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Chronic urticaria: profile from a reference center
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Fernandes de Souza, Ana Carolina Miranda Carvalho Ferreira

; Dortas Junior, Sérgio D.

; Azizi, Guilherme Gomes

; França, Alfeu Tavares

; Lupi, Omar

; Valle, Solange O.R.

Anais Brasileiros de Dermatologia

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aug 2022, Volume 97 N. 4 Pages 511 - 512

Abstract: En | Text: En | PDF: En

https://doi.org/10.1016/j.abd.2021.01.006

Validation and reproducibility of the International Study of Asthma and Allergies in Childhood (ISAAC) Written Atopic Eczema Questionnaire for telephone survey in children aged 6-7 years
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Oliveira, Elisa Fontenelle de

; Penedo, Camila

; Valle, Solange Oliveira Rodrigues

; Kuschnir, Fábio Chigres

Anais Brasileiros de Dermatologia

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apr 2022, Volume 97 N. 2 Pages 173 - 178

Abstract: En | Text: En | PDF: En

Abstract Background The prevalence of atopic eczema is unknown in many countries. The International Study of Asthma and Allergies in Childhood (ISAAC) is an epidemiological landmark in the study of allergic diseases. Objective To validate and assess the reproducibility of the ISAAC Written Atopic Eczema Questionnaire (WAEQ) for children aged between 6 and 7 years by telephone contact. Methods Observational study through interviews with guardians of children aged 6 to 7 years using the ISAAC atopic eczema module questionnaire in three different phases separated by 2 weeks: telephone interviews in the first and third contacts and in-person interviews under supervision in the second contact. Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients. Results Data from 88 children (32 from the atopic eczema group) were analyzed. Reproducibility showed almost perfect agreement for the questions “Recurrent pruritic lesions” and “Lesions in typical locations” (Kappa between 0.81-0.82), while a substantial agreement was observed for all other indicators (Kappa variation between 0.66 and 0.78). The validation showed high specificity (≥ 80.4%) and sensitivity (≥ 87.5%) for all questions, except those related to chronicity and medical diagnosis (34.4% and 40.6%, respectively). Study limitations Non-random selection, no sample size calculation, participants from a tertiary hospital and study period coincident with the Coronavirus pandemic. Conclusions Our results showed that the ISAAC atopic eczema module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of atopic eczema. It may be an appropriate alternative tool in epidemiological studies of childhood atopic eczema, especially in periods of social isolation.

https://doi.org/10.1016/j.abd.2021.03.010

Hereditary angioedema: a disease seldom diagnosed by pediatricians
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Campos, Régis de Albuquerque

; Valle, Solange Oliveira Rodrigues

; Toledo, Eliana Cristina

Jornal de Pediatria

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apr 2021, Volume 97 Suppl. 1 Pages 10 - 16

Abstract: En | Text: En | PDF: En

Abstract Objectives: To describe the hereditary angioedema to improve awareness of this condition and reduce diagnostic delay. Data sources: Relevant articles in the MEDLINE database through PubMed. Data synthesis: Hereditary angioedema is rare and has an autosomal dominant pattern of inheritance. Its onset occurs mainly in childhood, but there is an important delay in the diagnosis. In the most frequent phenotype, there is a quantitative and/or functional deficiency in the C1esterase inhibitor protein, which regulates the activation of the complement, contact and fibrinolysis systems with greater formation of bradykinin, the main mediator of angioedema. There is a third type, the hereditary angioedema with a normal C1 inhibitor level, which is rare in children. Clinical manifestations are characterized by recurrent angioedema attacks, mainly in the extremities, abdomen and upper airways, which can progress to asphyxia and death. The main triggers are mechanical trauma, infections and stress. The diagnosis is attained by patient clinical picture and decreased serum levels of C4 and C1esterase inhibitor or its function. In hereditary angioedema with a normal C1 inhibitor, there is no change in these parameters, thus requiring a genetic study. Treatment is based on the use of attack medications and long and short-term prophylaxis. Conclusions: Hereditary angioedema is little known by pediatricians due to the significant delay in diagnosis of this condition, whose onset usually begins in childhood. The presence of recurrent angioedema that does not respond to treatment with antihistamines, corticosteroids and adrenaline should increase the diagnostic suspicion.

