Sensitization to grass allergens: Phl p1, Phl p5 and Phl p7 Phl p12 in Adult and Children Patients in Beja (Southern Portugal)

Background In Portugal, the pollen types most implicated in respiratory allergy are grasses, olive and parietaria. The knowledge of sensitizations to molecular allergens in children and adults can contribute to better diagnosis and treatment of this pathology. Methods ImmunoCAP singleplex technology was used for molecular allergens and Phadia 250® automatic equipment. g205 (Phl p1); g215 (Phl p5b); g210 (Phl p7); and g212 (Phl p12) allergen determinations were made in 45 patients with positive grass sensitization tests. Results The majority of patients are sensitized to Phl p1 (91%) and Phl p1+/Phl p5−/Phl p7−/Phl p12− was the most dominant profile (40%). In the adult group, the IgE averages for Phl p1 were approximately 10.46, while they were 8.43 for Phl p5, 0.69 for Phl p7, and 0.06 for Phl p12. In the child group, these values were higher: 22.49, 20.23, 3.89, and 0.35, respectively. For allergens Phl p1, Phl p5, and Phl p7, these differences between the child and adult population were not statistically significant (p = 0.754, p = 0.806 and p = 0.102, respectively), but for Phl p12, a statistically significant difference (p = 0.018) was observed. Conclusions IgE antibodies Phl p1 is the most important allergic marker and sensitivities caused by Phl p12 give rise to higher IgE values in children

Atmospheric levels of Alternaria and Cladosporium spores in the city of Beja and their involvement in respiratory allergic disease

Introdução – Os esporos fúngicos são uma das maiores componentes biológicas atmosféricas; no entanto, são ainda pouco estudados e não lhes é reconhecida a influência devida na doença alérgica respiratória. Neste trabalho pretende-se determinar a importância dos níveis de esporos atmosféricos de Alternaria e Cladosporium na doença alérgica respiratória na cidade de Beja. Método – Analisaram-se os níveis atmosféricos de esporos de Alternaria e Cladosporium na cidade de Beja. A metodologia utilizada é recomendada pela Rede Portuguesa de Aerobiologia: utilizou-se um coletor volumétrico do tipo Hirst, um Burkard seven-day Volumetric Spore-trape®; os esporos foram coletados numa bobine que continha uma fita de Melinex impregnada com silicone e corados com solução de glicerogelatina com fucsina básica. Para a leitura das amostras utilizou-se o método de leitura das quatro linhas longitudinais ao microscópio ótico com uma ampliação de 400x. Os resultados obtidos foram convertidos e expressos em número de esporos por metro cúbico de ar. Selecionaram-se doentes alérgicos a fungos com provas de sensibilização positivas para o alergénio mx1 e realizou-se uma análise de diagnóstico molecular de sensibilização ao alergénio Alt a1 através do equipamento Phadia 250® pelo método de imunoensaio fluoroenzimático. Resultados – No período deste estudo registaram-se 320.862 esporos do tipo Cladosporium e 20.741 esporos do tipo Alternaria. Os testes de diagnóstico molecular confirmaram que 81% dos doentes sensibilizados a fungos são alérgicos a Alternaria. Conclusão – Os níveis atmosféricos de Alternaria são elevados e provocam sensibilização alérgica nos doentes da região de Beja. O alergénio Alt a1 permite identificar a maioria dos doentes alérgicos a fungos nesta região.ABSTRACT - Introduction – Fungal spores are one of the major biological components of the air but are still poorly studied and their influence on respiratory allergic disease is not recognized. In this work, we intend to determine the importance of the atmospheric spores of Alternaria and Cladosporium in respiratory allergic disease in Beja. Methods – The atmospheric levels of Alternaria and Cladosporium spores in Beja were analyzed. The methodology used and recommended by the Portuguese Aerobiology Network was used: a Hirst volumetric collector, a Burkard seven-day Volumetric Spore-trape®; the spores were collected on a reel containing a Melinex tape impregnated with silicone and stained with a glycerogelatin solution with basic fuchsin. For the reading of the samples was used the method of reading the four longitudinal lines to the optical microscope with a magnification of 400x. The results obtained were converted and expressed in a number of spores per cubic meter of air. Allergic patients with fungal allergens with positive mx1 allergen sensitization were selected and a molecular diagnosis of allergen sensitization to Alt a1 was performed via the Phadia 250® device by the fluoroenzyme immunoassay method. Results – During the study period, 320,862 Cladosporium spores and 20,741 spores of the Alternaria type were recorded. Molecular diagnostic tests have confirmed that 81% of patients sensitized to fungi are allergic to Alternaria. Conclusion – The atmospheric levels of Alternaria are high and cause allergic sensitization in patients in Beja region. The Alt a1 allergen allows the identification of most fungal allergic patients in this region.info:eu-repo/semantics/publishedVersio

