ABSTRACT Exposure to airborne pollen allergens is an important environmental factor in triggering respiratory allergic diseases, such as rhinitis and asthma. These diseases lead to a reduction in patients’ quality of life and an increase in socioeconomic costs throughout Europe, including Portugal. One of the most common information available to patients with pollinosis and their clinicians is the concentration of pollen grains present in the atmosphere of outdoor environments, bioaerosols whose temporal distribution is contained in the pollen calendars. Another fundamental instrument is the Pollen Bulletin, which provides pollen forecasts. Given the scientific evidence of the relationship between pollen concentrations and allergic symptoms, such information and prevention tools have been essential for the general population and the medical community assisting in these pathologies. The aeropalynological information disclosed is only possible with the continuous environmental monitoring carried out by the Portuguese Aerobiology Network for more than two decades in Portugal. The Pollen incidence maps presented here, constructed based on the information that gave rise to the pollen calendars, show the incidence of the main allergenic pollen types to which the populations of each region of the country are exposed and shall constitute an essential tool in the clinical practice in the allergic disease field in Portugal.

RESUMO A exposição a aeroalergénios polínicos é um importante fator ambiental desencadeante de doenças alérgicas respiratórias, tais como a rinite e a asma. Estas patologias conduzem a uma redução da qualidade de vida dos doentes e a um aumento dos custos socioeconómicos por toda a Europa, incluindo em Portugal. Uma das informações mais comuns disponíveis para os doentes com polinose e seus clínicos é a concentração de grãos de pólen presentes na atmosfera dos ambientes exteriores, bioaerossóis cuja distribuição temporal se encontra contida nos calendários polínicos. Outro instrumento fundamental é o “Boletim Polínico”, instrumento que informa as previsões de grãos de pólen na atmosfera. Dada a evidência cientificamente comprovada da relação entre concentrações de pólen e sintomatologia alérgica, tais ferramentas de informação e de prevenção têm sido imprescindíveis quer para a população em geral, quer para a comunidade médica que a assiste nestas patologias. As informações aeropalinológicas divulgadas só são possíveis com a monitorização ambiental contínua que tem sido feita pela Rede Portuguesa de Aerobiologia há mais de duas décadas em Portugal. Os mapas de incidência polínica aqui apresentados, construídos com base na informação que deu origem aos calendários polínicos, mostram a incidência dos principais tipos polínicos alergizantes a que as populações de cada região do país estão expostas e constituirão um instrumento essencial na prática clínica no domínio da doença alérgica em Portugal.

Abstract Introduction and Objectives: Oral food challenges (OFC) are the gold standard for the diagnosis of food allergy. The aim of this study was to characterize and analyze the OFCs performed in the Pediatric Department of the study hospital. Material and Methods: Retrospective analysis of all patients who underwent OFCs in the pediatric department of the study hospital from October 2016 to December 2021. All non-IgE-mediated reactions were excluded. Statistical analysis was performed using IBM Statistical Package for Social Sciences®. Results: A total of 301 OFCs were performed on a total of 172 patients during the study period. Most patients were preschool children (<6 years; 79.4%) and 40.1% had more than one OFC. The most frequently tested allergens were hen’s egg (26.2%), tree nuts (16.9%), and cow’s milk (16.7%). The positivity rate was 23.2%. Tests for milk and wheat were significantly associated with a positive result. The main reason for OFC testing was to establish a diagnosis (60.1%), but also to assess tolerance (25.6%) and to document the responsiveness threshold (14.3%). Most positive reactions were local/grade I (25.7%) or moderate/grade II (58.6%). Patients with a personal history of atopic comorbidities were more likely to have a positive test result (p=0.022), especially those with atopic dermatitis (p=0.022). Discussion and Conclusion: Most OFCs in this analysis were negative. Early recognition of food allergy resolution is essential to prevent unnecessary allergen avoidance. An increased risk of positive reactions to milk or wheat, or in the setting of a personal history of atopic dermatitis, should be considered.

Resumo Introdução e Objetivos: A prova de provocação oral é o gold standard para o diagnóstico de alergia alimentar. Este estudo pretendeu caracterizar e analisar as provas efetuadas no Serviço de Pediatria de um hospital de nível II. Material e Métodos: Estudo retrospetivo dos doentes submetidos a provas de provocação oral entre outubro 2016 e dezembro 2021 num hospital de nível II. As reações não mediadas por IgE foram excluídas. A análise estatística foi realizada através do software IBM Statistical Package for Social Sciences®. Resultados: Foram realizadas 301 provas num total de 172 doentes. A maioria dos doentes eram crianças com idade <6 anos (79,4%) e 40,1% realizou duas ou mais provas. Os alergénios mais frequentemente testados foram ovo (26,2%), frutos secos (16,9%) e leite de vaca (16,7%). Constatou-se que 23,2% das provas foram positivas. Verificou-se uma associação estatisticamente significativa entre as provas realizadas para o leite e trigo e a obtenção de um resultado positivo. Relativamente ao objetivo das provas, 60,1% destinavam-se a estabelecer o diagnóstico, 25,6% a avaliar a tolerância e 14,3% a documentar o limiar de reatividade. A maioria das reações positivas foram locais/grau I (25,7%) ou moderadas/grau II (58,6%). Foi identificada uma associação estatisticamente significativa entre antecedentes de atopia e um resultado positivo nas provas (p=0,022), particularmente antecedentes de dermatite atópica (p=0,022). Discussão: A maioria das provas realizadas foram negativas. O reconhecimento atempado da resolução de uma alergia alimentar permite suspender a evicção desnecessária de alergénios suspeitos. Deve ser considerado o risco acrescido de uma reação positiva com leite, trigo ou em contexto de antecedentes pessoais de dermatite atópica.

