Ullissis Pádua de Menezes

Atopy and adenotonsillar hypertrophy in mouth breathers from a reference center.

UNLABELLED Mouth breathers use the oral cavity as their principal breathing route. The main causes include: adenotonsillar hypertrophy and inflammatory diseases such as allergic rhinitis. OBJECTIVE To look for atopy, the main allergens involved and to check for atopy as a comorbidity with the degree of hypertrophy of the tonsils and adenoids in mouth breathers. METHOD A historical cohort study with cross-sectional review of 308 medical charts of patients treated at a mouth breather care center of a tertiary hospital in the period of 2008-2010. We collected data on the mouth breathers clinical history and we ran otolaryngological exams, flexible nasal endoscopy and skin prick test to aeroallergens. RESULTS Of 308 patients, 36% were positive on allergy testing, with 95 % of atopic patients being positive for mites. Among all patients, 46% had adenoid hypertrophy; of these, 37% were atopic and 47% had tonsillar hypertrophy, and among these, 33% were atopic. CONCLUSION We found no direct correlation between atopy and the degree of tonsils and adenoid hypertrophy observed among the mouth-breathing patients assessed. si.

Lung function in hyper IgE syndrome.

Pneumatoceles and bronchiectasis are secondary complications of respiratory infections in patients with hyper IgE syndrome (HIgES).

Renal Abscess in Hyper-IgE Syndrome

Kidney disease due to Aspergillus fumigatus is a rare finding in hyper-IgE syndrome. We report a patient with autosomal dominant hyper-IgE syndrome, recurrent pneumonia, and acute necrosuppurative pyelonephritis caused by Aspergillus fumigatus with a fatal outcome. We emphasize the severity and the difficulties in the management of renal complications that could be limiting the survival of these patients.

Unusual presentation of brain aspergillosis in chronic granulomatous disease.

Aspergillus is a frequently observed pathogen in patients with chronic granulomatous disease. We report on a patient with chronic granulomatous disease and severe brain aspergillosis with an unusual presentation and favorable course. We discuss the impact of this infection on morbidity and mortality, adequate therapeutic management, and the need to investigate a possible fungal infection, despite nonspecific signs.

Anafilaxia a cloridrato de benzidamina: relato de caso

RESUMO 1. Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Departamentos de Clínica Médica e Pediatria, Ribeirão Preto, SP, Brasil. 316 Reações de hipersensibilidade a medicamentos (RHM) podem induzir manifestações clínicas heterogêneas, desde leves até graves. São classificadas em imunológicas ou alérgicas quando mediadas por anticorpos ou linfócitos T, e não imunológicas quando decorrentes de efeitos farmacológicos da droga, incluindo inibição da enzima cicloxigenase (Cox). Os dois grupos mais frequentemente implicados nas RHM são os anti-inflamatórios não esteroidais (AINEs), e os antibióticos betalactâmicos. O manejo adequado das reações aos AINEs depende da identificação do mecanismo fisiopatológico envolvido, que permitirá classificar em reator seletivo (indivíduo que reage a um único fármaco e a outros com estrutura química similar), ou reator múltiplo ou intolerante cruzado (aquele que reage a múltiplos fármacos de estrutura química não relacionada). O cloridrato de benzidamina (CBZ) é um AINE de uso frequente e relativamente seguro, sem descrições de reações graves associadas ao seu uso. Atua inibindo as enzimas Prostaglandina Endoperoxidase H Sintase 1 e/ou 2, e a Fosfolipase A2. Em pacientes com história de reações aos AINEs, o teste de provocação é a ferramenta diagnóstica padrão ouro para confirmar ou excluir a reatividade cruzada a outros AINEs e definir um fármaco alternativo seguro. Descreveremos um caso raro de anafilaxia ao CBZ durante teste de provocação oral. Descritores: Benzidamina, anti-inflamatórios não esteroidais, hipersensibilidade a drogas, anafilaxia. Hypersensitivity drug reactions (HDRs) may induce mild to severe heterogeneous clinical manifestations. They are classified as immunological or allergic when mediated by antibodies or T lymphocytes, and non-immunological when resulting from pharmacological effects of the drug, including inhibition of the cyclooxygenase (Cox) enzyme. The two groups of drugs most frequently implicated in HDRs are non-steroidal anti-inflammatory drugs (NSAIDs) and beta-lactam antibiotics. Appropriate management of NSAID reactions depends on identification of the pathophysiological mechanism involved, which will allow to classify the patient as selective reactor (patient reacting to a single drug and others with similar chemical structure) or multiple or cross-intolerant reactor (patient reacting to multiple drugs with unrelated chemical structure). Benzydamine hydrochloride (BZH) is a frequently used, relatively safe NSAID for which descriptions of severe reactions are not available. BZH acts inhibiting the enzymes prostaglandin endoperoxide H synthase (PGHS) 1 and/ or 2 and phospholipase A2. In patients with a history of NSAID reactions, the challenge test is the gold standard diagnostic tool to confirm or exclude cross-reactivity to other NSAIDs, and to define a safe alternative drug. In this paper, we describe a rare case of anaphylaxis to BZH during an oral drug provocation test.

