Alergia ou tolerância ao leite de vaca: novos cut-offs

Objetivos: Estabelecer o diâmetro médio da pápula e a concentração sérica de IgE específica ao leite de vaca total (LV) e às suas frações proteicas capazes de diferenciar alérgicos de não alérgicos; após um período mínimo de seis meses, avaliar a aquisição de tolerância oral. Relacionar a história clínica sugestiva de alergia ao LV com os resultados dos testes in vivo, in vitro e o Teste de Provocação Oral (TPO)aberto. Métodos: Cento e vinte e duas crianças (mediana de idade: 17 meses) com história clínica de reações imediatas ao LV e testes cutâneos de leitura imediata (TCLI) e/ou IgE específicas para LV e/ou frações positivos foram submetidas a TPO aberto (TPO1) com LV. As crianças com TPO positivo foram reavaliadas, após um período mínimo de seis meses de exclusão dietética, por meio de novo TPO (TPO2), precedido de novos TCLI e dosagens de IgE séricas específicas. Resultados: O TPO1 foi positivo em 59,8% das crianças. Os sintomas observados foram cutâneos 52%), respiratórios (14%) e gastrintestinais (8%). Apenas um paciente apresentou anafilaxia. Entre os pacientes positivos, 56 (76,7%) deflagraram sintomas após ingestão de 0,05 ml a 5 ml de LV nos primeiros 30 minutos do procedimento. A maioria das reações foi leve (83%), controladas com anti-histamínicos orais em 40 pacientes. Não houve concordância estatisticamente significante (método Kappa) entre os sintomas iniciais relatados pelos familiares e os manifestados durante o TPO. Os níveis de IgE sérica específicas para LV e os diâmetros médios das pápulas no TCLI foram significantemente maiores nos alérgicos do que nos não alérgicos (mediana 3,39 kUA/L vs 1,16 kUA/L; 2,5 mm vs 0 mm, respectivamente). Foram construídas curvas ROC para LV total e frações com áreas acima de 0,6, consideradas discriminatórias. Os pontos de corte obtidos utilizando-se o Índice de Youden, para os níveis séricos de IgE específica para LV, ?-lactoalbumina, ?-lactoglobulina e caseína foram 5,17 kUA/L, 0,95kUA/L, 0,82 kUA/L, 0,72 kUA/L, respectivamente. Para os diâmetros das pápulas foram obtidas, com o Índice de Youden, medidas de 3,5 mm, 6,5 mm, 9,0 mm e 3,0 mm,respectivamente. Após seis meses, foi realizado o TPO2, e as novas mensurações séricas resultaram em valores de 0,34 kUA/L, 0,15 kUA/L, 0,43 kUA e 0,29 kUA/L para LV, ?-lactoalbumina, ?-lactoglobulina e caseína, respectivamente, considerados não adequados. Para o diâmetro médio da pápula no TPO2, foram encontrados pontos de corte de 2,0 mm para LV, de 4,5 mm, 3,0 mm e 4,5 mm para ?-lactoalbumina, ?-lactoglobulina e caseína, utilizando como método o Índice de Youden. Conclusão: O ponto de corte diagnóstico para os níveis séricos de IgE para LV foi 5,17 kUA/L e para o diâmetro médio da pápula, 3,5 mm. Na aquisição de tolerância, os desempenhos do diâmetro médio de pápula e do nível de IgE específica para LV e frações não foram satisfatórios. Não houve concordância estatisticamente significante entre os sintomas iniciais relatados pelos familiares e os manifestados durante o TPO.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

Alergia às proteínas do leite de vaca e a atenção primária à saúde: uma revisão narrativa das diretrizes atuais

OBJECTIVES: To perform a narrative review of the literature about current guidelines for food allergy and present the main recommendations for Cow’s Milk Protein Allergy (CMPA) management in children at primary health care by algorithms. METHODS: We searched for relevant publications on the Cochrane Library, MEDLINE, PubMed, Guidelines International Network, National Guidelines Clearinghouse and National Institute for Health and Clinical Excellence (NICE) using the keywords on this topic. We made a comprehensive review of these publications as well as the recommendations of the Brazilian guide and consensus for food allergy. FINAL REMARKS: Adequate diagnosis and treatment for CMPA in children is essential, considering its nutritional, emotional and socioeconomic burden. Clinical practice guidelines provide recommendations based on scientific evidence improving quality of care; however, their implementation is challenging due to the lack of practical algorithms applicable and accessible for the management of CMPA in primary care. In addition, the lack of algorithms that favor accessibility to information from the extensive scientific content available is a reality that makes relevant a more practical proposal for a management of CMPA, applicable and accessible in order to consolidate a clinical practice based on scientific evidence