https://doi.org/10.1016/j.jped.2020.10.011 207 downloads

TempTest®: un instrumento de precisión en las urticarias físicas
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Valle, Solange Rodrigues

; Azizi, Guilherme

; Dortas Junior, Sérgio Duarte

Revista alergia México

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mar 2021, Volume 68 N. 1 Pages 2 - 6

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Background: TempTest® is a new method based on the Peltier effect, which is validated for the diagnosis of patients with cold urticaria or heat urticaria, and it is able to measure the temperature variations and activity of these pathologies. Objective: To analyze the results of provocation tests by using this new method in patients with UFr and UCal, who were followed in a center of reference and excellence for urticaria (GA2LEN UCARE) in Rio de Janeiro. Methods: The medical records of 12 patients who had a history of UFr or UCal and were tested with TempTest® during December 2017 and February 2020 were analyzed. For temperature provocation tests, the patients were requested to place their forearm on the TempTest® thermal element for five minutes. A positive response was defined by the appearance of a 2-mm-papular lesion 10 minutes after the provocation test was started, as recommended. Results: 10 of the patients were women and 2 of them were men, from 13 to 77 years of age (mean = 50.2 years). Among the twelve patients, three of them had heat urticaria and nine of them had cold urticaria. The patients who were diagnosed with heat urticaria tested positive for The patients with cold urticarial tested positive for temperatures of 27 °C or lower. Conclusions: TempTest® is a reliable instrument to accurately diagnose and monitor diseases related to temperature variations, which is a factor that should be determined whenever possible since it can help patients prevent situations of exposure and danger.

Resumen Antecedentes: TempTest® es un nuevo método basado en el efecto Peltier, validado para el diagnóstico de pacientes con urticaria por frío o por calor, capaz de medir las variaciones de temperatura y la actividad de estas patologías. Objetivo: Analizar los resultados de las pruebas de provocación con TempTest® en pacientes con urticaria por frío o por calor, seguidos en un centro de referencia y excelencia para la urticaria (GA2LEN UCARE) en Río de Janeiro. Métodos: Fueron analizadas los registros médicos de 12 pacientes que tenían antecedentes de urticaria por frío o por calor y que se sometieron a una prueba de provocación con TempTest® durante diciembre de 2017 y febrero de 2020. En las pruebas de provocación de temperatura se solicitó a los pacientes que colocaran el antebrazo en el elemento de temperatura TempTest® durante cinco minutos. Una respuesta positiva se definió por la aparición de una pápula de 2 mm de extensión a los 10 minutos de iniciada la provocación, como se recomienda con el dispositivo. Resultados: 10 pacientes eran mujeres y dos hombres, edad de 13 a 77 años (media de 50.2 años). Entre los 12 pacientes, tres tenían urticaria por calor y nueve, urticaria por frío. Los pacientes diagnosticados con urticaria por calor fueron positivos para temperaturas iguales o superiores a 38 °C. Los pacientes con urticaria por frío fueron positivos para temperaturas iguales o inferiores a 27 °C. Conclusiones: TempTest® es un instrumento confiable para diagnosticar y monitorear con precisión las enfermedades relacionadas con las variaciones de la temperatura, factor que debe ser determinado siempre que sea posible, ya que puede ayudar a los pacientes a evitar situaciones de exposición y peligro.

https://doi.org/10.29262/ram.v68i1.827 69 downloads

Hereditary angioedema: how to approach it at the emergency department?
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Serpa, Faradiba Sarquis

; Mansour, Eli

; Aun, Marcelo Vivolo

; Giavina-Bianchi, Pedro

; Chong Neto, Herberto José

; Arruda, Luisa Karla

; Campos, Regis Albuquerque

; Motta, Antônio Abílio

; Toledo, Eliana

; Grumach, Anete Sevciovic

; Valle, Solange Oliveira Rodrigues

einstein (São Paulo)

