Zamir Calamita

Chronic Spontaneous Urticaria: Epidemiological Characteristics Focusing on the Histocompatibility Profile and Presence of Antibodies

BACKGROUND Understanding the etiopathogenesis of chronic spontaneous urticaria (CSU) remains a challenge. The clinical and laboratory characteristics relating to its histocompatibility profile and autoimmunity are constant research topics. OBJECTIVES To analyze the clinical and laboratory characteristics of patients with CSU by means of a cross-sectional study, focusing on the histocompatibility profile, presence of antinuclear antibodies (ANA) and presence of antithyroperoxidase antibodies (anti-TPO). MATERIALS & METHODS Sixty-seven adults with CSU were analyzed. The autologous serum skin test (ASST), ANA and anti-TPO were performed in all cases and MHC classes I and II (loci A, B and DR) were evaluated in 49 patients. RESULTS The factors that worsened urticaria included use of non-steroid anti-inflammatory drugs, emotional stress and physical stimuli, reported by 27%, 16% and 15% of these patients, respectively. The ASST test was positive in 49 patients (73%) and anti-TPO and ANA were present in 15 (22.4%) and 7 (10.5%), respectively. The OR (with 95% CI) for the association between ANA and anti-TPO was 5.94 (1.16-30.42), and thus statistically significant. There was a favorable association (with statistical significance) between HLA B*50 and patients with CSU, with OR (95% CI) of 2.96 (1.17- 7.48). CONCLUSION A significant favorable association was found between these patients and HLA B*50, and between the presence of anti-TPO and ANA. The greater prevalence of HLA B*50 in these patients and the association between ANA and anti-TPO reinforce the possibility that an immunogenic mechanism may be the triggering factor for CSU.

HLA in patients with chronic spontaneous urticaria who are positive for anti-thyroid antibodies

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Risk Factors for Cardiovascular Disease in Psoriasis: Relation to Inflammation Assessed by the Severity and Duration of Illness

BACKGROUND Recent studies have shown that psoriasis is associated with risk factors for cardiovascular diseases (CVDs). OBJECTIVES To evaluate the epidemiological profile of patients with psoriasis, focusing on the risk factors for CVDs and inflammation. MATERIALS & METHODS Patients with a diagnosis of psoriasis who were attended at the dermatology outpatient clinic of a university hospital were evaluated. RESULTS 229 adult patients of mean age 50 years, among whom 52% were male, were evaluated. Twenty patients (8.7%) were concomitantly affected by psoriatic arthritis. From analysis on laboratory tests from 177 patients, we saw that 111 (62.7%) were dyslipidemic and that among these, only 9 (8%) were undergoing treatment. 35.6% presented abnormal glycemia tests, but 22% were not having any treatment for the glycemic alteration observed. We analyzed possible associations of the severity of psoriasis and length of time with the disease with lipid disorders, glycemic disorders and systemic arterial hypertension, but did not find any significant associations. CONCLUSION The findings observed in this study corroborate previous findings in similar studies, thus demonstrating that the prevalence of risk factors for CVDs among patients with psoriasis is greater than in the general population, but that a large proportion of such patients do not undergo treatment for this. We did not find any possible association between the inflammatory process and the genesis of risk factors for CVDs, although the magnitude of this evidence is not strong. These findings serve to alert dermatologists to remain attentive to these factors, among patients with psoriasis.

Effects of Immunosenescence on the Lower Expression of Surface Molecules in Neutrophils and Lymphocytes

BACKGROUND Immunosenescence is a remodeling of the immune system, caused by aging, with changes in the function of neutrophils, lymphocytes, and Treg cells. OBJECTIVE This study aimed to evaluate the expression of molecules CD11b, CD16 and CD64 (neutrophils), CD154 (T lymphocytes), CD40 (B lymphocytes), and to quantitatively analyze the Treg cell subpopulation. METHODS 49 elderlies (≥60 years) and 49 adults (≤35 years) were studied. Flow cytometry was used to analyze the expression of surface molecules and the subpopulation of Treg cells, and the results between the groups were compared statistically by the t-test. RESULTS There was a decreased significance in the expression of CD11b and CD40 in the elderly. CONCLUSION Decreased CD11b expression can result in susceptibility to infectious diseases, and impairment of phagocytic capacity. Decreased CD40 expression can result in a decline in B lymphocyte activation. The other molecule studied presented alterations not significant, but compatible with the immunological changes in aging.