Relationship Between Asthma and High Blood Pressure Among Adolescents in Aracaju, Brazil

Background. Asthma has been linked to cardiovascular diseases (CVDs) and related risk factors such as hypertension in adults. It is unclear whether the relationship between asthma and hypertension found among adults is also observed in adolescents. Hence, the authors examined asthma and its association with prehypertension and hypertension among adolescents in Aracaju, Brazil. Methods. Data on asthma and blood pressure were collected among 1002 adolescents age 12 to 17 years old in 15 public schools, 5 municipal schools, and 10 private schools. Asthma data were ascertained by the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire. Sex-, age-, and height-specific percentile levels were used to define prehypertension (90-94th percentile) and hypertension (>= 95(th) percentile). Results. the prevalence of asthma was 20.6% in boys and 27.7% in girls. Among boys, the prevalence rates of prehypertension and hypertension were 26.7% and 17.0%, respectively. Among girls, the rates of prehypertension and hypertension were 14.3% and 12.9%, respectively. There were no statistically significant associations between asthma and prehypertension, and hypertension, even after adjusting for age, social economic status, physical activity, and body mass index (BMI) in both boys (prehypertension: odds ratio [OR] = 1.35, 95% confidence interval [CI]: 0.80-2.27; hypertension: OR = 0.60, 95% CI: 0.29-1.23) and girls (prehypertension: OR = 0.71, 95% CI: 0.40-1.28; hypertension: OR = 1.07, 95% CI: 0.60-1.94). Conclusions. These results suggest no association between asthma and high blood pressure in adolescents. More prospective studies are needed to establish whether hypertension becomes more pronounced at a specific age in asthmatics, and if so, the possible factors that may contribute to this.Univ Amsterdam, Acad Med Ctr, Dept Publ Hlth, NL-1105 AZ Amsterdam, NetherlandsUniv Fed Sergipe, Dept Med & Post Grad Nucleus Med, Aracaju, BrazilUniv Fed Sergipe, Univ Hosp, Aracaju, BrazilUniversidade Federal de São Paulo, Dept Paediat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Paediat, São Paulo, BrazilWeb of Scienc

Prevalência de asma e doenças alérgicas em adolescentes: estudo evolutivo de nove anos (2003 a 2012)

OBJECTIVE: To determine the prevalence of symptoms of asthma, rhinitis, and atopic eczema in adolescents (AD; 13-14 years) living in seven Brazilian cities, by applying the standardized written questionnaire (WQ) of the International Study of Asthma and Allergies in Childhood (ISAAC), and to evaluate the time trend nine years after the last assessment of ISAAC phase 3 (ISP3). METHODS: The ISAAC-WQ was answered by 20,099 AD from the Northern, Northeastern, Southeastern, and Southern Brazilian regions. Values obtained were compared to those observed in ISP3 using nonparametric (chi-squared or Fisher) tests, and the ratio of annual increment/decrement was established for each of the centers, according to the symptom assessed. RESULTS: Considering the national data and comparing to values of ISP3, there was a decrease in the mean prevalence of active asthma (18.5% vs. 17.5%) and an increase in the frequency of severe asthma (4.5% vs. 4.7%) and physician-diagnosed asthma (14.3% vs. 17.6%). An increase in prevalence of rhinitis, rhinoconjunctivitis, and atopic eczema was also observed. CONCLUSIONS: The prevalence of asthma, rhinitis, and atopic eczema in Brazil was variable; higher prevalence values, especially of asthma and eczema, were observed in regions located closer to the Equator.OBJETIVO: Determinar a prevalência de sintomas relacionados à asma, à rinite e ao eczema atópico em adolescentes (13-14 anos, AD) residentes em sete cidades brasileiras com o questionário escrito (QE) padronizado do International Study of Asthma and Allergies in Childhood (Isaac) e verificar a tendência temporal passados nove anos da última avaliação do Isaac fase 3 (ISF3). MÉTODOS: O QE Isaac foi respondido por 20.099 AD (13-14 anos) moradores em centros das regiões Norte, Nordeste, Sudeste e Sul. Os índices obtidos foram comparados aos do ISF3 com o teste não paramétrico (qui-quadrado ou Fisher) e foi estabelecida a taxa de incremento/decremento anual para cada um dos centros segundo o sintoma avaliado. RESULTADOS: Em relação ao ISF3, considerando-se os dados nacionais, houve queda da prevalência média de asma ativa (18,5% vs. 17,5%) com elevação da frequência de asma grave (4,5% vs. 4,7%) e de asma diagnosticada por médico (14,3% vs. 17,6%). Aumento da prevalência de rinite e rinoconjuntivite e de eczema flexural também ocorreram. CONCLUSÕES: A prevalência de asma, rinite e eczema atópico no Brasil foi variável. Valores mais altos, sobretudo de asma e eczema, foram observados nos centros localizados mais próximos ao Equador.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of PediatricsUniversidade Federal do ParanáUniversidade Federal de Pernambuco Department of PediatricsUniversidade Estadual do ParáUniversidade Federal de Alagoas Department of PediatricsUniversidade Federal de Sergipe Department of PediatricsUniversidade Federal de Minas Gerais Department of PediatricsUniversidade de SantiagoUNIFESP, EPM, Department of PediatricsSciEL