Abstract Objective: Perfume (Parfum) or fragrance is a natural or synthetic cosmetic ingredient added to emit a pleasant aroma or to improve the odor of a cosmetic formula. It is a mixture of substances, not revealed by the manufacturer, which may contain ingredients with allergenic potential, endocrine disruptors, and other possible harmful effects on human health. This study aims to analyze children’s cosmetics labels to assess the presence of Perfume. Methods: The researchers randomly visited points of sale in Curitiba, the capital of a southern Brazilian state; in order to catalog the largest possible number of children’s cosmetics items. Results: 398 children’s cosmetics were analyzed and found Parfum on 295 (74.1 %) of the labels, including 90.4 and 79,1 % of the shampoos and wet wipes, respectively. Conclusion: Exposure of children’s skin to fragrances can lead to local side effects such as allergies, but also to systemic effects, and the lack of knowledge of the general population and health professionals about its possible deleterious effects emphasizes the importance of changes in the regulation of cosmetics aiming to reduce the use of this ingredient. Objective (Parfum formula substances manufacturer potential disruptors childrens children s Methods Curitiba state items Results 39 29 74.1 741 74 1 (74. 904 90 4 90. 791 79 79, wipes respectively Conclusion allergies 3 2 74. 7 (74 9 (7 (

Abstract Objectives: To systematize the existing scientific evidence in relation to the pathology “Atopic Disease of the Central Compartment” (CCAD). Study Design: Systematic Bibliographic Review. Material and Methods: Conducting a systematic literature review in the MEDLINE, Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature databases, based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) model, selecting papers published between January 2010 and December 2022. Results: Of the 3114 studies initially found, a total of 13 articles were selected for full analysis. More than half of the articles (69.2%) were published from 2019 onwards. A total of 1780 patients with CRS were analyzed. Of these, the number of patients with CHD was 372 (20.9%), with a male:female ratio of 2.16. Allergic rhinitis (98.5%), asthma (25.2%) and smoking (8.2%) were identified as comorbidities. Conclusions: CCAD represents a variant of CRS described for the first time in 2017. It is associated with exposure to inhalational allergens and with edematous and polypoid repercussions in the middle and superior turbinates, as well as in the postero-superior region of the nasal septum. The basis of management of this pathology is medical treatment of the allergy, complemented, if necessary, with endoscopic sinus surgery.

Resumo Objetivos: Sistematizar a evidência científica existente em relação à patologia “Doença Atópica do Compartimento Central” (DACC). Desenho do Estudo: Revisão Bibliográfica Sistemática. Material e Métodos: Realização de uma revisão bibliográfica sistemática nas bases de dados MEDLINE, Cochrane Central Register of Controlled Trials e Cumulative Index to Nursing and Allied Health Literature, baseada no modelo PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), selecionando trabalhos publicados entre janeiro de 2010 e dezembro de 2022. Resultados: Dos 3114 estudos inicialmente encontrados, foram selecionados para análise na integra um total de 13 artigos. Mais de metade dos artigos (69.2%) foram publicados a partir do ano de 2019, inclusive. Um total de 1780 doentes com RSC foi analisado. Destes, o número de doentes com DACC foi 372 (20.9%), com um rácio masculino:feminino de 2.16. Identificaram-se como comorbilidades a rinite alérgica (98,5%), a asma (25.2%) e o tabagismo (8.2%). Conclusões: DACC representa uma variante de RSC descrita pela primeira vez em 2017. Está associada à exposição a alergénios inalatórios e com repercussões edematosas e polipóides nos cornetos médios e superiores, bem como na região postero-superior do septo nasal. A base da gestão desta patologia é o tratamento médico da alergia, complementado, se necessário, com cirurgia endoscópica nasossinusal.