Principais sensibilizantes em pacientes idosos e não idosos com dermatite de contato

Aims: To evaluate the prevalence of the main allergens found in allergic contact dermatitis among elderly and non-elderly patients.Methods: Retrospective study of the medical records of patients clinically diagnosed with contact dermatitis treated from August 2000 to January 2012 at the Allergy Outpatient Clinic of Marilia Medical School and at an Allergy and Dermatology private clinic in Marilia, state of Sao Paulo, Brazil. The inclusion criteria were clinical diagnosis of contact dermatitis, patch test performed during the study period, and no treatment with systemic corticosteroids or any other immunosuppressants. Age, sex, history of other types of allergy and allergens used were assessed. The patch test results were read 48 hours and 72 hours after application of the test chambers.Results: A total of 362 patients were included in the study: 60 elderly patients (aged 60 years or older) and 302 non-elderly patients. In addition to contact dermatitis, other types of allergies were observed in 20 (33.3%) of elderly patients and in 113 (37.4%) of non-elderly patients (p=0.54). There were 162 positive reactions on the patch test among elderly patients and 738 positive reactions among non-elderly patients (p=0.24). Strong positive reactions were present in 41 (68.3%) elderly patients and in 156 (51.6%) non-elderly patients (p=0.02). Strong and very strong positive reactions, when assessed together, were detected in 44 (73.3%) elderly patients and in 214 (70.8%) non-elderly patients (p=0.69). The most common allergens were nickel sulfate (in 33.3% of elderly and 38% of non-elderly patients) and fragrance mix (in 25% of elderly and 27.8% of non-elderly patients), with no statistical difference between the groups.Conclusions: There was a high rate of positive reactions on the patch test among patients with contact dermatitis, with no difference between elderly and non-elderly individuals, and the most common allergens were nickel sulfate and fragrance mix. Therefore, it is important that allergy to nickel and fragrances be included in the etiologic investigation of contact dermatitis, regardless of age.

Chronic spontaneous urticaria: cutaneous reaction and laboratory aspects

Introduction: The chronic spontaneous urticaria (CSU) is a cutaneous reaction characterized by the formation of episodic and recurrent erythematous papules, usually pruritic, which etiology may be associated with an autoimmune response resulting from the action of immunoglobulin subclass G (IgG) of autoantibodies directed against the immunoglobulin subclass E (IgE) receptors of cutaneous mast cells or against IgE bound to mast cells. The autologous serum skin test (ASST) is a screening test that indicates the presence of these autoantibodies in patients with CSU. Objective: To check for differences in ASST results among patients with CSU and the control group with other hypersensitivities. Material and method: This is a cross-sectional case-control study, in which 49 adults were analyzed, 27 with CSU and 22 with other hypersensitivity reactions. ASST, CD123, estimation of IgG bound to basophil, mean platelet volume (MPV), antinuclear antibody (ANA), thyroid-stimulating hormone (TSH), anti-thyroid peroxidase antibody (TPOab), erythrocyte sedimentation rate (ESR) and the total IgE were performed in both groups. Results: The ASST, shown positive results in 16 (59.2%) the patients with CSU and in five (22.7%) from the control group, with statistical significance. For the other variables above described, there was no statistical difference. Conclusion: A higher ASST positivity was found in CSU patients compared to patients with other hypersensitivities, and further studies with larger sample are needed for better analysis of other variables.

Symptoms of allergy in elderly attended by a geriatric outpatient clinic

AIMS: To describe the epidemiological characteristics of allergic manifestations observed in elderly attended in an outpatient clinic of geriatrics. METHODS: A cross sectional study was conducted with patients over 60 years of age, attended in the Outpatient Clinics of Geriatrics of the Faculty of Medicine of Marilia in Sao Paulo state, who were able to respond to an interview or were accompanied by caregivers able to do it. RESULTS: A total of 106 patients were interviewed. Among the 106 patients evaluated, 56 (52.8%) reported respiratory allergy, 47 (44.3%) possible allergic skin manifestation, and 14 (13.2%) reported drug allergies. The main medicines perceived by patients as drugs that caused allergic reactions were antibiotics (42.8%) and non-steroidal anti-inflammatory (28.6%), while the other 28.6% of reactions were attributed to other types of drugs. CONCLUSIONS: The elderly included in the study had a relevant prevalence of allergic symptoms.