Níveis atmosféricos de esporos de Alternaria e Cladosporium na cidade de Beja e seu envolvimento na doença alérgica respiratória

Introdução – Os esporos fúngicos são uma das maiores componentes biológicas atmosféricas; no entanto, são ainda pouco estudados e não lhes é reconhecida a influência devida na doença alérgica respiratória. Neste trabalho pretende-se determinar a importância dos níveis de esporos atmosféricos de Alternaria e Cladosporium na doença alérgica respiratória na cidade de Beja. Método – Analisaram-se os níveis atmosféricos de esporos de Alternaria e Cladosporium na cidade de Beja. A metodologia utilizada é recomendada pela Rede Portuguesa de Aerobiologia: utilizou-se um coletor volumétrico do tipo Hirst, um Burkard seven-day Volumetric Spore-trape®; os esporos foram coletados numa bobine que continha uma fita de Melinex impregnada com silicone e corados com solução de glicerogelatina com fucsina básica. Para a leitura das amostras utilizou-se o método de leitura das quatro linhas longitudinais ao microscópio ótico com uma ampliação de 400x. Os resultados obtidos foram convertidos e expressos em número de esporos por metro cúbico de ar. Selecionaram-se doentes alérgicos a fungos com provas de sensibilização positivas para o alergénio mx1 e realizou-se uma análise de diagnóstico molecular de sensibilização ao alergénio Alt a1 através do equipamento Phadia 250® pelo método de imunoensaio fluoroenzimático. Resultados – No período deste estudo registaram-se 320.862 esporos do tipo Cladosporium e 20.741 esporos do tipo Alternaria. Os testes de diagnóstico molecular confirmaram que 81% dos doentes sensibilizados a fungos são alérgicos a Alternaria. Conclusão – Os níveis atmosféricos de Alternaria são elevados e provocam sensibilização alérgica nos doentes da região de Beja. O alergénio Alt a1 permite identificar a maioria dos doentes alérgicos a fungos nesta região

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 longlasting 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

ESTUDO DA HIPERSENSIBILIDADE A AINES E TESTE DE ATIVAÇÃO DE BASÓFILOS

Introduction: Allergy to nonsteroidal anti-inflammatory drugs (NSAIDs) is often associated with severe hypersensitivity reactions and with difficult diagnosis. Basophil activation test by flow cytometry with Flow2cast (BAT) is a novel in vitro test for identification of hypersensitivity reactions to these drugs but with some limitations.Clinical case: Young male manifesting chronic urticaria since childhood presented with worsening of hives with angioedema immediately after NSAID intake. Last reaction happened over a year before after lysine acetylsalicylate. Initial BAT for diagnosis with acetylsalicylic acid (ASA) was inconclusive. Drug provocation test (DPT) negative to celecoxib. Another DPT with 700mg of ASA triggered anaphylaxis three hours later with hypoxia and serum tryptase 27.1μg / L. A second BAT had higher basal activation and marked increase with ASA incubation.Discussion: This case shows current BAT recommendation in NSAID hypersensitivity: a negative BAT does not avoid NSAID DPT. However, time between last reaction and BAT seems to influence results.Introdução: A alergia a anti-inflamatórios não esteroides (AINEs) está frequentemente associada a reações de hipersensibilidade graves e de difícil diagnóstico. O teste de ativação de basófilos, com citometria de fluxo Flow2cast (BAT), surge como um teste in vitro promissor para identificação de reações de hipersensibilidade a estes fármacos mas com limitações.Caso Clínico: Jovem do sexo masculino, com urticária crónica desde a infância, apresentava episódios de agravamento da urticária com angioedema imediatamente após ingestão de AINEs. Último episódio ocorrera há mais de um ano após acetilsalicilato de lisina. Primeiro BAT diagnóstico com ácido acetilsalicílico (AAS) foi inconclusivo. Prova de provocação oral (PPO) com celecoxib negativa. PPO com AAS 700mg desencadeou anafilaxia às 3 horas, com hipoxémia e triptase sérica de 27.1μg/L. Repetição de BAT demonstrou expressivo aumento da ativação basal e após incubação com AAS.Discussão: Este caso enquadra-se na indicação atual do BAT na hipersensibilidade a AINEs: resultados negativos não evitam PPO a AINEs. Contudo a proximidade temporal da última reação ao BAT aparenta influenciar os resultados

