 ± 1.66 vs. 0.64 ± 0.57, p < 0.01) were lower in CF children compared to controls. Shwachman score was the strongest predictor of lean body mass (R = 0.63). Leptin levels explain 60% of the variability in FBM. Conclusion: Serum concentrations of IGF-1 and leptin are decreased in children with CF and are associated with clinical conditions and body composition.

Paracoccidioidomycosis in children with different skeletal involvement

The rarity of paracoccidioidomycosis in childhood prompted us to report two cases with different clinical and radiological skeletal involvement. The number of osteolytic lesions, the presence of periosteal reaction and the finding of Paracoccidioides brasiliensis in biopsy specimens, were distinctive features in both cases.

Phadiatop® in the diagnosis of respiratory allergy in children: Allergy Project - PROAL

OBJETIVO: Avaliar a positividade do Phadiatop® em criancas acompanhadas em servicos brasileiros de alergologia e compara-la aos resultados de IgE serica especifica a alergenos inalantes e alimentares. CASUISTICA E METODO: Em 457 criancas acompanhadas em servicos de alergia pediatrica e um grupo de criancas controle nao-alergicas (n = 62), distribuidas em cinco faixas etarias, foram determinados em amostra de soro: Phadiatop® e IgE especifica (RAST) a alergenos inalantes e alimentares (UniCAP - Pharmacia®). RESULTADOS: O Phadiatop® foi positivo em 305 criancas atopicas (67,6%) e em 25,8% das controles (p < 0,001). Entre as criancas atopicas, a distribuicao de positividade variou de acordo com a faixa etaria: 7,9% (24/305) entre as abaixo de 2 anos, 15,4% (47/305) nas de 2 a 3 anos, 22,0% (67/305) nas de 3 a 4 anos, 19,3% (59/305) nas de 4 a 5 anos e 35,4% (108/305) nas de 5 a 12 anos. Nao houve concordância entre os alergenos alimentares e a presenca de Phadiatop® positivo. O estudo da relacao entre os RAST positivos para alergenos inalados e o Phadiatop® positivo mostrou melhores indices com os acaros domiciliares (D. pteronyssinus, D. farinae e Blomia tropicalis). CONCLUSOES: O Phadiatop®e metodo util no diagnostico de alergia aos acaros domiciliares.

Impacto de fatores externos sobre a mecânica respiratória avaliada por um modelo fotogramétrico específico: biofotogrametria

This is a report on a methodological adaptation of the photogrammetric technique, which is used in other medical specialties, for use in analyzing respiratory movements. Photogrammetry and a model of photogrammetry designated biofotogrametria para análise da mecânica respiratória (BAMER, photogrammetric analysis of respiratory mechanics) were tested under previously described pathophysiological conditions: post-exercise dynamic hyperinflation using positive end-expiratory pressure. The BAMER model identified an increase in the thoraco-abdominal area following exercise using positive end-expiratory pressure. These results are comparable to those obtained with more robust systems of respiratory kinematics. The use of photogrammetry has value in many areas, since it produces quantitative data, being particularly relevant in pediatrics, in which monitoring resources are scarce.