Abstract Objective Evaluate biomarkers capable of safely guiding Yellow fever vaccine (YFV) vaccination among individuals suspicious of hen's egg allergy, and identify factors associated with a higher risk for adverse events after immunization (AEAI). Methods Patients underwent skin prick test (SPT) for standardized allergens: whole egg, egg white, egg yolk; YFV (1:10 dilution; Biomanguinhos-Fiocruz), and intradermal test (IDT; YFV 0.02 mL, 1:100 dilution) and positive and negative controls. Serum levels of specific IgE (sIgE) for a whole egg, egg white, egg yolk, egg albumin, ovomucoid, lysozyme, and conalbumin (ImmunoCap®; ThermoFisher®) were obtained. Patients sensitized to YFV were submitted to YFV desensitization, and those negatives received YFV (0.5mL) and remained under surveillance for at least one hour. Results 103 patients were enrolled, 95% under 12 years old. 71% (81/103) of patients had reactions: 80% immediate, 11% mixed, and 9% delayed. There was an association between positive skin test results with YFV and the severity of the reaction (OR:7.64; 95%CI:1.61-36.32; p =0,011). Only the presence of sIgE to ovomucoid was associated with clinical symptoms (p =0,025). Thirty patients underwent the YFV desensitization protocol. Conclusion There is a relationship between the positivity of the egg's components and the severity of the clinical reaction. Furthermore, the relationship between the positivity of the tests with the YFV and egg's components may show a tendency to look at ovomucoid and conalbumin, but it is not a certainty. Therefore, further studies are needed to confirm these associations, and for now, the authors still recommend using the vaccine for testing when necessary. (YFV hens hen s allergy AEAI. AEAI . (AEAI) SPT (SPT allergens white yolk 110 1 10 (1:1 dilution BiomanguinhosFiocruz, BiomanguinhosFiocruz Biomanguinhos Fiocruz , Biomanguinhos-Fiocruz) IDT (IDT 002 0 02 0.0 mL 1100 100 1:10 controls (sIgE albumin lysozyme ImmunoCap® ImmunoCap (ImmunoCap® ThermoFisher® ThermoFisher obtained 0.5mL 05mL 5mL (0.5mL hour enrolled 95 old 71 81/103 81103 81 (81/103 reactions 80 immediate 11 mixed 9 delayed OR7.64 OR764 OR 7.64 7 64 (OR:7.64 95%CI1.6136.32 95CI1613632 CI 95%CI 1.61 36.32 61 36 32 95%CI:1.61-36.32 =0,011. 0011 =0,011 011 =0,011) =0,025. 0025 =0,025 025 =0,025) protocol eggs Furthermore certainty Therefore associations now necessary (AEAI (1: Biomanguinhos-Fiocruz 00 0. 1:1 (ImmunoCap 81/10 8110 8 (81/10 OR7 OR7.6 OR76 764 7.6 6 (OR:7.6 CI1 6136 95%CI1.6136.3 95CI161363 95CI 161 1.6 3632 36.3 3 95%CI:1.61-36.3 001 =0,01 01 =0,02 (1 1: 81/1 811 (81/1 OR7. 76 7. (OR:7. 613 95%CI1.6136. 95CI16136 16 1. 363 36. 95%CI:1.61-36. =0,0 ( 81/ (81/ (OR:7 95%CI1.6136 95CI1613 95%CI:1.61-36 =0, (81 (OR: 95%CI1.613 95CI161 95%CI:1.61-3 =0 (8 (OR 95%CI1.61 95CI16 95%CI:1.61- = 95%CI1.6 95CI1 95%CI:1.61 95%CI1. 95%CI:1.6 95%CI1 95%CI:1. 95%CI:1 95%CI:

Abstract Objectives The aim of this study was to explore the differences in the pattern of allergen sensitization in CR individuals without or with asthma, according to asthma severity. Methods A total of 1066 adults were evaluated. Asthma and chronic⁄allergic rhinits were identified by specialists, questionnaries and skin-prick test. The phenotypic characterization was avaliable from skin-prick test to an aeroallergen extended panel, total IgE and pulmonary function. Using questionnaires and clinical evaluation, participants were classified into the groups: chronic rhinitis alone (CRA) and chronic rhinitis + asthma, the latter subdivided into CR + mild asthma (CRMA) and CR + moderate to severe asthma (CRMSA). Aerollergen sensitization was defined by a positive prick test to one or more allergens associated with nasal symptoms and/or asthma. The association between CR and asthma was evaluated by multivariable logistic regression. The evidence of effect modification of pattern of sensitization in CR on the association with asthma severity and outcomes was examined by introducing interactions terms in the logistic regression models adjusting for confounders. Results Frequency of sensitization to aeroallergens was higher in association with asthma in comparison to CRA (CRMA 70.4%; CRMSA 65.0%; CRA 47.0%; p= 0.000). Similarly, the presence of asthma was associated to aeroallergen multiple sensitization (51.5%) (OR = 2.10, 95% CI 1.27-3.50). Additionally, the sensitization to mites, cockroaches, animal epithelium, grasses, and molds, were higher in asthma (56.8%, 24.3%, 12%, 7.13% and 10.3%, respectively). Sensitization to Alternaria alternata, Cladosporium herbarum and dog epithelium was exclusive in asthma groups. A concomitant asthma diagnosis was directly associated with a positive allergen sensitization at least one allergen (62.7%, OR = 2.45, 95% CI 1.80-3.34) and polissensitization (51.5%, OR = 2.10, 95% CI 1.27-3.50). Conclusion Asthma is associated with multiple allergen sensitization among patients with CR. Some unique profiles of aeroallergen sensitization were observed in patients with CR and asthma. Nevertheless, no difference was found in the sensitization in relation to asthma severity, which suggest atopy is not the main underlying mechanism for asthma severity among patients with CR. Level of evidence: Level 3. 106 chronicallergic allergic specialists skinprick skin panel function evaluation groups (CRA CRMA CRMSA. . (CRMSA) andor confounders 70.4% 704 70 4 65.0% 650 65 0 47.0% 470 47 p 0.000. 0000 0.000 000 0.000) Similarly 51.5% 515 51 5 (51.5% 210 2 10 2.10 95 1.273.50. 127350 1.27 3.50 1 27 3 50 1.27-3.50) Additionally mites cockroaches grasses molds 56.8%, 568 56 8 (56.8% 243 24 24.3% 12 12% 713 7 13 7.13 103 10.3% respectively. respectively respectively) alternata 62.7%, 627 62 (62.7% 245 45 2.45 1.803.34 180334 1.80 3.34 80 34 1.80-3.34 51.5%, Nevertheless (CRMSA 70.4 65.0 6 47.0 0.00 00 51.5 (51.5 21 2.1 9 273 1.273.50 12735 127 1.2 350 3.5 1.27-3.50 56.8% (56.8 24.3 71 7.1 10.3 62.7% (62.7 2.4 803 1.803.3 18033 180 1.8 334 3.3 1.80-3.3 70. 65. 47. 0.0 51. (51. 2. 1.273.5 1273 1. 35 1.27-3.5 56.8 (56. 24. 7. 10. 62.7 (62. 1.803. 1803 18 33 1.80-3. 0. (51 1.273. 1.27-3. 56. (56 62. (62 1.803 1.80-3 (5 1.273 1.27-3 (6 1.80- ( 1.27-

Abstract This study investigated the relationship between food introduction and celiac disease development. This bibliographic review was conducted from May to June 2023 and covered publications from 2013 to 2023. The Virtual Health Library (VHL) and PubMed databases were used, with the following search terms: “Celiac Disease,” “Gluten enteropathy” (with the Boolean operator “OR”), “Infant,” “Preschooler” (also using the Boolean operator “OR”) and “Food Introduction.” A total of 28 articles were found and, after careful analysis, only 6 met the inclusion and exclusion criteria. These articles addressed topics such as the relationship between dietary patterns and the risk of celiac disease, the prevalence of the disease in children born before and after the epidemic in Sweden, the feasibility of introducing allergens and their relationship with breastfeeding, and the implications of introducing gluten into the diet and early weaning in celiac disease. The results of the study highlight the importance of further research into this topic to develop possible methods of prevention and intervention in the manifestation process of celiac disease. From the bibliographic review, it was possible to identify the variables that imply the development of celiac disease and refute the hypotheses of the direct influence of the early introduction of gluten in the diet on the manifestation of the disease. 202 201 VHL (VHL used terms Celiac Disease, Disease Gluten enteropathy OR, OR , Infant, Infant “Infant, Preschooler “Preschooler also “OR” Food Introduction. Introduction 2 analysis criteria Sweden breastfeeding 20 “Infant “OR

Abstract Objectives: This thesis aims to provide patients with a preventive and therapeutic basis by analyzing IgE level influencing factors of common allergens for Allergic Rhinitis (AR). Method: Multiple linear regression analysis is made upon questionnaires among 749 cases of AR patients that are divided into 5 age-based groups. Perform serum-specific IgE content testing on patients. Results: Cockroach being an allergen, AR patients' IgE Level is influenced by allergic history, home-raised plants and animals. For AR patients with mugwort as an allergen, allergy and asthma history could increase IgE level, respectively, β = 4.291 and β = 4.364. If the allergen turns out to be peanut, allergic history would increase the IgE level (β = 0.171), however, the level would be lower in female patients compared with male patients (β = -0.078). For patients with egg as an allergen, allergic history, home-raised plants and animals (pets) would all affect the IgE level, respectively, β = 0.182, β = 0.118 and β = -0.101. Conclusions: IgE level varies according to allergic history, home-raised plants & animals, gender, furniture renewal, asthma, and ages for patients with different allergens including cockroach, mold, mugwort, peanut, egg and crab. For each kind of allergen, the IgE levels react differently to different influencing factors, thus requiring a thorough analysis of each AR patient's allergen and allergenic factors. Objectives AR. . (AR) Method 74 agebased age based groups serumspecific serum specific Results homeraised home raised respectively 4291 4 291 4.29 4364 364 4.364 peanut 0.171, 0171 0.171 , 0 171 0.171) however 0.078. 0078 0.078 078 -0.078) pets (pets 0182 182 0.182 0118 118 0.11 0.101. 0101 101 -0.101 Conclusions gender renewal cockroach mold crab patient s (AR 7 429 29 4.2 436 36 4.36 017 0.17 17 007 0.07 07 -0.078 018 18 0.18 011 11 0.1 0.101 010 10 -0.10 42 2 4. 43 3 4.3 01 1 00 0.0 -0.07 0. 0.10 -0.1 -0.0 -0. -0 -