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2021, Volume 19 elocation eRW5498

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO As crises de angioedema são causas comuns de atendimentos nas emergências, e devido ao potencial de gravidade, é importante que os profissionais que atuam nesses serviços conheçam suas causas e abordagem. Os mecanismos envolvidos no angioedema sem urticas podem ser histaminérgicos ou mediados por bradicinina. As causas mais comuns de angioedema mediado por histamina são alimentos, medicamentos, ferroada de insetos e idiopática. Quando o mediador é a bradicinina, os desencadeantes são os inibidores da enzima conversora de angiotensina e fatores relacionados ao angioedema adquirido com deficiência do inibidor de C1 ou angioedema hereditário que são menos comuns, mas muito importantes pela possibilidade de desfecho fatal. O angioedema hereditário é uma doença rara, caracterizada por crises de edema que acometem o tecido subcutâneo e mucosas de vários órgãos, manifestando-se principalmente por crises de angioedema e dor abdominal. Esse tipo de angioedema não responde ao tratamento usual com adrenalina, anti-histamínicos e corticosteroides. Assim, se não identificados e tratados adequadamente, esses pacientes têm risco de morte por edema de laringe estimado em 25% a 40%. O tratamento do angioedema hereditário mudou drasticamente nos últimos anos, com o desenvolvimento de novos e eficientes fármacos para as crises: inibidor de C1 derivado de plasma, inibidor de C1 recombinante humano, antagonista do receptor B2 da bradicinina (icatibanto) e o inibidor da calicreína (ecalantide). No Brasil, até o momento, estão liberados para uso o inibidor de C1 derivado de plasma e o icatibanto. O manejo correto desses pacientes na emergência evita cirurgias desnecessárias e, principalmente, desfechos fatais.

ABSTRACT Angioedema attacks are common causes of emergency care, and due to the potential for severity, it is important that professionals who work in these services know their causes and management. The mechanisms involved in angioedema without urticaria may be histamine- or bradykinin-mediated. The most common causes of histamine-mediated angioedema are foods, medications, insect sting and idiopathic. When the mediator is bradykinin, the triggers are angiotensin-converting enzyme inhibitors and factors related to acquired angioedema with deficiency of C1-inhibitor or hereditary angioedema, which are less common, but very important because of the possibility of fatal outcome. Hereditary angioedema is a rare disease characterized by attacks of edema that affect the subcutaneous tissue and mucous membranes of various organs, manifesting mainly by angioedema and abdominal pain. This type of angioedema does not respond to the usual treatment with epinephrine, antihistamines and corticosteroids. Thus, if not identified and treated appropriately, these patients have an estimated risk of mortality from laryngeal edema of 25% to 40%. Hereditary angioedema treatment has changed dramatically in recent years with the development of new and efficient drugs for attack management: plasma-derived C1 inhibitor, recombinant human C1-inhibitor, bradykinin B2 receptor antagonist (icatibant), and the kallikrein inhibitor (ecallantide). In Brazil, plasma-derived C1 inhibitor and icatibant have already been approved for use. Proper management of these patients in the emergency department avoids unnecessary surgery and, especially, fatal outcomes.

https://doi.org/10.31744/einstein_journal/2021rw5498 369 downloads

Omalizumab as add-on therapy in patients with asthma and allergic bronchopulmonary aspergillosis
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Cunha, Fernanda Sales da

; Valle, Solange Oliveira Rodrigues

; Elabras Filho, José

; Dortas Júnior, Sérgio Duarte

; França, Alfeu Tavares

Jornal Brasileiro de Pneumologia

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oct 2018, Volume 44 N. 5 Pages 439 - 441

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/s1806-37562017000000325 1776 downloads

Brazilian Guidelines for Hereditary Angioedema Management - 2017 Update Part 1: Definition, Classification and Diagnosis
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Giavina-Bianchi, Pedro

; Arruda, Luisa Karla

; Aun, Marcelo V.

