Insect repellents: recommendations for use in children

OBJETIVO: Apresentar uma revisão bibliográfica sobre o uso de repelentes de insetos em crianças, com ênfase especial na proteção contra mosquitos. FONTES DE DADOS: Realizou-se uma pesquisa bibliográfica nas bases de dados Pubmed e Lilacs, cujos artigos incluíam produtos comercialmente disponíveis no Brasil. Foram selecionados artigos publicados nos últimos dez anos em língua inglesa ou portuguesa, referentes a crianças, obtidos com as seguintes palavras-chave: "insect repellents", "children", "mosquitoes", "N,N-dietil-metatoluamida (DEET)". SÍNTESE DOS DADOS: Entre os repelentes tópicos, DEET, icaridina e óleo natural de eucalipto-limão apresentam, em concentrações adequadas, perfil de segurança favorável e são eficazes na prevenção de picadas de mosquitos em crianças e adultos. Em geral, são indicados para crianças acima de dois anos de idade. Medidas físicas são fundamentais para proteger lactentes jovens, especialmente menores de seis meses, com destaque para o uso de telas com permetrina. CONCLUSÕES: Os mosquitos são vetores de doenças infectoparasitárias que acometem, anualmente, milhões de pessoas no mundo e causam milhares de mortes. O combate aos mosquitos inclui medidas ambientais e de proteção individual. O uso de repelentes tópicos para proteção individual da criança exige cuidados específicos e conhecimento quanto ao produto ideal para cada idade, especialmente quando consideradas sua eficácia e segurança.OBJECTIVE: To present a literature review about the use of insect repellents on children, highlighting the protection against mosquitoes. DATA SOURCES: Pubmed and Lilacs databases were searched for articles in English and Portuguese published in the last ten years with the following key-words: "insect repellents", "children", "mosquitoes", "N,N-dietil-metatoluamida (DEET)". DATA SYNTHESIS: Concerning topical repellents, DEET, icaridine and natural oil of lemon eucalyptus are effective to prevent mosquito bites in children and adults and have favorable safety profile when used in appropriate concentration. They are generally recommended for children older than two years-old. Physical barriers are essential for infant protection, especially if they are six months old or less, with special interest in the permethrin-treated nets. CONCLUSIONS: Mosquitoes are vectors of a variety of infectious and parasitic diseases which annually affect millions of people and cause thousands of deaths worldwide. The combat to mosquitoes includes individual and environmental measures. Topic repellents for children's individual protection demand specific handling attention and knowledge about the ideal product for each age, especially regarding their efficacy and safety

DiGeorge Syndrome: a not so rare disease

INTRODUCTION: The DiGeorge Syndrome was first described in 1968 as a primary immunodeficiency resulting from the abnormal development of the third and fourth pharyngeal pouches during embryonic life. It is characterized by hypocalcemia due to hypoparathyroidism, heart defects, and thymic hypoplasia or aplasia. Its incidence is 1:3000 live births and, despite its high frequency, little is known about its natural history and progression. ←This is probably due to diagnostic difficulties and the great variety of names used to describe it, such as velocardiofacial, Shprintzen, DiGeorge, and CATCH 22 Syndromes, as well as conotruncal facial anomaly. All represent the same genetic condition, chromosome 22q11.2 deletion, which might have several clinical expressions. OBJECTIVES: To describe clinical and laboratorial data and phenotypic characteristics of patients with DiGeorge Syndrome. METHODS: Patients underwent standard clinical and epidemiological protocol and tests to detect heart diseases, facial abnormalities, dimorphisms, neurological or behavioral disorders, recurrent infections and other comorbidities. RESULTS: Of 14 patients (8m - 18y11m), only one did not have 22q11.2 deletion detected. The main findings were: conotruncal malformation (n = 12), facial abnormalities (n = 11), hypocalcemia (n = 5) and low lymphocyte count (n=2). CONCLUSION: The authors pointed out the necessity of DGS suspicion in all patient presenting with heart defects, facial abnormalities (associated or not with hypocalcemia), and immunological disorders because although frequency of DGS is high, few patients with a confirmed diagnosis are followed up