RESUMEN La alergia a las proteínas de la leche de vaca aparece en los primeros meses de vida y es la alergia alimentaria más frecuente en el lactante y el niño pequeño. Esta investigación tiene como objetivo caracterizar clínica y epidemiológicamente a pacientes con alergia a las proteínas de la leche de vaca. Se realizó un estudio longitudinal, descriptivo, retrospectivo en el hospital infantil Hermanos Cordové del municipio Manzanillo en Granma, Cuba. La población estuvo constituida por los 10 infantes egresados de la institución durante el período 2017-2021. Se estudiaron las variables: edad, sexo, estadía, tiempo de evolución de la enfermedad, lactancia, factores de riesgo, evaluación nutricional. Entre los principales resultados se obtuvieron que predominó el sexo femenino y las edades de uno a seis meses (60 %). El 50 % de niños estaban desnutridos. El 70 % de los pacientes presentaron diarreas como principal síntoma, seguido por las lesiones de piel (60 %). Solo el 20 % recibieron lactancia materna exclusiva hasta los 6 meses de edad. El parto por cesárea fue el factor de riesgo más predominante (50 %). Se concluye que el sexo femenino y las edades de uno a seis meses fueron las más sobresalientes. La diarrea y las lesiones de piel fueron las manifestaciones clínicas más frecuentes de los pacientes con alergia a las proteínas de la leche de vaca. Los lactantes desnutridos, con lactancia artificial y antecedentes de parto por cesárea tienen mayores probabilidades de padecer esta enfermedad.

RESUMO A alergia à proteína do leite de vaca aparece nos primeiros meses de vida e é a alergia alimentar mais comum em lactentes e crianças pequenas. Esta pesquisa tem como objetivo caracterizar clínica e epidemiologicamente pacientes com alergia à proteína do leite de vaca. Foi realizado um estudo longitudinal, descritivo e retrospectivo no Hospital Infantil Hermanos Cordové, no município de Manzanillo, em Granma, Cuba. A população foi composta por 10 crianças que se formaram na instituição no período de 2017 a 2021. As seguintes variáveis foram estudadas: idade, sexo, tempo de internação, tempo de evolução da doença, aleitamento materno, fatores de risco, avaliação nutricional. Dentre os principais resultados, predominaram o sexo feminino e a faixa etária de um a seis meses (60%). 50% das crianças estavam desnutridas. A diarreia foi o principal sintoma de 70% dos pacientes, seguida pelas lesões cutâneas (60%). Apenas 20% foram amamentados exclusivamente até os 6 meses de idade. O parto cesáreo foi o fator de risco mais prevalente (50%). Conclui-se que o sexo feminino e a idade de um a seis meses foram os que mais se destacaram. Diarreia e lesões cutâneas foram as manifestações clínicas mais frequentes dos pacientes com alergia à proteína do leite de vaca. Lactentes desnutridos, lactentes com alimentação com fórmula e história de parto cesáreo são mais propensos a sofrer dessa doença.

ABSTRACT Allergy to cow's milk proteins, appears in the first months of life and is the most common food allergy in infants and young children. This research aims to characterize clinically and epidemiologically patients with allergy to cow's milk proteins. A longitudinal, descriptive, retrospective study was conducted at the Hermanos Cordové Children's Hospital in the municipality of Manzanillo in Granma, Cuba. The population consisted of the 10 children who graduated from the institution during the period 2017-2021. The following variables were studied: age, sex, length of stay, duration of disease progression, breastfeeding, risk factors, nutritional assessment. Among the main results, it was found that the female sex and the ages of one to six months predominated (60 %). The 50 % of children were malnourished. 70 % of patients had diarrhea as the main symptom, followed by skin lesions (60 %). Only 20 % were exclusively breastfed up to 6 months of age. Caesarean section was the most prevalent risk factor (50 %). It is concluded that the female sex and the ages of one to six months were the most outstanding. Diarrhea and skin lesions were the most common clinical manifestations in patients with cow's milk protein allergy. Malnourished infants, breastfed infants and a history of cesarean delivery are more likely to have this disease.

RESUMEN Objetivo. Identificar los países que tienen legislación relacionada con la declaración obligatoria de alergenos alimentarios, alimentos irradiados y transgénicos en el etiquetado nutricional de alimentos envasados. Métodos. Estudio exploratorio en el cual se revisaron los reglamentos sanitarios o normas técnicas de los alimentos de los países de América Latina con el fin de recopilar información sobre la declaración de alergenos, trazas de alergenos, alimentos irradiados y transgénicos. La búsqueda de la información se realizó a través de páginas gubernamentales de los países. Los resultados se presentan de manera descriptiva y narrativa. Resultados. De los 19 países revisados, 89% declara alergenos en su etiquetado nutricional, 76% incorpora la declaración de trazas en su legislación de manera explícita y 82% sigue las recomendaciones del Codex Alimentarius con algunas modificaciones en las categorías de alimentos. Conclusiones. La declaración de alergenos como medida de seguridad alimentaria, así como avanzar en mejorar la rotulación de trazas de alergenos y la disponibilidad universal de epinefrina son los desafíos pendientes de la Región.

