Sublingual immunotherapy in the treatment of allergic asthma: a systematic review with meta-analysis

Introduction: The guidelines for the management of allergic respiratory diseases oriented towards control from medical treatment combined with measures of environmental hygiene. Immunotherapy is one of several types of treatment, applied in combination with prophylactic drugs and environmental care. The aim of the study is to evaluate the efficacy of sublingual immunotherapy (SLIT) for house dust mites (HDM) in people with allergic asthma.Methods: The study is based on a systematic review with meta-analysis of randomized clinical trials, associating sublingual immunotherapy with the treatment of allergic patients with HDM.Results: The searches were applied in PubMed, ScienceDirect and Scielo databases. Initially, 98 articles were recovered, of which only nine were eligible. Of these, eight (88.9%) were conducted in Europe and only one (11.1%) in Asia. Comparing the outcomes expiratory volume in the first minute (FEV1) and sensitivity to allergens (HDM) between SLIT and placebo groups before and after intervention, no differences were observed between the groups.Conclusions: SLIT is not evidenced significantly by meta-analysis for the treatment of allergic asthma.Keywords: Mites; asthma; rhinitis; respiratory diseas

Usefulness of the WHOQOL-BREF questionnaire in assessing the quality of life of parents of children with asthma

AbstractObjectiveTo evaluate the quality of life (QOL) of parents of children with asthma and to analyze the internal consistency of the generic QOL tool World Health Organization Quality of Life, abbreviated version (WHOQOL-BREF).MethodsWe evaluated the QOL of parents of asthmatic and healthy children aged between 8 and 16, using the generic WHOQOL-BREF questionnaire. We also evaluated the internal consistency using Cronbach's alpha (αC), in order to determine whether the tool had good validity for the target audience.ResultsThe study included 162 individuals with a mean age of 43.8±13.6 years, of which 104 were female (64.2%) and 128 were married (79.0%). When assessing the QOL, the group of parents of healthy children had higher scores than the group of parents of asthmatic children in the four areas evaluated by the questionnaire (Physical, Psychological Health, Social Relationships and Environment), indicating a better quality of life. Regarding the internal consistency of the WHOQOL-BREF, values of αC were 0.86 points for the group of parents of asthmatic children, and 0.88 for the group of parents of healthy children.ConclusionsParents of children with asthma have impaired quality of life due to their children's disease. Furthermore, the WHOQOL-BREF, even as a generic tool, showed to be practical and efficient to evaluate the quality of life of parents of asthmatic children

Efeito da claritromicina na celularidade do lavado broncoalveolar em camundongos com doença pulmonar neutrofílica induzida

OBJECTIVE: Macrolide antibiotics have anti-inflammatory properties in lung diseases. The aim of this study was to investigate the effect of clarithromycin in pulmonary cellular inflammatory response in mice. METHOD: Eight adult Swiss mice were studied. All animals received an intranasal challenge (80 µL) with dead Pseudomonas aeruginosa (1.0 x 10(12) CFU/mL). Bronchoalveolar lavage was performed 2 days later, with total cell count and differential cell analysis. The study group (n = 4) received clarithromycin treatment (50 mg/kg/day, intraperitoneal) for 5 days. Treatment was initiated 2 days before intranasal challenge. RESULTS: There was no significant difference in total cell count between the groups (mean: 2.0 x 10(6) and 1.3 x 10(6), respectively). In both groups, there was a predominance of neutrophils. However, the study group had a higher percentage of lymphocytes in the bronchoalveolar lavage than the control group (median of 19% vs 2.5%, P = .029). CONCLUSION: Clarithromycin alters the cytological pattern of bronchoalveolar lavage of Swiss mice with neutrophil pulmonary inflammation, significantly increasing the percentage of lymphocytes.OBJETIVO: Os antibióticos macrolídeos podem apresentar um efeito antiinflamatório em doenças pulmonares. O objetivo deste estudo é investigar o efeito da claritromicina na resposta inflamatória celular pulmonar em camundongos Swiss. MÉTODO: Foram utilizados 8 camundongos Swiss adultos (6-8 semanas). Todos os animais receberam um desafio intranasal (80 µL) com Pseudomonas aeruginosa mortas (1 x 10(12) UFC/mL). Dois dias após o desafio, foi realizado lavado broncoalveolar (LBA) com contagem total de células (CTC) e exame citológico diferencial. O grupo em estudo (n=4) recebeu tratamento com claritromicina (50mg/kg/dia, intraperitoneal) por 5 dias, sendo iniciado o tratamento 2 dias antes do desafio intranasal. O grupo controle (n=4) não recebeu tratamento com claritromicina. RESULTADOS: Não houve diferença significativa na CTC entre os grupos (média de 2x10(6) e 1,3x10(6), respectivamente). Em ambos os grupos, houve predomínio absoluto de neutrófilos. Contudo, o grupo tratado com claritromicina, apresentou um número percentual significativamente maior de linfócitos no LBA (mediana de 2,5% vs 19%, p=0,029). CONCLUSÃO: O uso de claritromicina altera o exame citológico diferencial do lavado bronco-alveolar de camundongos Swiss com inflamação pulmonar neutrofílica, aumentando significativamente o número percentual de linfócitos

