Test for Respiratory and Asthma Control in Kids (TRACK): validation of the Portuguese version

Abstract Background TRACK (Test for Respiratory and Asthma Control in Kids) questionnaire is an instrument developed and validated in English to evaluate the control of respiratory symptoms in children under 5 years of age. Objective To validate the Portuguese version of the TRACK questionnaire. Methods The validation was done in an observational, prospective and multicenter evaluation (six centers in Brazil) in children with recurrent respiratory symptoms. Children were classified according to symptoms, GINA criteria and medical evaluation. Parents and doctors rated child respiratory symptom control in the last month (VAS). Approval from the Institutional Review Board was obtained in each centre, and written informed consent was obtained from parents. Results Data from 299 children were obtained at baseline, and 195 at follow-up. The median score of the TRACK questionnaire was 65 and Cronbach’s α was 0.70. TRACK scores showed significant correlation with the medical and family opinions about symptom control (r: 0.74 and r: 0.61). TRACK scores were significantly lower in children who had used systemic steroids (median [IQR]: 45 [30–65] vs 75 [55–80]; p < 0.001) and had an emergency visit in the last month (45 [35–60] vs 70 [55–80]; p < 0.001). TRACK scores were also significantly different when children were separated by the medical opinion, GINA criteria and symptoms. Comparison of different respiratory symptom control cut-off points showed that the cut-off of 80 points had the highest area under ROC curve (0.800). Conclusion We have demonstrated that the Portuguese version of the TRACK questionnaire has satisfactory reliability (internal consistency), adequate criterion validity (compared against GINA levels of control) and constructive validity (compared against respiratory symptoms and medical opinion), showing that it can be a useful tool to discriminate among children with different levels of respiratory symptom control. Trial registration ClinicalTrials.gov: NCT03290222

Investigating Ambrosia Pollen Episodes in Poland Using Back-Trajectory Analysis

Background: The pollen grains of Ambrosia spp. are considered to be important aeroallergens. Previous studies have shown that the long-range transport of Ambrosia pollen to Poland is intermittent and mainly related to the passage of air masses over the Carpathian and Sudetes mountains from sources to the south, e.g. the Czech Republic, Slovakia and Hungary. In this study, Ambrosia pollen counts and back-trajectories from specific episodes in 1999 and 2002 have been analysed with the aim of identifying possible new sources of Ambrosia pollen arriving at three sites in Poland. Method: The combination of Ambrosia pollen measurements (daily average and bi-hourly concentrations) and air mass trajectory calculations were used to investigate two Ambrosia pollen episodes recorded at Rzeszow, Krakow and Poznań on the 4th and 5th September 1999 and 3rd September 2002. Ambrosia pollen counts were recorded by volumetric spore traps of the Hirst design. Trajectories were calculated using the transport model within the Lagrangian air pollution model, ACDEP (Atmospheric Chemistry and Deposition). Results: The collective results of pollen measurements and back-trajectory analysis indicate plumes of Ambrosia pollen travelling up through Poland from the southeast during the investigated episodes. In 1999, the plume was first recorded at Rzeszow in Southeastern Poland during the morning of the 4th September. Its route can be followed as it passed Krakow during the afternoon of the 4th, and later on the 4th and 5th September at Poznań. Similarly, back-trajectories calculated during the morning and afternoon from Krakow and Rzeszow on the 3rd September 2002 indicates that the air masses arrived at these sites from the East or Southeast. Conclusion: This study shows the progress of Ambrosia plumes into Poland from the southeast. Ambrosia pollen release occurs mainly during the day and so a midday peak in Ambrosia pollen concentrations may indicate a local source. However, if the plume of Ambrosia pollen tracked along its northwesterly path over Poland during investigated episodes did not originate from inside Poland, then it is likely that it came from the Ukraine. This identifies a possible new source of ragweed pollen for Poland. Trajectory analysis can only show the path along which an air mass travels, not the specific source area. Further investigation could therefore include source based transport models such as 3D Eulerian atmospheric transport models

Sensibilização a alérgenos inalantes e alimentares em crianças brasileiras atópicas, pela determinação in vitro de IgE total e específica: Projeto Alergia (PROAL)

OBJETIVO: Determinar a freqüência de sensibilização a alérgenos inalantes e alimentares em crianças atendidas em serviços brasileiros de alergia. PACIENTES E MÉTODOS: IgE sérica total e específica (RAST) a alérgenos inalantes e alimentares (UniCAP® - Pharmacia) foram determinados em 457 crianças acompanhadas em serviços de alergia pediátrica e em um grupo de controles (n = 62). Resultados classe igual ou maior que 1 foram considerados positivos (R+). RESULTADOS: A freqüência de R+ foi significantemente maior entre os atópicos (361/457, 79%) quando comparados aos controles (16/62, 25,8%). Não houve diferenças quanto ao sexo. A prevalência de R+ entre os atópicos foi significantemente maior para todos os alérgenos avaliados. Os níveis séricos de IgE total foram significantemente mais elevados entre os atópicos com R+ quando comparados aos com R-. Comparando-se atópicos e controles, a freqüência de R+ para os principais alérgenos inalantes foi como segue: D. pteronyssinus = 66,7 versus 14,5% (p < 0,05), D. farinae = 64,5 versus 17,8% (p < 0,05), B. tropicalis = 55,2 versus 19,4% (p < 0,05), barata = 32,8 versus 9,7% (p < 0,05) e gato = 12 versus 8,1%. Com os alimentos, observou-se: peixe = 29,5 versus 11,3% (p < 0,05), ovo = 24,4 versus 4,8% (p < 0,05), leite de vaca = 23,1 versus 3,2% (p < 0,05), trigo = 20 versus 8,1% (p < 0,05), amendoim = 14 versus 4,8% (p < 0,05), soja = 11,8 versus 4,8% (p < 0,05) e milho = 10,6 versus 4,8% (p < 0,05). Segundo a idade, os R+ aos alimentares predominaram entre as crianças mais jovens, e o inverso ocorreu com os inalantes. CONCLUSÕES: Nesta população, predominou a sensibilização aos aeroalérgenos, sobretudo aos ácaros domiciliares, e os alimentos foram importantes em crianças mais jovens