; Campos, Regis A.

; Chong-Neto, Herberto J.

; Constantino-Silva, Rosemeire N.

; Fernandes, Fátima R.

; Ferraro, Maria F.

; Ferriani, Mariana P.L.

; França, Alfeu T.

; Fusaro, Gustavo

; Garcia, Juliana F.B.

; Komninakis, Shirley

; Maia, Luana S.M.

; Mansour, Eli

; Moreno, Adriana S.

; Motta, Antonio A.

; Pesquero, João B.

; Portilho, Nathalia

; Rosário, Nelson A.

; Serpa, Faradiba S.

; Solé, Dirceu

; Takejima, Priscila

; Toledo, Eliana

; Valle, Solange O.R.

; Veronez, Camila L.

; Grumach, Anete S.

Clinics

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2018, Volume 73 elocation e310

Abstract: En | Text: En | PDF: En

Hereditary angioedema is an autosomal dominant disease characterized by recurrent angioedema attacks with the involvement of multiple organs. The disease is unknown to many health professionals and is therefore underdiagnosed. Patients who are not adequately diagnosed and treated have an estimated mortality rate ranging from 25% to 40% due to asphyxiation by laryngeal angioedema. Intestinal angioedema is another important and incapacitating presentation that may be the main or only manifestation during an attack. In this article, a group of experts from the “Associação Brasileira de Alergia e Imunologia (ASBAI)” and the “Grupo de Estudos Brasileiro em Angioedema Hereditário (GEBRAEH)” has updated the Brazilian guidelines for the diagnosis and treatment of hereditary angioedema.

https://doi.org/10.6061/clinics/2018/e310 1717 downloads

Impact of chronic urticaria on the quality of life of patients followed up at a university hospital
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Dias, Gabriela Andrade Coelho

; Pires, Gisele Viana

; Valle, Solange Oliveira Rodrigues do

; Dortas Júnior, Sérgio Duarte

; Levy, Soloni

; França, Alfeu Tavares

; Baiardini, Ilaria

; Canonica, Walter Giorgio

Anais Brasileiros de Dermatologia

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dec 2016, Volume 91 N. 6 Pages 754 - 759

Abstract: En | Text: En | PDF: En

Abstract BACKGROUND: Chronic urticaria is a debilitating disease that considerably affects health-related quality of life, and the Chronic Urticaria Quality of Life Questionnaire is the only questionnaire specifically designed for its evaluation. OBJECTIVE: To evaluate the quality of life of patients with chronic urticaria, using the Brazilian Portuguese version of the Chronic Urticaria Quality of Life Questionnaire. METHODS: The Chronic Urticaria Quality of Life Questionnaire was self-administered in 112 chronic urticaria patients and disease activity was assessed through the Urticaria Activity Score. Clinical and socio-demographic characteristics of patients were studied, such as: age, sex, etiologic diagnosis of chronic urticaria, duration of disease and Urticaria Activity Score. RESULTS: The population studied was composed 85.72% of women with a mean age of 46 years (18-90), while the median disease duration period was 10 years (3 months-60 years). Regarding the etiologic diagnosis, 48.22% had chronic spontaneous urticaria; 22.32% associated with inducible urticaria, 28.57% with chronic autoimmune urticaria, and 23.21% had physical urticaria alone. Disease activity evaluated using the Urticaria Activity Score was 1.04 ± 1.61 (0-6). The total score for the Chronic Urticaria Quality of Life Questionnaire was 36 (0-100) and dimension I (sleep/mental status/eating) had a greater impact on quality of life. The items with the highest mean scores were nervousness and shame over lesions, while the items with the lowest scores were lip swelling and limitations on sporting activities. CONCLUSIONS: Chronic urticaria compromises patients' quality of life, mainly those with more severe disease or who are diagnosed with chronic autoimmune urticaria.

https://doi.org/10.1590/abd1806-4841.20165071 1882 downloads

Asthma exacerbation and viral infection in adult patients, Brazil
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Silva, Raquel Cirlene

; Couceiro, José Nelson

; Câmara, Fernando Portela

; Valle, Solange

; Santos, Norma

Brazilian Journal of Infectious Diseases

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aug 2015, Volume 19 N. 4 Pages 446 - 448

Abstract: En | Text: En | PDF: En

https://doi.org/10.1016/j.bjid.2015.03.004 802 downloads

10.