Variation of the Anthropometric Index for pectus excavatum relative to age, race, and sex

OBJECTIVES: To determine possible variations in the Anthropometric Index for pectus excavatum relative to age, race, and sex in individuals free of thoracic wall deformities. METHODS: Between 2002 and 2012, 166 individuals with morphologically normal thoracic walls consented to have their chests and the perimeter of the lower third of the thorax measured according to the Anthropometric Index for pectus excavatum. The participant characteristics are presented (114 men and 52 women; 118 Caucasians and 48 people of African descent). RESULTS: Measurements of the Anthropometric Index for pectus excavatum were statistically significantly different between men and women (11-40 years old); however, no significant difference was found between Caucasians and people of African descent. For men, the index measurements were not significantly different across all of the age groups. For women, the index measurements were significantly lower for individuals aged 3 to 10 years old than for individuals aged 11 to 20 years old and 21 to 40 years old; however, no such difference was observed between women aged 11 to 20 years old and those aged 21 to 40 years old. CONCLUSION: In the sample, significant differences were observed between women aged 11 to 40 years old and the other age groups; however, there was no difference between Caucasian and people of African descent

Hipogamaglobulinemia secundária ao uso de carbamazepina: apresentação de caso clínico e revisão da literatura

As alterações imunológicas relacionadas ao uso de anti-convulsivantes têm sido descrita há três décadas, envolvendo alterações celulares e humorais, sendo os mecanismos fisiopatológicos ainda não totalmente elucidados. Este relato descreve o caso de paciente portador de epilepsia parcial complexa com hipogamaglobulinemia durante o tratamento com carbamazepina, tendo apresentado melhora clínica e laboratorial importantes após substituição da droga pelo ácido valpróico. Os autores ressaltam a importância do acompanhamento clínico e laboratorial, incluindo avaliação dos níveis de imunoglobulinas e hemogramas seriados dos pacientes em uso contínuo de anticonvulsivantes.Immunologic disorders related to anticonvulsant therapy have been described in the last three decades, including cellular and humoral alterations that result in recurrent infections; however, the physiopathologic mechanisms are not completely understood. This report describes a patient with complex partial epilepsy and hypogammaglobulinemia while in treatment with carbamazepine, with significant improvement in clinical signs and laboratory tests after substitution to sodium valproate. The authors stress the importance of clinical and laboratory evaluation of patients in continuous anticonvulsant therapy, including immunoglobulins levels and peripheral blood evaluations

Interleukin 10 (IL10) and transforming growth factor 1 (TGF1) gene polymorphisms in persistent IgE-mediated cow's milk allergy

OBJECTIVES: The aim of this cross-sectional study was to evaluate whether interleukin 10 (IL10) and transforming growth factor β1 (TGFβ1) gene polymorphisms were associated with persistent IgE-mediated cow's milk allergy in 50 Brazilian children. The diagnostic criteria were anaphylaxis triggered by cow's milk or a positive double-blind, placebo-controlled food challenge. Tolerance was defined as the absence of a clinical response to a double-blind, placebo-controlled food challenge or cow's milk exposure. METHOD: The genomic DNA of the 50 patients and 224 healthy controls (HCs) was used to investigate five IL10 gene polymorphisms (-3575A/T, -2849A/G, -2763A/C, -1082G/A, -592C/A) and one TGFβ1 polymorphism (-509C/T). RESULTS: Among the five IL10 polymorphisms analyzed, homozygosis for the G allele at the -1082 position was significantly higher in the patients compared with the healthy controls (p = 0.027) and in the persistent cow's milk allergy group compared with the healthy controls (p = 0.001). CONCLUSIONS: Homozygosis for the G allele at the IL10 -1082G/A polymorphism is associated with the persistent form of cow's milk allergy