RESUMO Objetivo. Identificar os países que têm legislação relacionada à declaração obrigatória de alimentos alergênicos, irradiados e transgênicos na rotulagem nutricional de alimentos embalados. Métodos. Estudo exploratório com revisão dos regulamentos sanitários ou normas técnicas de alimentos dos países da América Latina, a fim de coletar informações sobre a declaração de alimentos alergênicos, traços de alergênicos, alimentos irradiados e transgênicos na rotulagem nutricional. A busca de informações foi realizada por meio dos sites governamentais dos países. Os resultados são apresentados de forma descritiva e narrativa. Resultados. Dos 19 países analisados, 89% declaram alergênicos na rotulagem nutricional, 76% incorporam explicitamente a declaração de traços na legislação e 82% seguem as recomendações do Codex Alimentarius, com algumas modificações nas categorias de alimentos. Conclusões. Entre os desafios pendentes na Região estão a implementação da declaração de alergênicos como medida de segurança alimentar e a melhoria da rotulagem de traços de alergênicos e da disponibilidade universal de epinefrina.

ABSTRACT Objective. Identify countries that have legislation on mandatory declarations of food allergens, irradiated foods, and transgenic foods on the nutritional labels of packaged foods. Methods. Exploratory study reviewing the health regulations and technical standards for foods in Latin American countries in order to gather information on declarations of allergens, trace allergens, irradiated foods, and transgenic foods. The information search was carried out through the countries’ government web pages. Presentation of the results is descriptive and narrative. Results. Of the 19 countries reviewed, 89% require a declaration of allergens on their nutrition labeling, 76% have legislation that explicitly require a statement on trace allergens, and 82% follow Codex Alimentarius recommendations with some modifications of food categories. Conclusions. Three pending challenges in the Region are: requiring statements on allergens as a food safety measure; making progress toward improved labeling of trace allergens; and ensuring universal availability of epinephrine.

ABSTRACT Introduction: Allergic diseases are very common in the pediatric population. Among the frequent causes are aeroallergens from the environment and the identification of these is a great help for diagnosis and treatment. Objectives: To determine the frequency of aeroallergens, through the determination of Immunoglobulin E (IgE) specific to common allergens by the skin sensitivity test in pediatric patients with symptoms of asthma and allergic rhinitis. Materials and Methods: Observational, descriptive, prospective, cross-sectional design, population of patients from 4 to 17 years old with symptoms compatible with asthma and allergic rhinitis who attended a pediatric care center during the study period. It was carried out by means of Skin Puncture Tests (PCP). Results: The mean age of the patients was 8 years, 57% male patients and 43% female. 53% of the patients presented Rhinitis and Asthma, 45% only Rhinitis and 2% only Asthma. 79% of the patients presented a positive allergic sensitization reaction through PCP. Taking into account the sensitization by type of aeroallergens, 64% of the patients had a positive reaction to mites, 19 % to animals 18% to cockroaches, 8% to pollens and 6% to fungi. Conclusion: The vast majority of patients with asthma suffered from concomitant allergic rhinitis and dust mites were the most frequently determined aeroallergens in allergic skin tests in children with asthma and rhinitis in our population.

RESUMEN Introducción: Las enfermedades alérgicas son muy comunes en la población pediátrica. Entre las causas frecuentes se encuentran los aeroalérgenos del ambiente, y la identificación de estos es de gran ayuda tanto para el diagnóstico como para el tratamiento. Objetivos: Determinar la frecuencia de aeroalérgenos, por medio de la determinación de Inmunoglobulina E (IgE) específica a alérgenos comunes por la prueba de sensibilidad cutánea en pacientes pediátricos con síntomas de asma y rinitis alérgica. Materiales y Métodos: Diseño observacional, descriptivo, prospectivo, transversal, población de pacientes de 4 a 17 años con síntomas compatibles con asma y rinitis alérgica que acudieron a un centro asistencial pediátrico en el periodo de estudio. Se realizó por medio de las Pruebas de punción cutánea (PCP). Resultados: La edad media de los pacientes fue de 8 años, 57% pacientes de sexo masculino y 43% de sexo femenino. El 53% de los pacientes presenta rinitis y asma, 45% solo rinitis y el 2% solo asma. El 79% de los pacientes presentó reacción positiva de sensibilización alérgica por medio de la PCP. Teniendo en cuenta la sensibilización por tipo de aeroalérgenos se tuvo que el 64% de los pacientes tuvo reacción positiva a ácaros, 19% a animales 18% a cucarachas, 8% a pólenes y 6% a hongos. Conclusión: La gran mayoría de pacientes con asma padecía rinitis alérgica concomitante y los ácaros del polvo fueron los aeroalérgenos más frecuentemente determinados en las pruebas cutáneas de alergia en niños con asma y rinitis de nuestra población.