Frequency of viral etiology in symptomatic adult upper respiratory tract infections
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Silva, Raquel Cirlene da

; Mendes, Gabriella da Silva

; Rojas, Miguel Angel

; Amorim, Ariane Ribeiro

; Couceiro, José Nelson

; Lupi, Omar

; Elabras, José

; Pires, Gisele

; Valle, Solange

; Santos, Norma

Brazilian Journal of Infectious Diseases

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feb 2015, Volume 19 N. 1 Pages 30 - 35

Abstract: En | Text: En | PDF: En

Aims: To determine the frequency of viral pathogens causing upper respiratory tract infections in non-hospitalized, symptomatic adults in the city of Rio de Janeiro.Methods:Respiratory samples (nasal/throat swabs) were collected between August 2010 and November 2012 and real time PCR was used to detect different viral pathogens.Results:Viruses were detected in 32.1% (43/134) of samples from 101 patients. Speciﬁcally, 9% (12/134) were positive for HBoV, 8.2% (11/134) were positive for HAdV, 5.2% (7/134) were positive for HRV, and 1.5% (2/134) were positive for FLUBV or HMPV, as single infections. HRSV-A, HPIV-3, and HCoV-HKU1 were detected in one (0.75%) sample each. Co-infections were detected in 4.8% (6/134) of the samples. Peaks of viral infections were observed in March, April, May, August, and October. However, positive samples were detected all year round. Only 23.3% (10/43) of the positive samples were collected from patients with febrile illness.Conclusion:Results presented in this report suggest that respiratory viral infections are largely under diagnosed in immunocompetent adults. Although the majority of young adult infections are not life-threatening they may impose a signiﬁcant burden, especially in developing countries since these individuals represent a large fraction of the working force.

https://doi.org/10.1016/j.bjid.2014.08.005 2201 downloads

11.

Icatibant, an inhibitor of bradykinin receptor 2, for hereditary angioedema attacks: prospective experimental single-cohort study
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Campos, Regis Albuquerque

; Valle, Solange Oliveira Rodrigues

; França, Alfeu Tavares

; Cordeiro, Elisabete

; Serpa, Faradiba Sarquis

; Mello, Yara Ferreira

; Malheiros, Teresinha

; Toledo, Eliana

; Mansour, Elie

; Fusaro, Gustavo

; Grumach, Anete Sevciovic

Sao Paulo Medical Journal

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2014, Volume 132 N. 5 Pages 261 - 265

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

CONTEXTO E OBJETIVO: O angioedema hereditário (AEH) com deficiência de inibidor de C1 manifesta-se por episódios recorrentes de edema envolvendo pele, trato respiratório superior e gastrointestinal. Pode ser letal por asfixia. O objetivo foi avaliar a resposta à terapia dos ataques com icatibanto, inibidor do receptor de bradicinina, recentemente introduzido no Brasil.TIPO DE ESTUDO E LOCAL: Estudo experimental prospectivo de coorte, sem grupo controle, da eficácia e segurança do icatibanto em paciente com AEH.MÉTODOS: Pacientes com diagnóstico confirmado de AEH foram incluídos de acordo com os sintomas, independentemente do tempo de início do ataque. Icatibanto foi administrado segundo protocolo aprovado no Brasil. A gravidade do sintoma foi estabelecida continuamente e os eventos adversos foram monitorados.RESULTADOS: 24 ataques em 20 pacientes com AEH foram tratados (19 F:1 M; 19-55 anos; mediana 29 anos). Os sintomas foram: edema subcutâneo (22/24), dor abdominal (15/24) e obstrução de vias aéreas superiores (10/24). O tempo para o início do alívio foi: 5-10 minutos, 5/24 (20,8%); 10-20, 5/24 (20,8%); 20-30, 8/24 (33,4%); 30-60, 5/24 (20,8%) e 2 horas, 1/24 (4,3%). O tempo para a resolução completa variou de 4,3-33,4 horas. Somente efeitos adversos nos locais das injeções foram relatados. Eritema leve a moderado e/ou sensação de ardor foram relatados por 15/24 pacientes, prurido em 3, e 6 não tiveram efeitos adversos.CONCLUSÃO: Pacientes com AEH tipo I receberam icatibanto com pronta resposta; a maioria teve melhora na gravidade dos sintomas em 30 minutos. Eventos adversos locais ocorreram em 75% dos pacientes.