PERCEPTIONS OF CAREGIVERS OF PATIENTS WITH COW’S MILK ALLERGY REGARDING THE TREATMENT

The aim of this qualitative study was to understand the perceptions of caregivers of children and adolescents with cow’s milk allergy regarding the disease and its treatment. Nine caregivers were interviewed and content analysis method was used. Three categories with subcategories emerged: treatment and education of the patient and their caregivers (life experiences, bases of treatment, coping with the disease), resolution of the disease (hope, gradual  improvement), quality of life (social inclusion, family daily activities, costs of dietary treatment). Caregivers experienced difficulties during the initial treatment but pointed out that the guidance given during follow-up made the adjustments easier. Family members commented on the difficulties about lack of cooperation fromother family members regarding the restrictive diet, their experience coping with the allergic reaction,doubts about the treatment and gaps on knowledge about the disease by other physicians andpeople. Some of them believed that there is no treatment for the disease, because there are nodrugs or vaccines, but they were waiting for cure. The majority of relatives were satisfied with the gradual improvement of patients observed by reduction on the severity of symptoms and tolerance of milk traces within foods. In addition, they commented on the efforts to give a normal life for their children, the changes in their daily lives and the difficulty to buy special products. Concluding,caregivers of children and adolescents with cow’s milk allergy feel a great burden of the disease.Este estudo qualitativo teve como objetivo compreender as percepções de familiares de crianças eadolescentes com alergia à proteína do leite de vaca (APLV) em relação à doença e seu tratamento.Foram realizadas nove entrevistas e foi utilizado o método de análise de conteúdo. Surgiram trêscategorias com subcategorias: tratamento e educação do paciente e familiares (experiências vividas,base do tratamento e como lidar com a doença), resolução da doença (expectativa e melhoragradativa), qualidade de vida (inclusão social, cotidiano familiar e custo dos alimentos). Os familiaresvivenciaram dificuldades durante o início do tratamento, mas revelaram que as orientações fornecidasno seguimento tornaram as adaptações à doença mais fáceis. Comentaram sobre as dificuldades emobter a colaboração de outros membros da família em relação à dieta de exclusão, suas experiênciasfrente a uma reação alérgica, dúvidas quanto ao tratamento e lacunas do conhecimento sobre adoença entre outros médicos e na população em geral. Alguns deles acreditavam que não haviatratamento para a APLV, porque não existiam medicamentos ou vacinas, mas mantinham a esperançada descoberta de uma cura. A maioria dos familiares estava satisfeita com a melhora gradativa dosseus filhos, percebida pela redução da gravidade dos sintomas e tolerância a traços de leite. Tambémcomentaram sobre os esforços em proporcionar uma vida normal para seus filhos, as mudanças emsuas vidas e a dificuldade em comprar alimentos especiais. Em conclusão, os familiares de criançase adolescentes com APLV sentem grande impacto da doença