Abstract Skin tests, also known as prick tests, in food allergies are restricted to IgE-mediated food allergies, with results that barely indicate sensitization to a certain food and do not necessarily suggest food allergy. The clinical context of the patient is the decisive point before performing any type of food allergy skin test; Contextualizing and relating the patient's clinical picture with the immunological mechanism of IgE-mediated allergies will allow a better selection of the allergy test for each case. Positive tests should be interpreted more carefully, and consider that during early childhood it is common that several patients may have negative specific serum IgE tests in the blood for food allergens compared to those performed on the skin, which are positive. Skin testing can be carried out with standardized strata of foods, but they are not always available for all foods and some are very unstable. Skin tests can even be performed with raw foods, using the prick to prick technique to perform the puncture with fresh foods (especially fruits or vegetables) or other products that are not commercially available. The skin prick test is a test where, after having placed the allergenic extract in drops or with fresh food itself, the puncture must be carried out with a standardized lancet.

Resumen Las pruebas cutáneas, también conocidas como prick test, en alergia alimentaria están restrictas a las alergias a alimentos mediadas por IgE, con resultados que apenas indican sensibilización a cierto alimento y no necesariamente sugieren alergia alimentaria. El contexto clínico del paciente es el punto decisivo antes de realizar cualquier tipo de prueba cutánea de alergia a alimentos; contextualizar y relacionar el cuadro clínico del paciente con el mecanismo inmunológico de las alergias mediadas por IgE permitirá una mejor selección de la prueba de alergia para cada caso. Las pruebas positivas deben interpretarse con más cuidado, y considerar que durante la infancia precoz es común que varios pacientes pueden tener pruebas IgE séricas especificas negativas en sangre para alérgenos alimentarios comparadas con las realizadas en piel, que resultan positivas. La prueba cutánea puede llevarse a cabo con estratos estandarizados de alimentos, pero no siempre se encuentran disponibles para todos los alimentos y algunos son muy inestables. Incluso pueden realizarse pruebas cutáneas con alimentos in natura, mediante la técnica prick to prick para efectuar la punción con alimentos frescos (especialmente con frutas o vegetales) u otros productos que no estén disponibles comercialmente. El skin prick test es una prueba donde después de haber colocado el extracto alergénico en gotas o con el propio alimento fresco debe llevarse a cabo la punción con una lanceta estandarizada.

Abstract The pollen-food allergy syndrome, also known as oral allergy syndrome, is characterized by local reactions inthe mouth and throat after consuming certain raw plant foods in individuals sensitized to pollen from grass, weeds, and trees. Birch-apple is the prototype of this syndrome, with apple, pear, and plum being the most commonly associated foods. Symptoms are usually limited to the oral cavity but can include systemic reactions, including anaphylaxis. Sensitization to pollen allergens, such as lipid transfer proteins, profilin, and PR-10 proteins, triggers this syndrome. Its prevalence varies by geographic region and the predominant pollen type, affecting between 30% and 60% of food allergies. Diagnosis involves a clinical history, skin tests, and, in ambiguous cases, double-blind, placebo-controlled oral food challenges. Treatment primarily involves avoiding trigger foods.

Resumen El síndrome de alergia a alimentos y pólenes, también conocido como síndrome polen-alimento o síndrome de alergia oral, se caracteriza por una reacción local en la boca y faringe después de ingerir ciertos alimentos vegetales crudos, en individuos sensibilizados al polen de hierbas, malezas y árboles. El abedul-manzana es el prototipo de este síndrome, siendo la manzana, pera y ciruela los alimentos más comúnmente asociados. Los síntomas suelen limitarse a la cavidad oral, pero pueden incluir reacciones sistémicas, incluida la anafilaxia. La sensibilización a alérgenos de polen, como las proteínas de transferencia de lípidos, profilina y proteínas PR-10, desencadena este síndrome. Su prevalencia varía según la región geográfica y el tipo de polen predominante, afectando entre el 30% y el 60% de las alergias alimentarias. El diagnóstico implica historia clínica,pruebas cutáneas y, en casos ambiguos, pruebas de provocación alimentaria oral. El tratamiento consiste principalmente en evitar los alimentos desencadenantes.

Abstract Food allergens are capable of producing adverse reactions through multiple mechanisms of an allergicor non-allergic nature, and through different routes of exposure; generally by ingestion or contact, as in protein contact dermatitis or contact urticaria, including inhalation. Food allergy reactions, in turn, can be mediated by immediate hypersensitivity mechanisms, delayed hypersensitivity or mixed immediate-delayed mechanisms. The reference diagnostic method in food allergy is the double-blind placebo-controlled food challenge test (DBPCFC), but skin and serological tests are important in the clinical context. The diagnosis of immediate food allergy depends on well-standardized allergological tests, such as the skin prick test (SPT) or specific IgE dosing, which are ideally tested by food challenge testing. However, the diagnosis of delayed mechanism food allergy and mixed allergies, which combine both immune mechanisms, is more complex. Delayed hypersensitivity reactions are evaluated with the epicutaneous patch test, or patch testing, for the diagnosis of contact dermatitis. The atopy patch test is initially used for the investigation of inflammatory reactions, which may be linked to food allergens in patients with atopic dermatitis. It was later applied in other diseases, whose pathogenesis is mainly mediated by a mechanism of delayed hypersensitivity to protein allergens: eosinophilic esophagitis, enterocolitis induced by food proteins, protein contact dermatitis, contact urticaria, among other disorders.