Revisão sistemática sobre modelos experimentais de asma aguda e crônica induzidos com extrato de ácaro da poeira doméstica

Introdução: Asma é uma doença crônica das vias aéreas inferiores com elevada prevalência. Pesquisadores no mundo todo têm desenvolvido vários estudos experimentais em camundongos com o objetivo de entender melhor os mecanismos da doença e testar novas terapias. Ácaros estão presentes de forma abundante na poeira doméstica, sendo considerados os alérgenos mais comuns desencadeantes de asma alérgica. Este estudo objetiva apresentar e discutir desfechos inflamatórios no tecido pulmonar dos camundongos, verificar a diferença entre os modelos agudo e crônico de asma alérgica, tempo de exposição ao alérgeno, dose administrada e seu impacto nas pesquisas em modelos experimentais com asma. Métodos: A revisão da literatura foi realizada em quatro bancos de dados (PubMed, Scielo, Scopus e ScienceDirect). Os artigos selecionados foram avaliados primeiramente por dois pesquisadores de forma independente, de acordo com os critérios de inclusão. Resultados: Foram separados 126 artigos. Aplicados os critérios de inclusão e exclusão, somente 15 foram selecionados. São artigos que apresentaram diferentes protocolos de exposição ao HDM. A dose de HDM mais encontrada foi 100µg seguida por 25µg, e o tipo de modelo foi agudo. Conclusão: No modelo agudo, observa-se um elevado nível de inflamação das vias aéreas. Já o modelo crônico reproduz melhor as características da asma em humanos, hiper-responsividade brônquica e remodelamento das vias aéreas. Palavras-chave: Asma; ácaro; alérgeno; camundongo

Severe lower respiratory tract infection in infants and toddlers from a non-affluent population: viral etiology and co-detection as risk factors

Abstract\ud \ud \ud \ud Background\ud \ud Lower respiratory tract infection (LRTI) is a major cause of pediatric morbidity and mortality, especially among non-affluent communities. In this study we determine the impact of respiratory viruses and how viral co-detections/infections can affect clinical LRTI severity in children in a hospital setting.\ud \ud \ud \ud Methods\ud \ud Patients younger than 3 years of age admitted to a tertiary hospital in Brazil during the months of high prevalence of respiratory viruses had samples collected from nasopharyngeal aspiration. These samples were tested for 13 different respiratory viruses through real-time PCR (rt-PCR). Patients were followed during hospitalization, and clinical data and population characteristics were collected during that period and at discharge to evaluate severity markers, especially length of hospital stay and oxygen use. Univariate regression analyses identified potential risk factors and multivariate logistic regressions were used to determine the impact of specific viral detections as well as viral co-detections in relation to clinical outcomes.\ud \ud \ud \ud Results\ud \ud We analyzed 260 episodes of LRTI with a viral detection rate of 85% (n = 222). Co-detection was observed in 65% of all virus-positive episodes. The most prevalent virus was Respiratory Syncytial Virus (RSV) (54%), followed by Human Metapneumovirus (hMPV) (32%) and Human Rhinovirus (HRV) (21%). In the multivariate models, infants with co-detection of HRV + RSV stayed 4.5 extra days (p = 0.004), when compared to infants without the co-detection. The same trends were observed for the outcome of days of supplemental oxygen use.\ud \ud \ud \ud Conclusions\ud \ud Although RSV remains as the main cause of LRTI in infants our study indicates an increase in the length of hospital stay and oxygen use in infants with HRV detected by RT-PCR compared to those without HRV. Moreover, one can speculate that when HRV is detected simultaneously with RSV there is an additive effect that may be reflected in more severe clinical outcome. Also, our study identified a significant number of children infected by recently identified viruses, such as hMPV and Human Bocavirus (HBov), and this is a novel finding for poor communities from developing countries.This study was supported by Abbott Laboratórios do Brasil Ltda (academic grant), from an unrestricted investigator-generated proposal

