Exercise and immunoinflammatory responses

O estudo da relação entre o exercício e a resposta inflamatória e imunológica tem motivado um elevado interesse, desde há vários anos. Existe uma estreita comunicação entre o sistema neuroendócrino e as células imunocompetentes através de mensageiros que vão ter uma intervenção importante nessa resposta. O exercício físico determina em geral uma imunossupressão transitória, precedida de um aumento da componente celular e humoral de intensidade e duração variáveis, dependendo da natureza do exercício e da susceptibilidade específica aos mediadores libertados. Os leucócitos totais, particularmente os neutrófilos e células natural killer mantêm-se elevados no período que se segue ao exercício intenso, enquanto os linfócitos tendem rapidamente a atingir contagens semelhantes ou inferiores aos valores pré-exercício. O exercício intenso pode favorecer um desvio do fenótipo linfocitário Th1 para o fenótipo Th2. As imunoglobulinas, particularmente a IgG, tendem a aumentar transitoriamente. As proteínas de fase aguda e as citocinas, principalmente a IL6 e TNFα, terão intervenções particularmente destacadas neste processo. A prática regular de desporto moderado induz um retorno à estabilidade basal da maioria dos parâmetros, bem como a uma protecção acrescida relativamente a agressores microbianos ambientais. Esta observação está limitada pela dificuldade em distinguir uma actividade moderada continuada de um esforço físico intenso cíclico, sendo contudo certo que os benefícios na saúde atribuídos ao exercício físico moderado estão em larga medida relacionados com as modificações que provocam no sistema inflamatório e imunológico

The role of the epithelial cell in asthma

It is done a review of the intervention of the epithelial bronchial cell in the pathophysiology of asthma. The respiratory epithelium acts as a physical barrier that separates the external environment from the pulmonary internal environment. It controls the intercellular and trans -cellular permeability and this way the accessibility of the inhaled pathogens to the antigen presenting cells involved in the immuno -inflammatory response. Epithelial cells connected by tight junctions contribute to the barrier function of the airways. They express a poliovirus receiver - related protein (PRR), toll like receptors (TLRs) and protease- -activated receptors (PARs), which recognize bacterial agents and allergens. Its dysfunction turns them into important sources of inflammatory mediators. The bidirectional interaction between the epithelium and other bronchial wall elements with inhaled particles originates a structure with its own identity, the designated EMTU - Epithelial Mesenchymal Trophic Unit. These observations support a central role for the epithelial cell in chronic inflammation and in the remodelling of the asthmatic process. Infectious diseases and environmental stress can activate different cell receptors and signalling pathways that induce changes in the cell surface modifying their response to future stimulations, namely to other infectious aggressions. The bronchial epithelium has barrier functions with selective permeability; it has metabolic activity producing cytokines and chemokines stimulating the cell's recruitment and activation, increasing the bronchial reactivity and the remodelling of the airways

Elevated neopterin levels in non-allergic asthma

Neopterin is synthesized by human monocyte-derived macrophages upon stimulation with interferon-gamma (IFN-gamma). Measurement of neopterin concentration is useful to monitor cell-mediated (Th1-type) immune activation. In this study, we aimed to analyze the behaviour of neopterin in long lasting asthma considering its role as a marker of the Th1 environment and to establish the distinction between patients belonging either to the allergic or the non-allergic population, particularly in the elderly where asthma is often under diagnosed. Therefore we evaluated allergic parameters such as skin prick tests, IgE and hemogram (eosinophils count), and we compared our findings with neopterin values found in an age-matched control population. A group of individuals older than 65 was selected. It included 64 asthmatic patients (mean age 72+/-5 years) and 41 healthy individuals (mean age 79+/-7 years). In our study population, 42 patients presented positive skin tests, mainly to house dust mites. All patients were clinically stable and presented an average percentage of predicted forced expiratory volume in the first second (FEV1) of 73.6+/-25.3 and predicted median expiratory flow percentage (MEF50) of 38.8+/-26.7. Blood cell counts showed statistically different mean values of eosinophils between allergic and non-allergic controls (5.42+/-4.7% versus 2.8+/-2.8%; p2.1ng/ml) presented lower mean IgE values (IgE</=336.58IU) than those with lower neopterin values (</=2.1ng/ml) who presented mean IgE values of 402.70IU. Our initial findings may lead to a better understanding of the immunoinflammatory pathways in asthma. Further studies will probably show that serum neopterin could became a useful marker for asthma classification including in elderly patients with long lasting disease