Oral challenge test with nsaids: evaluation of patients attending a specialty clinic in Ribeirão Preto, Brazil

Methods Prospective study including 116 patients with positive history of hypersensitivity to NSAIDs, evaluated at the Allergy Clinic of the Clinical Hospital of Ribeirao Preto Medical School, between October 2010 and July 2014. Patients were evaluated using the European Network for Drug Allergy questionnaire, and underwent single blind, placebo controlled OCT, in a hospital-controlled environment. Patients were required to be clinically stable, and to withdraw antihistamines or corticosteroids seven days prior to the OCT. Patients were given 10%, 20%, 30% and 40% of the therapeutic NSAID dosage, selecting an NSAID different from the one implicated in the allergic reaction. Fifteen minutes after each dosage, patients were evaluated with Peak Flow and blood pressure measurements, heart and respiratory rates and general examination.

Characterization of aspirin-sensitivity in patients with asthma and chronic rhinosinusitis without a history of symptoms upon acetyl-salicylic acid (ASA) ingestion: a case series

Background Sensitivity to Non-steroidal Anti-inflammatory Drugs (NSAIDs) is a possible cause of exacerbations in patients with asthma. NSAID sensitivity associated to chronic rhinosinusitis with nasal polyps features Aspirin-Exacerbated Respiratory Disease (AERD). Patients with AERD generally require long-term treatment with inhaled corticosteroids for moderate to severe persistent asthma. Respiratory reactions may begin within minutes to hours after ingestion of NSAIDs.

Aspectos práticos no diagnóstico e manejo das reações de hipersensibilidade a fármacos

As reacoes de hipersensibilidade a farmacos (RHF) podem ser de natureza alergica ou nao alergica, e correspondem a aproximadamente 15% de todas as reacoes adversas a farmacos (RAF). As reacoes alergicas sao mediadas por mecanismo imune, nao previsiveis, podendo ser grave se ate mesmo fatais, ou requererem internacoes hospitalares prolongadas. Erros na classificacao das RHF ocorrem com frequencia, principalmente quando o diagnostico e baseado apenas na historia clinica (superdiagnostico) ou quando as reacoes nao sao documentadas de maneira apropriada (subdiagnostico). O diagnostico inadequado pode levar a exclusao desnecessaria, com diminuicao das opcoes terapeuticas, e ao uso de farmacos alternativos ineficazes e/ou de custo elevado. Os grupos de farmacos mais comumente envolvidos em reacoes de hipersensibilidade sao os betalactâmicos e os anti-inflamatorios nao esteroidais (AINEs). Consensos atuais preconizam uma investigacao diagnostica sistematizada das RHF atraves da realizacao de testes cutâneos, laboratoriais e testes de provocacao, direcionados por uma historia clinica detalhada. O objetivo do presente estudo e abordar aspectos praticos do diagnostico e manejo das reacoes de hipersensibilidade a farmacos, com enfase aos betalactâmicos e AINEs, de acordo com os estudos e consensos atuais... Drug hypersensitivity reactions (DHRs) may be classified as allergic or non-allergic, and they correspond to approximately 15% of all adverse drug reactions (ADRs). Allergic reactions are non-predictable and mediated by immune mechanisms; they may be severe and even life threatening, or may require prolonged hospitalization. Misclassification of DHRs is frequent, especially when diagnosis is based only on medical history (overdiagnosis), or when reactions are not properly documented (underdiagnosis). An incorrect diagnosis may lead to unnecessary exclusion of drugs, reducing treatment options, as well as to the use of alternative ineffective and/or expensive medications. Beta-lactam and non-steroidal anti-inflammatory drugs are the groups most commonly involved in DHRs. Current guidelines recommend a systematic diagnostic investigation of DHRs using skin, laboratory, and provocations tests, guided by a detailed medical history. The aim of this study was to address practical aspects of the diagnosis and management of DHRs, with a focus on beta-lactam and non-steroidal anti-inflammatory drugs, according to current studies and consensuses...