innovation through design

Background: Asthma affects the lives of hundred million people around the World. Despite notable progresses in disease management, asthma control remains largely insufficient worldwide, influencing patients' wellbeing and quality of life. Poor patient handling of inhaling devices has been identified as a major persistent problem that significantly reduces inhaled drugs' efficacy and is associated with poor adherence to treatment, impairing clinical results such as asthma control and increasing disease-related costs. We herein review key research and development (R&D) innovation in inhaler devices, highlighting major real-world critical errors in the handling and inhalation technique with current devices and considering potential solutions. Furthermore, we discuss current evidence regarding breath-triggered inhalers (BTI). Main body: The two most common significant problems with inhalers are coordinating actuation and inhalation with pressurized metered-dose inhalers (pMDIs), and the need to inhale forcibly with a dry powder inhaler. BTI R&D plans were designed to overcome these problems. Its newest device k-haler® has several other important features, generating a less forceful aerosol plume than previous pMDIs, with efficient drug delivery and lung deposition, even in patients with low inspiratory flow. The local and systemic bioavailability of fluticasone propionate and formoterol (FP/FORM) administered via k-haler® has been shown to be therapeutically equivalent when administered via the previous FP/FORM pMDI. This device requires very few steps and has been considered easy to use (even at first attempt) and preferred by the patients in a randomized crossover study. In our country, FP/FORM k-haler is available without additional costs compared to FP/FORM pMDI. All devices continue to require education and regular checking of the correct inhalation technique. Conclusion: BTI R&D can bring advantage over current available inhalers, avoiding the two most common identified critical errors in inhalation technique. K-haler® BTI is currently available, without an increased cost, and approved for adolescents and adults with asthma in whom treatment with inhaled combined therapy with long-acting beta2-agonists and corticosteroids is indicated. Its attractive and practical design to facilitate its use has been awarded. K-haler® represents added value through innovation to fulfill actual asthma patient needs, thus with potential relevant impact in asthma management and effective control.publishersversionpublishe

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.(SFRH/BPD/115169/2016) funded by Fundação para a Ciência e Tecnologia (FCT); ERDF (European Regional Development Fund) through the operations: POCI-01-0145-FEDER-029130 ('mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases—generalisation and evaluation of gamification, peer support and advanced image processing technologies') cofunded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).info:eu-repo/semantics/publishedVersio

Analysis of airborne grass pollen concentrations in the atmosphere of mainland Portugal

Introdução: A exposição ao pólen atmosférico da família das Poaceae constitui a principal causa de polinose em Portugal. Objectivos: Analisar e comparar a estação de pólen atmosférico principal (EPAP) do pólen de gramíneas das estações de monitorização continentais da Rede Portuguesa de Aerobiologia: Porto, Coimbra, Lisboa, Évora e Portimão. Métodos: No estudo utilizaram -se os dados diários de 7 anos (2002 -2008) resultantes das monitorizações de pólen de gramíneas das cinco estações. Resultados: Entre as localidades encontraram -se diferenças estatisticamente significativas, em termos de índices polínicos, de duração e na data de término da EPAP. Este tipo polínico encontrou -se bem representado nas várias localidades, com valores próximos ou acima de 10% do pólen total. Esteve presente na atmosfera durante todo o ano mas com concentrações elevadas de Maio a Julho. O início da EPAP foi mais precoce no litoral, Lisboa e Porto, e mais tardio no interior sul, em Évora, com a respectiva duração a diminuir de Norte para Sul. As concentrações máximas absolutas diárias registaram -se em Junho e Julho no Porto, finais de Maio e início de Junho em Coimbra, e em Maio em Lisboa, Évora e Portimão. A EPAP terminou em Agosto no Norte e em Julho no Sul. Porto e Coimbra revelaram os mais baixos índices polínicos, com valores médios de 2151 e 1617 pólen/ano, respectivamente, enquanto Évora registou os mais elevados índices de pólen com 16736 pólen/ano. Concentrações médias diárias >25 pólen/m3 registaram -se no Porto durante 23 ± 5 dias, em Coimbra durante 16 ± 8 dias, em Lisboa durante 34 ± 15 dias, em Évora durante 54 ± 9 dias e em Portimão durante 39 ± 12 dias. Conclusões: Entre as localidades registaram -se diferenças na EPAP das gramíneas. É nas regiões do Sul, interiores e rurais, que o risco de exposição a este pólen é maior.Background: Airborne grass pollen constitutes the main cause of pollinosis in Portugal. Objectives: To analyze and to compare the main atmospheric pollen season (MAPS) of grass pollen in different monitoring stations of the Portuguese Aerobiology Network: Oporto, Coimbra, Lisbon, Évora and Portimão. Methods: In this study, daily sampling data of Poaceae pollen from five monitoring stations over the last seven years (2002 -2008) were used. Results: Statistical significant differences were observed in pollen indices and in main pollen atmospheric seasons: length and ending date. The highest concentrations of grass pollen were recorded from May to July. The beginning of the MAPS was earlier at the monitoring stations near the coast, Lisbon and Oporto, and it was recorded later in the south part of the country, in Évora. The absolute daily maximum concentrations were recorded in June and July in Oporto, at the end of May and beginning of June in Coimbra, on May in Lisbon, Évora and Portimão. The length of MAPS decreased from north to south. The end of MAPS was in August in the north and in July in the south. Although the observed interannual differences, Oporto and Coimbra showed the lowest pollen index, 2.151 and 1.617 pollen/year respectively, while Évora recorded the highest pollen index, 16.736 pollen/year. Concentrations >25 pollen/m3 were recorded in Oporto during 23 ± 5 days, in Coimbra during 16 ± 8 days, in Lisbon 34 ± 15 days, in Évora during 54 ± 9 days and in Portimão during 39 ± 12 days. Conclusions: Between the stations there were differences in MAPS of grasses. In Portugal, the risk of exposure to this pollen type is higher in the southern inland and rural areas.info:eu-repo/semantics/publishedVersio