Nickel induced endogenous dermatitis: two cases report

A sensibilização ao níquel representa uma das principais causas de dermatite de contacto alérgica. Um número significativo de doentes apresenta lesões cutâneas, em locais que não estão em contacto directo com este metal. Nos últimos anos a influência do conteúdo em níquel da dieta na evolução da dermatite ao níquel tem merecido particular atenção. Descrevem-se os casos de duas doentes com dermatite de contacto ao níquel em que, apesar da evicção total do contacto com este metal, persistiam lesões de dermatite eczematosa, predominando nas zonas de maior sudação. Com a exclusão da dieta de alimentos com alto teor em níquel observou-se uma redução progressiva da intensidade do eczema, conducente ao desaparecimento total das lesões. As doentes foram, então, submetidas a prova de provocação oral com sulfato de níquel. Na primeira doente estudada observou-se aparecimento de eritema, prurido e reacção eczematosa, generalizados, doze horas após a ingestão de 20 mg de sulfato de níquel. Concomitantemente verificou-se a ocorrência de eritema pruriginoso e pequenas vesículas, no local de aplicação do patch teste ao níquel. No segundo caso a reactivação da dermatite ocorreu seis horas após a ingestão de 10 mg de sulfato de níquel. A manutenção de dieta restritiva em alimentos com alto teor em níquel permitiu o desaparecimento total da dermatite e estabilização clínica que se mantém desde há 6 meses. O diagnóstico de dermatite endógena induzida pela ingestão de níquel foi demonstrado através da realização de prova de provocação oral. A excreção de níquel através do suor parece ser relevante. A redução da ingestão diária de níquel, permitindo a menor concentração deste elemento no suor poderá explicar a melhoria da dermatite, particularmente, nas zonas cutâneas de maior sudação

The influence of meteorological parameters on Alternaria and Cladosporium fungal spore concentrations in Beja (Southern Portugal): preliminary results

Introduction Fungal spores constitute an important fraction of bioaerosols in the atmosphere. Objectives To analyse the content of Alternaria and Cladosporium spores in the atmosphere of Beja and the effect of meteorological conditions on their concentrations. Methodology The daily and hourly data of Alternaria and Cladosporium fungal spores concentration in the atmosphere of Beja were monitored from April 12, 2012 to July 30, 2014, based on the Portuguese Aerobiology Network methodology. The influence of meteorological conditions on the studied types of fungal spore concentrations was assessed through Spearman’s correlation analysis. Results During the study period, 20,741 Alternaria spores and 320,862 Cladosporium spores were counted. In 2013, there were 5,822 Alternaria spores and 123,864 Cladosporium spores. The absolute maximum concentrations of Alternaria and Cladosporium spores were recorded on November 8, 2013, with 211 and 1301 spores/m3, respectively. Temperature,insolation and wind direction parameters showed a positive correlation with Alternaria and Cladosporium spore levels, while relative humidity and precipitation presented a negative correlation, which is statistically significant. Wind speed only showed a statistically significant positive correlation in terms of Alternaria spore levels. Conclusion Alternaria and Cladosporium spores are present in the atmospheric air of Beja throughout the year, with the highest concentration period occurring during spring and autumn. There was a clear effect of meteorological parameters on airborne concentrations of these fungal spores

the portuguese version of rhinitis and asthma patient s perspective rapp validation and assessment

Abstract Background Allergic rhinitis (AR) and asthma are two common chronic diseases that often coexist. There is a need for a validated tool to evaluate HRQoL of Portuguese speakers with asthma and/or rhinitis patients in clinical practice. Objectives To adapt and validate RhinAsthma Patient Perspective (RAPP) in Portuguese. Methods The RAPP questionnaire was translated into Portuguese. Asthmatics with comorbidities and rhinitis attending the allergy department of Coimbra University Hospital were asked to complete the Portuguese translation of RAPP, in addition to the SF-12, ACT, and a Symptomatologic VAS twice, with a 4-week interval between visits. During Visit 2, a Global Rating Scale (GRS) was completed to assess any change in health status. Scale dimensions, internal consistency and convergent validity, reliability, discriminant ability and responsiveness to change, as well as Minimal Clinical Difference were assessed. Results Factor and confirmatory analysis confirm the unidimensional structure of the questionnaire. Internal consistency has been shown to be satisfactory (0.82 visit 1 and 0.86 at visit 2). The tool is able to discriminate between patients on the basis of asthma severity, asthma control level, and rhinitis severity; convergent validity showed a significant correlation with SF-2 Physical component (r = −0.46 and 0.42, p at Visits 1 and 2). An ICC of 0.97 and a CCC = 0.94 indicate that the tool is highly reliable. Responsiveness was shown in detecting a significant association with GRS changes (r = 0.41, p Conclusions The Portuguese version of RAPP has been demonstrated to have good measurement properties and sensitivity to health changes, which will provide a valid, reliable and standardized HRQoL measurement in patients with asthma and comorbid allergic rhinitis in clinical practice