Resumen Los alergenos alimentarios son capaces de producir reacciones adversas por múltiples mecanismos de naturaleza alérgica o no, y mediante distintas vías de exposición; generalmente por ingestión o por contacto, como en la dermatitis por contacto a proteínas o urticaria por contacto, incluso por inhalación. Las reacciones de alergia alimentaria, a su vez, pueden ser mediadas por mecanismos de hipersensibilidad inmediata, hipersensibilidad retardada o mecanismos mixtos inmediato-retardados. El método diagnóstico de referencia en alergia alimentaria es la prueba de desafío con alimentos a doble ciego controlado con placebo (DBPCFC), pero las pruebas cutáneas y serológicas son importantes en el contexto clínico. El diagnóstico de alergia alimentaria inmediata depende de pruebas alergológicas bien estandarizadas, como la prueba de prick (skin prick test-SPT) o la dosificación de IgE específica, que idealmente se comprueban mediante la prueba de provocación con alimentos. Sin embargo, el diagnóstico de alergia alimentaria de mecanismo retardado y alergias mixtas, que combinan ambos mecanismos inmunes, resulta más complejo. Las reacciones de hipersensibilidad retardada se evalúan con la prueba de parche epicutáneo, o patch testing, para el diagnóstico de las dermatitis por contacto. La prueba de parche de atopia se utiliza, inicialmente, para la investigación de reacciones inflamatorias, que pueden vincularse con alergenos alimentarios en pacientes con dermatitis atópica. Posteriormente fue aplicada en otras enfermedades, cuya patogenia es principalmente mediada por un mecanismo de hipersensibilidad retardada a alérgenos proteicos: esofagitis eosinofílica, enterocolitis inducida por proteínas alimentarias, dermatitis por contacto a proteínas, urticaria por contacto, entre otras alteraciones.

Abstract The most effective method for diagnosing food allergy is the clinical history, which includes anamnesis and physical examination. The anamnesis must include a directed and detailed questioning, and together with the physical examination, it will provide the necessary data to guide the diagnosis and suggest whether the pathophysiology is mediated or not by IgE, which is relevant for the selection and interpretation of the tests. specific and establish the accurate diagnosis, in addition to evaluating the possibility of distinguishing between the different differential diagnoses. It is important to assess the clinical history, because no in vivo or in vitro test is relevant if it is not confirmed with it. Even if there is a strong history of food allergy detected in the history, positive tests can confirm the diagnosis without the need for oral challenge, thus avoiding the risk and cost of performing it. The expression of food allergy is influenced by non-modifiable risk factors that include sex, race and genetics (familial), and modifiable factors: atopic dermatitis, vitamin D deficiency, diet high in polyunsaturated fats and deficient in antioxidants, consumption of antacid drugs, obesity, increased hygiene, influence of the microbiota, time and route of food exposure (increased risk by delaying oral ingestion of allergens and concomitant environmental exposure of the same that leads to sensitization and allergy).

Resumen El método más efectivo para el diagnóstico de alergia alimentaria es la historia clínica, que comprende la anamnesis y el examen físico. La anamnesis debe incluir el interrogatorio dirigido y detallado, y junto con el examen físico aportarán los datos necesarios para orientar hacia el diagnóstica, y sugerir si la fisiopatología es mediada o no por IgE, lo que es pertinente para la selección e interpretación de las pruebas específicas y establecer el diagnóstico certero, además de evaluar la posibilidad de distinguir entre los distintos diagnósticos diferenciales. Es importante valorar la historia clínica, porque ninguna prueba in vivo o in vitro tienen relevancia de no ser confirmados con la misma. Incluso si existe un fuerte antecedente de alergia alimentaria detectado en la anamnesis, las pruebas positivas pueden confirmar el diagnóstico sin necesidad del desafío oral, y de esta forma evitarse el riesgo y costo de su realización. La expresión de la alergia alimentaria está influenciada por factores de riesgo no modificables que incluyen sexo, raza y genética (familiares), y factores modificables: dermatitis atópica, deficiencia de vitamina D, dieta con alta cantidad de grasas poliinsaturadas y deficiente de antioxidantes, consumo de fármacos antiácidos, obesidad, aumento de la higiene, influencia de la microbiota, tiempo y vía de exposición de los alimentos (mayor riesgo al retrasar la ingestión oral de alérgenos y concomitante exposición ambiental de los mismos que conduce a sensibilización y alergia).