Laboratorial approach in the diagnosis of food allergy

OBJCTIVE: Review the available laboratory tests used to assist in the diagnosis of IgE-mediated and non-IgE-mediated food allergy. DATA SOURCES: Papers in English and Portuguese published in PubMed and Embase, in the last ten years. Terms searched were food allergy, diagnose and laboratory, isolated and/or associated. DATA SYNTHESIS: The diagnostic approach to food allergy reactions includes a good medical history, laboratory studies, elimination diets and blinded food challenges. More recently, the use of a quantitative measurement of food-specific IgE antibodies has been shown to be more predictive of symptomatic IgE-mediated food allergy. Food-specific IgE serum levels exceeding the diagnostic values indicate that the patient is greater than 95% likely to experience an allergic reaction if he/she ingests the specific food. Such decision point values have been defined just for some foods and inconsistent results were obtained when allergy to the same food was studied in different centers. Food challenges, in particular the double-blind placebo-controlled food challenge (DBPCFC), represent the most reliable way to establish or rule out food hypersensitivity. CONCLUSIONS: A number of recent developments are improving the predictive value of some laboratory tests for the diagnosis of food allergies. However, to date, no in-vitro or in-vivo test shows full correlation with clinical food allergy and the DBPCFC remains the gold standard for the definitive diagnosis of specific food allergies. There is an urgent need for new and fundamentally improved diagnostic approaches, which must be validated in patients with food allergy confirmed by a positive DBPCFC.OBJETIVO: Revisar os exames laboratoriais disponíveis utilizados no diagnóstico da alergia alimentar mediada ou não por IgE. FONTES DE DADOS: Artigos publicados em base de dados PubMed e Embase (língua inglesa e portuguesa) nos últimos dez anos. As palavras-chave utilizadas como fonte de busca foram alergia alimentar, diagnóstico e laboratório, isolados e/ou associados. SÍNTESE DOS DADOS: A abordagem diagnóstica das reações alérgicas a alimentos inclui história clínica completa, estudos laboratoriais, dietas de eliminação e desencadeamentos cegos com alimentos. Recentemente, a medida quantitativa de anticorpos IgE específicos a alimentos tem mostrado ser mais preditiva de alergia alimentar sintomática mediada por IgE. Níveis séricos de IgE específica a alimento que excedam os valores diagnósticos indicam que o paciente tem chance maior que 95% de apresentar uma reação alérgica se ingerir o alimento em questão. Estes valores de decisão foram definidos para alguns alimentos e resultados inconsistentes são obtidos ao se estudar diferentes populações. Os desencadeamentos com alimento, especialmente o duplo-cego controlado por placebo (DADCCP), representa a maneira mais confiável de estabelecer ou descartar o diagnóstico de hipersensibilidade alimentar. CONCLUSÕES: Número crescente de aquisições tem melhorado o valor preditivo de alguns testes laboratoriais empregados no diagnóstico de alergias alimentares. Entretanto, até hoje, não há teste in vitro ou in vivo que mostre correlação completa com a clínica da alergia alimentar. O DADCCP continua sendo o padrão-ouro no diagnóstico definitivo de alergia alimentar específica. São necessárias, urgentemente, novas abordagens diagnósticas válidadas em pacientes com alergia alimentar confirmada por DADCCP positivo.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP-EPM Departamento de PediatriaUniversidade de São Paulo Faculdade de Medicina Departamento de PediatriaUniversidade Federal da Bahia Departamento de PediatriaUNIFESP-EPMUniversidade Federal do Paraná Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPM Depto. de PediatriaUNIFESP, EPMSciEL

Study of asthma and allergic diseases prevalence, aeroallergens sensitization and the risk factors exposure in students from 13 - 14 years in the west area of the city of São Paulo