Sensitisation patterns in legume hypersensitivity. A study from the central region of Portugal

Background: Foods from the legume family are used in the Mediterranean diet as a source of protein. In some cases, their ingestion triggers potentially life -threatening reactions. A high degree of immunological cross-reactivity has been described, but its clinical relevance is controversial. Aim: To carry out a clinical and laboratory characterisation of patients sensitised to leguminosae who had symptoms after the ingestion of at least one food from the leguminosae botanical family. Methods: We selected 13 consecutive patients from a food allergy outpatient clinic with allergy symptoms after the ingestion of leguminosae during the year of 2006. Case history data, skin prick tests (SPT) with commercial extracts of white bean, green bean, pea, chickpea, soya bean and peanut, and prick-to-prick (PP) tests to these legumes, both raw and boiled, and also to lupini bean and black -eyed bean were performed. Serum specific IgE and immunoblotting assays were also carried out. Results: Most patients had had symptoms with more than one legume (mean 3 legumes) with bean the most reported. The first culprit leguminosae reported was chickpea in 4 patients, bean in 4 patients and lupini bean in 3. Sensitisation to other legumes without clinical symptoms also occurred (mean 2 legumes). Anaphylaxis was described in 3 patients, to bean, soya and lupini bean, respectively. Asthma was connected to chickpea (2 patients) and to bean (1). One or more of the following symptoms: urticaria, angiooedema and oral allergy syndrome were reported by other patients. Symptomatic patients always had positive PP tests to leguminosae and most SPT were also positive. Conclusions: Lifethreatening reactions to leguminosae were found. PP tests used alone to raw and boiled legumes seem to be the most reliable diagnostic tests as in the case of other vegetable foods. However, immunoblotting assays are still important in the identification of new allergens

Substance P in Long-Lasting Asthma: Immunoinflammatory pathways

Background: Substance P (SP) was described at the beginning of the 20th Century, and its biological action was recognized to have implications in neurogenic inflammation and constriction of smooth muscles. The changes associated with inflammatory chronicity can compromise organ function reversibility. The role of neuromechanisms in the pathology of the disease has been investigated in order to achieve better diagnosis and therapeutic approaches. The stimulation of human cells, such as macrophages and polymorphonuclear cells by SP leads to their activation and to the release of reactive oxygen species (ROS) by these cells. Consequently, a continuous inflammatory disability is observed, mainly if a decrease in antioxidant defence occurs. SP is a substrate for dipeptidyl peptidase IV (DPPIV), which is a multifunctional molecule with enzymatic and proinflammatory activities. CD26 is considered an activation T cell marker. The aim of the present study was to analyse if serum SP values in long-lasting asthma patients were related to lung function parameters. It was also decided to analyze the relationship of SP with superoxide dismutase (SOD) and total antioxidant activity in serum (TAS), as well as its association to CD26/DPPIV values considering their immunological and inflammatory properties. Methods/Data base: A group of individuals older than 65 years, including 64 asthmatic patients (mean age 72±5 years) and 41 healthy individuals (mean age 79±7years) was selected. Both subgroups were submitted to clinical observation, to skin prick tests (SPT) and to SP, TAS, SOD, and DPPIV determinations. T cell CD26 typing was also performed. Lung function tests were done on all patients. Results: Among the patients studied, 42 had positive skin tests, mainly to house dust mites. Asthmatic patients showed a significant increase in SP values (116.2±138.9 vs 39.5±17.9 pg/ml) when compared to controls and a significant decrease in TAS levels (.85±.13 vs .91±.10 mM) and in SOD levels (588.1±156.l vs 822.9±179.5 U/gHb). All patients were clinically stable and presented an average percentage of predict forced expiratory volume in the first second (FEV1) of 73.6±25.3 and median expiratory flow percentage of predict (MEF50) of 38.8±26.7. DPPIV values were significantly increased in asthmatics compared to controls (69.7±15.2 vs 58.6±14.3 U/L). The CD26 expression was only slightly increased in asthmatic patients (41.9±10.2 vs 39.4±11.4). Conclusion: These results confirm the role of SP in asthma and give a contribution for a better knowledge of the immunoinflammatory pathway associated with this chronic disorder. A final goal for these studies would be to achieve a better therapeutic approach in order to improve the outcome of asthmatic patients