Brazilian pediatricians' adherence to food allergy guidelines-A cross-sectional study.

Food allergy is an emerging clinical condition in pediatrics, so recommendations on its management have been widely published. Studying pediatricians' adherence to these clinical practice guidelines (CPG) and understanding the reasons for their non-compliance can help to promote better management of this condition. A cross-sectional study was conducted by a survey among Brazilian pediatricians, randomly selected during the 38th Brazilian Congress of Pediatrics, which took place in October, 2017. A validated questionnaire with 16 questions addressing knowledge and practice on food allergy, as well as self-reported adherence to international guidelines was applied. Of the total of 415 pediatricians from all regions of the country who were surveyed, only 69 (16.7%) had a satisfactory adherence rate (≥80%). Adequate adherence to the guidelines was associated with the variables: 'evaluating more than 10 children with suspected cow's milk allergy (CMA) per month'; 'having read the Brazilian consensus'; or 'being aware of any international food allergy guideline'. In 8 of the 10 questions that assessed conscious adherence, a minority of those surveyed (20.3-42.3% variation) stated that they knew that their response was in line with the guidelines. This finding was statistically significant (p<0.05) in 7 of these 8 questions. The self-reported adherence of Brazilian pediatricians to international food allergy guidelines was low. Pediatricians who evaluated a higher number of children with suspected CMA or who were aware of the recommendations, had a higher rate of adherence. The results of the survey found that lack of resource was the major reported barrier to guideline adherence but lack of awareness must be a relevant non perceived barrier. This study shows the pediatricians´ self-reported adherence to food allergy guidelines in a widely overview for the first time in Brazil. More studies are necessary to investigate adherence to guidelines by pediatricians in other countries and to develop strategies to improve adherence

Laboratory screening test with inhalant and food allergens in atopic Brazilian children and adolescents : a performance

The Phadiatop Infant (R)) is a panel developed to assess allergic sensitization (immunoglobulin E [IgE]) in children aged &lt;5 years and combines inhalant and food allergens. The test has not been evaluated outside Europe. This is a cross-sectional study conducted at 11 pediatric allergy centers to evaluate PhInf as an allergic disease screening method in Brazilian children. Children as controls and patients (aged 6 months-18 years) were grouped according to their primary disease and age group. PhInf and specific serum IgE (sIgE) screening was performed for Dermatophagoides pteronyssinus (DP), cat and dog epithelia, a mix of grasses and pollens, eggs, cow's milk, peanuts, and shrimp. Values &gt;= 0.35 kU (A)/L (or PAU/L) were considered positive. A total of 470 children and adolescents, which included 385 patients and 85 controls, participated in the study (47.7% boys, average age: 6.3 years). In all, 72.6% of the participants had positive PhInf test (n = 341), with a higher proportion of those having food allergy (92.6%), atopic dermatitis (91.9%), and those aged &gt;13 years having allergy (95%). The PhInf and sIgE agreement between patients (Kappa = 0.94, P &lt; 0.001) and controls (Kappa = 0.84, P &lt; 0.001) was high. PhInf and DP agreement in patients aged &gt;13 years was excellent (Kappa = 0.936, P &lt; 0.001). Compared with sIgE dosage, PhInf had high sensitivity (97%) and specificity (93%). Positivity of PhInf test in this population was high and had an excellent correlation with the allergens comprising the panel. It is a useful method for screening children suspected of having allergic diseases in a non-European country