INTRODUÇÃO: O aumento da prevalência das doenças alérgicas tem sido associado a vários fatores de risco e a detecção destes e a avaliação da prevalência em diferentes regiões é fundamental. O protocolo padronizado ISAAC (International Study of Asthma and Allergies in Childhood), possibilitou a comparação destes dados epidemiológicos. Os OBJETIVOS deste estudo foram: avaliar a prevalência da asma, rinite e eczema alérgicos e sintomas relacionados, entre escolares de 13 a 14 anos, da região oeste da cidade de São Paulo, utilizando-se o questionário escrito ISAAC e identificar possíveis fatores de risco associados à presença de asma ou à positividade ao teste cutâneo de hipersensibilidade imediata (TCHI). MÉTODOS: Entre fevereiro de 2002 e outubro de 2003 foi aplicado questionário escrito ISAAC em 3181 alunos. Após amostragem sistemática, 528 alunos foram submetidos ao TCHI para o diagnóstico de atopia e responderam a um questionário complementar sobre antecedentes familiares e condições ambientais. Foram constituídos grupos de alunos com ou sem asma, considerando-se a presença de sintomas de asma nos últimos 12 meses, e com ou sem TCHI positivo a pelo menos um aeroalérgeno. A análise dos fatores de risco foi realizada pelo teste do qui-quadrado ou teste exato de Fisher e por regressão binária logística (Backward Stepwise). RESULTADOS: As prevalências encontradas foram: asma de 21,9%, diagnóstico médico de asma 8,9%, rinite de 30,1%, rinoconjuntivite de 19,8% , diagnóstico médico de rinite 18,9%, eczema atópico de 9,7% e o diagnóstico médico de eczema 8,6%. Houve associação entre asma, rinite e eczema atópico em 2,3% dos adolescentes. O sexo feminino foi prevalente em todas as questões sobre asma, rinite e eczema atópico. Houve associação entre TCHI e a presença de asma (OR = 2,6) e de rinite (OR = 1,9). Em relação à asma, os fatores de risco foram: sintomas de rinite no último ano (ORajustado = 3,2); positividade ao TCHI (ORajustado = 2,8); parto prematuro (ORajustado = 3,8); nunca consumir vegetais cozidos (ORajustado = 2,6); presença de eczema em locais característicos (ORajustado = 2,9) e mãe alérgica (ORajustado = 2,0). Em relação à positividade do TCHI, os fatores de risco foram: presença de asma (ORajustado = 2,3); sintomas de rinite no último ano (ORajustado = 1,9); pai alérgico (ORajustado = 2,2) e parto cesáreo (ORajustado = 1,7). CONCLUSÕES: A prevalência de asma neste estudo mostrou valores elevados em comparação ao diagnóstico médico de asma. A prevalência da rinoconjuntivite foi comparável ao diagnóstico médico de rinite, que foram menores que a prevalência de rinite no último ano. A prevalência de eczema atópico foi maior que aquela avaliada pelo critério combinado. Houve predomínio do sexo feminino nas respostas positivas para todas as doenças atópicas. Houve associação entre TCHI e presença de rinite ou asma. Os fatores de risco associados à asma foram: mãe alérgica, rinite, parto prematuro, eczema em locais característicos, dieta sem vegetais cozidos e TCHI positivos e os relacionados à positividade do TCHI: pai alérgico, cesárea, asma e rinite no último ano.INTRODUCTION: The increase of allergic diseases has been associated to several risk factors, the detection of them and prevalences evaluations from different areas are essential. The written questionnaire standardized by "International Study of Asthma and Allergies in Childhood" - ISAAC, made possible the comparison of epidemiologic data. The aims of the present study were: to evaluate the prevalence of asthma, rhinitis and allergic eczema and related symptoms, among students from 13 to 14 years in the west area of São Paulo city, through the written questionnaire from the ISAAC study and to identify possible risk factors associated to asthma or positive skin prick test in this population. METHODS: In the period from February/2002 to October/2003 written questionnaire was applied to 3181 students. After selection by systematic samples, 528 students were submitted to skin prick test regarding the atopic diagnose and they answered a complementary questionnaire about family history and environmental conditions. The students' groups were constituted with or without asthma according the positive answer to asthma symptoms in the last 12 months, and with or without positive skin prick test at least one aeroallergen. The risk factors analysis was accomplished by univariated (qui-square or Fisher exact test) and multivariated analysis by binary logistic regression (Backward Stepwise). RESULTS: The prevalence found were: asthma 21,9%, medical diagnosis of asthma 8,9%, rhinitis 30,1%, rhinoconjunctivitis 19,8%, medical diagnosis of rhinitis 18,9%, atopic eczema 9,7% and the medical diagnosis of eczema 8,6%. There was association among asthma, rhinitis and atopic eczema in 2,3% of the adolescents. Female sex was prevalent in all of the subjects on asthma, rhinitis and atopic eczema. There was association between skin prick test and asthma (OR = 2,6) and rhinitis (OR = 1,9). In relation to asthma, the risk factors were: rhinitis symptoms in the last year (ORadjusted = 3,2); positive skin prick test (ORadjusted = 2,8); premature delivery (ORadjusted = 3,8); never to consume cooked vegetables (ORadjusted = 2,6); eczema presence in characteristic areas (ORadjusted = 2,9) and allergic mother (ORadjusted = 2,0). In relation to positive skin prick test, the risk factors were: asthma (ORadjusted = 2,3); rhinitis symptoms in the last year (ORadjusted = 1,9); allergic father (ORadjusted = 2,2) and cesarean section (ORadjusted = 1,7). CONCLUSIONS: This study showed high prevalence of asthma when compared with medical diagnosis of asthma. The prevalence of rhinoconjunctivitis was similar to medical diagnostic of rhinitis that was lower than the rhinitis prevalence in the last year. The prevalence of atopic eczema was higher than combined criteria. The female gender predominates in all positive responses regarding allergic diseases. There was association between skin prick test and asthma or rhinitis. The risk factors associated with asthma were allergic mother, rhinitis, premature delivery, eczema at characteristic areas, diet without cooked vegetables and positive skin prick test. The risk factors associated with positive skin prick test were: allergic father, cesarean section, asthma and rhinitis in the last year