CONTEXT AND OBJECTIVE: Hereditary angioedema (HAE) with C1 inhibitor deficiency manifests as recurrent episodes of edema involving the skin, upper respiratory tract and gastrointestinal tract. It can be lethal due to asphyxia. The aim here was to evaluate the response to therapy for these attacks using icatibant, an inhibitor of the bradykinin receptor, which was recently introduced into Brazil.DESIGN AND SETTING: Prospective experimental single-cohort study on the efficacy and safety of icatibant for HAE patients.METHODS: Patients with a confirmed HAE diagnosis were enrolled according to symptoms and regardless of the time since onset of the attack. Icatibant was administered in accordance with the protocol that has been approved in Brazil. Symptom severity was assessed continuously and adverse events were monitored.RESULTS: 24 attacks in 20 HAE patients were treated (female/male 19:1; 19-55 years; median 29 years of age). The symptoms were: subcutaneous edema (22/24); abdominal pain (15/24) and upper airway obstruction (10/24). The time taken until onset of relief was: 5-10 minutes (5/24; 20.8%); 10-20 (5/24; 20.8%); 20-30 (8/24; 33.4%); 30-60 (5/24; 20.8%); and 2 hours (1/24; 4.3%). The time taken for complete resolution of symptoms ranged from 4.3 to 33.4 hours. Adverse effects were only reported at injection sites. Mild to moderate erythema and/or feelings of burning were reported by 15/24 patients, itching by 3 and no adverse effects in 6.CONCLUSION: HAE type I patients who received icatibant responded promptly; most achieved improved symptom severity within 30 minutes. Local adverse events occurred in 75% of the patients.

https://doi.org/10.1590/1516-3180.2014.1325652 3576 downloads

12.

Hereditary angioedema: quality of life in Brazilian patients
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Gomide, Maria Abadia Consuelo M. S.

; Toledo, Eliana

; Valle, Solange Oliveira Rodrigues

; Campos, Regis A.

; França, Alfeu T.

; Gomez, Nieves Prior

; Andrade Jr., Heitor Franco

; Caballero, Teresa

; Grumach, Anete S.

Clinics

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jan 2013, Volume 68 N. 1 Pages 81 - 83

Abstract: En | Text: En | PDF: En

OBJECTIVE: Hereditary angioedema is a serious medical condition caused by a rare autosomal dominant genetic disorder and it is associated with deficient production or dysfunction of the C1 esterase inhibitor. In most cases, affected patients experience unexpected and recurrent crises of subcutaneous, gastrointestinal and laryngeal edema. The unpredictability, intensity and other factors associated with the disease impact the quality of life of hereditary angioedema patients. We evaluated the quality of life in Brazilian hereditary angioedema patients. METHODS: Patients older than 15 years with any severity of hereditary angioedema and laboratory confirmation of C1 inhibitor deficiency were included. Two questionnaires were used: a clinical questionnaire and the SF-36 (a generic questionnaire). This protocol was approved by the Ethics Committee of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. RESULTS: The SF-36 showed that 90.4% (mean) of all the patients had a score below 70 and 9.6% had scores equal to or higher than 70. The scores of the eight dimensions ranged from 51.03 to 75.95; vitality and social aspects were more affected than other arenas. The internal consistency of the evaluation was demonstrated by a Cronbach's alpha value above 0.7 in seven of the eight domains. CONCLUSIONS: In this study, Brazilian patients demonstrated an impaired quality of life, as measured by the SF-36. The most affected domains were those related to vitality and social characteristics. The generic SF-36 questionnaire was relevant to the evaluation of quality of life; however, there is a need for more specific instruments for better evaluation.

https://doi.org/10.6061/clinics/2013(01)OA13 1965 downloads

13.