Dietary Intake of Flavonoids and Ventilatory Function in European Adults : A GA(2)LEN Study

Background: Flavonoids exert anti-inflammatory properties and modulate oxidative stress in vitro, suggesting a protective effect on lung function, but epidemiological studies examining this association are scarce. Methods: A stratified random sample was drawn from the GA(2)LEN screening survey, in which 55,000 adults aged 15 to 75 answered a questionnaire on respiratory symptoms. Post-bronchodilator spirometry was obtained from 2850 subjects. Forced vital capacity (FVC), the ratio between the forced exhaled volume in 1 second (FEV1) and FVC (FEV1/FVC), FVC below lower limit of normal (FVC <LLN), and FEV1/FVC <LLN were calculated. Intake of the six main subclasses of flavonoids was estimated using the GA(2)LEN Food Frequency Questionnaire. Adjusted associations between outcomes and each subclass of flavonoids were examined with multivariate regressions. Simes' procedure was used to test for multiple comparisons. Results: A total of 2599 subjects had valid lung function and dietary data. A lower prevalence of FVC <LLN (airway restriction) was observed in those with higher total flavonoid (adjusted odds ratio (aOR), higher vs. lowest quintile intake 0.58; 95% Confidence Interval (CI) 0.36, 0.94), and pro-anthocyanidin intakes (aOR 0.47; 95% CI 0.27, 0.81). A higher FEV1/FVC was associated with higher intakes of total flavonoids and pro-anthocyanidins (adjusted correlation coefficient (a -coeff 0.33; 0.10, 0.57 and a -coeff 0.44; 95% CI 0.19, 0.69, respectively). After Simes' procedure, the statistical significance of each of these associations was attenuated but remained below 0.05, with the exception of total flavonoids and airway restriction. Conclusions: This population-based study in European adults provides cross-sectional evidence of a positive association of total flavonoid intake and pro-anthocyanidins and ventilatory function, and a negative association with spirometric restriction in European adults.Peer reviewe

Is fruit and vegetable intake associated with asthma or chronic rhino-sinusitis in European adults? Results from the Global Allergy and Asthma Network of Excellence (GA(2)LEN) Survey

Background: Fruits and vegetables are rich in compounds with proposed antioxidant, anti-allergic and anti-inflammatory properties, which could contribute to reduce the prevalence of asthma and allergic diseases. Objective: We investigated the association between asthma, and chronic rhino-sinusitis (CRS) with intake of fruits and vegetables in European adults. Methods: A stratified random sample was drawn from the Global Allergy and Asthma Network of Excellence (GA(2)LEN) screening survey, in which 55,000 adults aged 15-75 answered a questionnaire on respiratory symptoms. Asthma score (derived from self-reported asthma symptoms) and CRS were the outcomes of interest. Dietary intake of 22 subgroups of fruits and vegetables was ascertained using the internationally validated GA(2)LEN Food Frequency Questionnaire. Adjusted associations were examined with negative binomial and multiple regressions. Simes procedure was used to control for multiple testing. Results: A total of 3206 individuals had valid data on asthma and dietary exposures of interest. 22.8% reported having at least 1 asthma symptom (asthma score >= 1), whilst 19.5% had CRS. After adjustment for potential confounders, asthma score was negatively associated with intake of dried fruits (beta-coefficient -2.34;95% confidence interval [CI] -4.09,-0.59), whilst CRS was statistically negatively associated with total intake of fruits (OR 0.73; 95% CI 0.55, 0.97). Conversely, a positive association was observed between asthma score and alliums vegetables (adjusted beta-coefficient 0.23; 95% CI 0.06, 0.40). None of these associations remained statistically significant after controlling for multiple testing. Conclusion and clinical relevance: There was no consistent evidence for an association of asthma or CRS with fruit and vegetable intake in this representative sample of European adults.Peer reviewe