Basophil Activation Test with Indomethacin to Assess Hypersensitivity to Non-Steroidal Anti-Inflammatory Drugs: A Preliminary Study

BACKGROUND The basophil activation test has been investigated for diagnosing hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs). This has not yet been done in relation to indomethacin. OBJECTIVE First seek to establish the viable concentrations of indomethacin and the diluent propylene glycol (PPG) in relation to basophils then test this in patients with hypersensitivity to NSAIDs. MATERIALS & METHODS The ideal concentrations of PPG and indomethacin were assessed by incubating them with basophils from an atopic donor and evaluating the intensity of expression of CD63 molecules by means of flow cytometry. We also evaluated the cell viability directly using the trypan blue in seven controls. Then indomethacin was tested in ten patients with hypersensitivity to NSAIDs compared with eight persons in control group. RESULTS In relation to the toxicity of propylene glycol, concentrations less than or equal to 0.5% are safe. There was no cytotoxicity or nonspecific stimulation from using indomethacin at concentrations of 10 mcg/mL, 1 mcg/mL and 0.1 mcg/mL. Then indomethacin was tested at concentration of 10 mcg/mL diluted in 0.5% propylene glycol in both groups. There was no statistical difference in the intensity of activation of basophils comparing the group of patients with hypersensitivity to NSAIDs and the control group. CONCLUSIONS As a diluent for indomethacin, PPG should be used at concentrations less than or equal to 0.5%. The indomethacin at concentration of 10 mcg/mL was not able to differentiate patients with and without hypersensitivity to NSAIDs.

576 Hla and Chronic Urticaria with Positive Autologous Serum Skin Test among Brazilians

Background Many autoimmune diseases are associated with certain alleles of the human leukocyte antigen (HLA) system, and recent studies have shown that, in many cases, chronic urticaria has autoimmune etiology. An association between class I and II alleles of the major histocompatibility complex (MHC) and idiopathic chronic urticaria (ICU) has previously been observed in different populations, but there are still no studies on Brazilian populations in this respect. The involvement of MHC classes I and II (loci A, B and DR) in Brazilian patients with ICU and a positive autologous serum skin test (ASST) was investigated and compared with a healthy population group. Methods DNA was extracted from the blood of 42 patients with ICU (28 women; mean age ± SD: 44 ± 12 years; range: 19 to 88 years) and MHC classes I and II alleles were determined using the polymerase chain reaction (PCR) and a laboratory test for oligonucleotide hybridization using a single-filament probe. The frequencies of these alleles in patients with chronic urticaria were compared with the frequencies in 1000 genetically unrelated voluntary blood donors from the same region of Brazil. The diagnosis of idiopathic chronic urticaria was based on the patients’ clinical histories and routine laboratory tests. Only the patients with positive ASSTs were selected. The allele distribution results from the patient and control groups were analyzed using odds ratios and 95% confidence intervals. Results No statistically significant differences were found between the ASST-positive patients with chronic urticaria and the control group, in relation to the MHC classes I and II alleles studied. Conclusions We found that in this population group, there was no specific association between the HLA alleles studied (HLA-A, HLA-B and DRB1) and ASST-positive chronic urticaria. We believe that further population studies are needed in order to investigate the possible existence of this association.

CD63 e CD123 expressão, autoanticorpos IgG e acurácia do teste do soro autólogo em pacientes com urticária crônica

INTRODUCTION: The autologous serum skin test (ASST) may suggest an autoimmune etiology in chronic urticaria (CU). A new laboratory technique called basophil activation test (BAT) has been currently employed for its diagnosis. OBJECTIVE: To analyze ASST in relation to BAT as well as to evaluate interleukin 3 (IL3) receptors (CD123) and non-specific immunoglobulin G (IgG) autoantibodies bound to basophils in patients with chronic urticaria. METHODS: We studied 33 adults with CU and mean age of 42.5 + 14 years. After stimulation by serum from patients with CU, CD63 expression on basophils from one atopic donor was analyzed by flow cytometry. Furthermore, we investigated CD123 and IgG autoantibody expressions. RESULTS: The odds ratio (OR) between ASST and BAT was 1.00 (95% confidence interval [CI]: 0.22 to 4.5). The ASST for autoimmune CU diagnosis showed an accuracy of 54.5%, sensitivity of 66%, specificity of 33%, positive predictive value of 63%, and negative predictive value of 36%. There was no statistical difference between the studied groups as to mean non-specific IgG and CD123 expressions (for a p < 0.05). DISCUSSION: This study demonstrated that ASST has low accuracy in the diagnosis of autoimmune CU. Concerning other analyzed aspects, there was no statistical difference between positive ASST and negative ASST. CONCLUSIONS: Due to insufficient studies in this area and the relevance of this issue, further investigation is required.