Atopy patch test (APT) in the diagnosis of food allergy in children with atopic dermatitis
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Levy, Soloni Afra Pires

; Dortas Junior, Sergio Duarte

; Pires, Andrea Huguenim Silva

; Abe, Augusto Tiaqui

; Valle, Solange Oliveira Rodrigues

; Coelho, Vilma Perez

; Hahnstadt, Ludwig Ruppert

; França, Alfeu Tavares

Anais Brasileiros de Dermatologia

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oct 2012, Volume 87 N. 5 Pages 724 - 728

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

FUNDAMENTOS: A Dermatite Atópica é uma doença inflamatória crônica da pele. Os alimentos são importantes na patogênese da doença em 1/3 dos casos. Diversos mecanismos estão envolvidos na fisiopatogenia da dermatite Atópica. As reações imediatas são identificadas pela dosagem de IgE específica e teste de puntura. O teste de contato atópico parece ter relevância na investigação de pacientes com suspeita de reação tardia. OBJETIVOS: Avaliar a padronização do método com relação à concentração do alérgeno, tempo de oclusão e de interpretação; e determinar a especificidade e a sensibilidade do teste de contato atópico em relação ao teste de puntura e a dosagem de IgE específica, no diagnóstico de alergia alimentar em crianças com dermatite Atópica. MÉTODOS: Setenta e duas crianças com 2 a 12 anos foram submetidas a teste de puntura e dosagem de IgE específicas para alimentos (leite de vaca, ovo, soja, trigo). O teste de contato atópico foi aplicado em 3 grupos: (1) Dermatite Atópica com ou sem Rinite e Asma; (2) Rinite e ou Asma sem Dermatite Atópica; (3) Saudáveis. RESULTADOS: No grupo 1, 40% dos pacientes apresentaram reação positiva. Quanto maior o tempo de exposição, maior foi a sensibilidade. No grupo 2, o teste foi mais específico que sensível para todos os extratos; com aumento da sensibilidade com maior tempo de exposição (72h). No grupo 3, 8.3% apresentaram testes positivos. CONCLUSÃO: O teste de contato atópico mostrou ter valor diagnóstico em relação às reações de fase tardia a alimentos, com elevada especificidade. Mostrou-se um teste específico e confiável ao comparar com os resultados do grupo controle.

BACKGROUND: Atopic Dermatitis is a chronic inflammatory skin disease. Food allergens are important in the pathogenesis in 1/3 of the cases. Several mechanisms are involved in the pathogenesis of Atopic Dermatitis. Immediate reactions are identified by both measurement of specific IgE and skin prick test. Atopy Patch Test seems to be relevant in the investigation of patients with suspected delayed-type reactions. OBJECTIVES: To evaluate the standardization of this method concerning allergen concentration, occlusion time and interpretation, and determine the specificity and sensitivity of the Atopy Patch Test according to the skin prick test and specific IgE levels in food allergy diagnosis in children with Atopic Dermatitis. METHODS: Seventy-two children, aged 2-12 years were selected and followed at the allergy clinic of the Hospital São Zacharias. Skin prick test, specific IgE and food Atopy Patch Test (cow's milk, egg, soy and wheat) were carried out. Three groups were submitted to the Atopy Patch Test: (1) Atopic Dermatitis with or without Rhinitis and Asthma; (2) Rhinitis and or Asthma without AD; (3) Healthy individuals. RESULTS: In group 1, 40% of the patients presented positive reactions. The longer the exposure time (48h and 72h), the higher the sensitivity. In group 2, the test was more specific than sensitive for all the extracts, with increased sensitivity the longer the time of exposure (72h). In group 3, 8.3% presented positive tests. CONCLUSION: APT evidenced a great diagnostic value in late-phase reactions to food, with high specificity. It showed to be a specific and reliable tool in comparison with the healthy group's results.