Evidence for involvement of IL-9 and IL-22 in cows’ milk allergy in infants

Although allergic inflammation is characterized by a T helper (Th) 2-dominant immune response, the discovery of a role for new T cell subsets in inflammatory diseases has added an additional layer of complexity to the understanding of the pathogeneses of allergic diseases. We evaluated plasma cytokine profiles in infants with cows’ milk allergy (CMA), who were being treated with an elimination diet. In a prospective, randomized and controlled study, infants (aged 8.4 ± 3.9 months) with CMA were treated with an elimination diet for 120 days, which replaced cows’ milk with a hydrolysed soy protein formula (n = 26) or a free amino acid formula (n = 20). Blood samples were collected before treatment during active disease (T0) and after 120 days, when symptoms were absent (T1). Plasma cytokine concentrations were measured. Infants with CMA had higher plasma concentrations of interleukin (IL)-4 and IL-13 and lower concentrations of IL-9, IL-17A and interferon-γ, compared with healthy breast-fed infants. At T0, there was a positive correlation between blood eosinophil numbers and plasma concentrations of IL-4, IL-9, IL-17A and IL-22. Treatment with a cows’ milk elimination diet resulted in a decrease in plasma IL-4, IL-9, IL-13 and IL-22 and an increase in plasma IL-17A. We conclude that IL-4 and IL-13 are elevated in active CMA. The association of IL-9 and IL-22 with eosinophilia, and the decrease in these two cytokines with cows’ milk elimination, suggests that they both play a role in the symptoms observed in CMA and may be important targets for future intervention

Allergic sensitization pattern of patients in Brazil

Objective: Allergic sensitization is one of the key components for the development of allergies. Polysensitization seems to be related to the persistence and severity of allergic diseases. Furthermore, allergic sensitization has a predictive role in the development of allergies. The aim of this study was to characterize the pattern of sensitization of atopic patients treated at different pediatric allergy referral centers in Brazil. Methods: A nation-wide transversal multicenter study collected data on patients attended in Brazil. Peripheral blood samples were collected to determine the serum levels of allergen-specific IgE. If allergen-specific IgE was higher than 0.1 kUA/L, the following specific components were quantified. Results: A total of 470 individuals were enrolled in the study. Mite sensitization was the most frequent kind in all participants. A high frequency of sensitization to furry animals and grasses featured in the respiratory allergies. Regarding components, there was a predominance of sensitization to Der p 1 and Der p 2. It has been verified that having a food allergy, atopic dermatitis, or multimorbidity are risk factors for the development of more severe allergic disease. Conclusion: Studies on the pattern of allergic sensitization to a specific population offer tools for the more effectual prevention, diagnosis, and treatment of allergic diseases. Sensitization to dust mites house was the most prevalent in the evaluated sample. High rates of sensitization to furry animals also stand out. Patients with food allergy, atopic dermatitis, or multimorbidity appear to be at greater risk for developing more severe allergic diseases

Is the prevalence of asthma and related symptoms among Brazilian children related to socioeconomic status?

Objective. To evaluate the relationship between socioeconomic status (SES) and the prevalence of asthma and related symptoms among Brazilian children. Methods. The International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire was applied to 23,457 six- to seven- year-old schoolchildren (SC) and 58,144 thirteen- to fourteen-year-old adolescents (AD) from 20 Brazilian cities. SES was evaluated by infant mortality index, poverty index, and average nominal income for people older than 10 years of age. Results. Current asthma ranged from 16.5% to 31.2% among SC and from 11.8% to 30.5% among AD and severe asthma from 2.9% to 8.5% (SC) and 2.6% to 9.1% (AD). Higher values were observed in Brazilian-Northern, -Northeastern and -Southeastern centers. No significant association between SES and prevalence of asthma and related symptoms was observed. Conclusions. In Brazil, the prevalence of asthma and related symptoms is quite variable and independent of SES. Copyright © 2008 Informa Healthcare USA, Inc

Prevalence of rhinitis among Brazilian schoolchildren: ISAAC phase 3 results

Objective: The International Study of Asthma and Allergies in Childhood (ISAAC) is a standardized method that allows international and regional comparisons of asthma and allergic diseases prevalence. The objective of this study was to evaluate the prevalence of rhinitis and related symptoms among 6-7 year-old children (SC) and 13-14 year-old adolescents (AD) from 20 Brazilian cities applying the ISAA C's standardized written questionnaire (WQ). Methods: ISAAC's WQ was applied to 23,422 SC and 58,144 AD living in different regions of Brazil: North (N), Northeast (NE), Middle West (MW), Southeast (SE), and South (S). Results: The prevalence of rhinoconjunctivitis in the last year ranged from 10.3% to 17.4% and from 8.9% to 28.5% among SC and AD, respectively. Considering SC the highest values were observed in SE region. In NE, the prevalence in countryside centres was higher than those along the coast. Among AD, the highest values were observed in N and S regions, mainly in Pará (Belém). The evaluation of populations probably with the same genetic background has shown higher prevalence among those living in urban centres (capital) in comparison to those in the countryside. Conclusions: The prevalence of rhinitis and related symptoms were variable and predominate in Brazilian N and NE centres