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14.

Prevalence of autoantibodies in a group of hereditary angioedema patients
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Dortas Junior, Sergio Duarte

; Valle, Solange Oliveira Rodrigues

; Levy, Soloni Afra Pires

; Tortora, Rosangela P.

; Abe, Augusto Tiaqui

; Pires, Gisele Viana

; Papi, José Angelo de Souza

; França, Alfeu Tavares

Anais Brasileiros de Dermatologia

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apr 2012, Volume 87 N. 2 Pages 332 - 334

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O Angioedema Hereditário é uma doença autossômica dominante. A pesquisa de rotina para autoanticorpos não é recomendada para pacientes com Angioedema Hereditário; entretanto, a prevalência desses anticorpos em pacientes com Angioedema Hereditário não está bem documentada. Objetivamos determinar a prevalência de autoanticorpos para identificar indivíduos sob risco de desenvolver doenças autoimunes. Quinze pacientes com Angioedema Hereditário atendidos no Hospital Universitário Clementino Fraga Filho aceitaram participar do estudo. A prevalência de autoanticorpos foi de 40%. Nossos dados indicam alta prevalência de autoanticorpos em pacientes com Angioedema Hereditário. Estudos de maior escala deveriam ser considerados para determinar a significância desses autoanticorpos no acompanhamento clínico de pacientes com Angioedema Hereditário.

Hereditary Angioedema is a dominantly inherited disease. Routine screening of autoantibodies (AAB) is not recommended for individuals with Hereditary Angioedema; however, prevalence of these antibodies in Hereditary Angioedema patients is not well documented. We aim to determine the prevalence of AAB so that individuals at risk of developing autoimmune diseases can be identified. Fifteen patients with Hereditary Angioedema attended at Clementino Fraga Filho University Hospital accepted to participate in this study. Prevalence of AAB was 40%. Our data indicate high prevalence of AAB in patients with Hereditary Angioedema. Large-scale studies should be considered to determine the significance of these AAB in the follow-up care of patients with Hereditary Angioedema.

2619 downloads

15.

Brazilian guidelines for the diagnosis and treatment of hereditary angioedema
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Giavina-Bianchi, Pedro

; França, Alfeu T.

; Grumach, Anete S.

; Motta, Abílio A

; Fernandes, Fátima R

; Campos, Regis A.

; Valle, Solange O

; Rosário, Nelson A

; Sole, Dirceu

Clinics

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2011, Volume 66 N. 9 Pages 1627 - 1636

Abstract: En | Text: En | PDF: En

Hereditary angioedema is an autosomal dominant disease characterized by edema attacks with multiple organ involvement. It is caused by a quantitative or functional deficiency of the C1 inhibitor, which is a member of the serine protease inhibitor family. Hereditary angioedema is unknown to many health professionals and is therefore an underdiagnosed disease. The causes of death from hereditary angioedema include laryngeal edema with asphyxia. The estimated mortality rate in patients in whom the disease goes undetected and who are therefore incorrectly treated is 25-40%. In addition to edema of the glottis, hereditary angioedema often results in edema of the gastrointestinal tract, which can be incapacitating. Patients with hereditary angioedema may undergo unnecessary surgical interventions because the digestive tract can be the primary or only organ system involved, thus mimicking acute surgical abdomen. It is estimated that patients with hereditary angioedema experience some degree of disability 20-100 days per year. The Experts in Clinical Immunology and Allergy of the "Associação Brasileira de Alergia e Imunopatologia -ASBAI" developed these guidelines for the diagnosis, therapy, and management of hereditary angioedema.

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