Toxoplasmosis, interdisciplinarity and geography

This special issue of Scientia Medica, a journal that has been increasingly standing out in interdisciplinarity, brings together original articles from several areas of knowledge and different geographical origin, which have in common the approach to toxoplasmosis. Some of the articles address basic or clinical topics of universal nature, while others have a definite regional character. These latter, being of utmost importance to the respective communities, will also bring valuable information for researchers and professionals from other regions. Additionally, review articles in this issue, written by experts, will be useful to update professionals and students from different areas of life and health sciences.Este número especial da Scientia Medica, revista que vem se destacando em interdisciplinaridade, reune artigos originais de diversas áreas do conhecimento e de diferentes procedências geográficas, tendo em comum a abordagem da toxoplasmose. Alguns deles referem-se a temas básicos ou clínicos de cunho universal, enquanto outros apresentam caráter bem regional. Estes últimos, de grande importância para as respectivas comunidades, também trazem informações valiosas para pesquisadores e profissionais de outras regiões. Adicionalmente, os artigos de revisão deste número, escritos por especialistas, serão úteis para a atualização de profissionais e estudantes de diversas áreas das ciências biológicas e da saúde

Sublingual immunotherapy in the treatment of allergic asthma: a systematic review with meta-analysis

Introduction: The guidelines for the management of allergic respiratory diseases oriented towards control from medical treatment combined with measures of environmental hygiene. Immunotherapy is one of several types of treatment, applied in combination with prophylactic drugs and environmental care. The aim of the study is to evaluate the efficacy of sublingual immunotherapy (SLIT) for house dust mites (HDM) in people with allergic asthma.Methods: The study is based on a systematic review with meta-analysis of randomized clinical trials, associating sublingual immunotherapy with the treatment of allergic patients with HDM.Results: The searches were applied in PubMed, ScienceDirect and Scielo databases. Initially, 98 articles were recovered, of which only nine were eligible. Of these, eight (88.9%) were conducted in Europe and only one (11.1%) in Asia. Comparing the outcomes expiratory volume in the first minute (FEV1) and sensitivity to allergens (HDM) between SLIT and placebo groups before and after intervention, no differences were observed between the groups.Conclusions: SLIT is not evidenced significantly by meta-analysis for the treatment of allergic asthma.Keywords: Mites; asthma; rhinitis; respiratory diseas

SUBLINGUAL IMMUNOTHERAPY IN THE TREATMENT OF ALLERGIC ASTHMA: A SYSTEMATIC REVIEW WITH META-ANALYSIS

Introduction: The guidelines for the management of allergic respiratory diseases oriented towards control from medical treatment combined with measures of environmental hygiene. Immunotherapy is one of several types of treatment, applied in combination with prophylactic drugs and environmental care. The aim of the study is to evaluate the efficacy of sublingual immunotherapy (SLIT) for house dust mites (HDM) in people with allergic asthma. Methods: The study is based on a systematic review with meta-analysis of randomized clinical trials, associating sublingual immunotherapy with the treatment of allergic patients with HDM. Results: The searches were applied in PubMed, ScienceDirect and Scielo databases. Initially, 98 articles were recovered, of which only nine were eligible. Of these, eight (88.9%) were conducted in Europe and only one (11.1%) in Asia. Comparing the outcomes expiratory volume in the first minute (FEV1) and sensitivity to allergens (HDM) between SLIT and placebo groups before and after intervention, no differences were observed between the groups. Conclusions: SLIT is not evidenced significantly by meta-analysis for the treatment of allergic asthma. Keywords: Mites; asthma; rhinitis; respiratory diseas

Asthma education: main techniques adopted in intervention programs

AIMS: Asthma education is one of the outcomes that should be applied to self-management, in order to increase adherence to treatment, thus increasing the control of the disease. The objective of this review was to identify the main interventional studies for asthma education. METHODS: A review was performed to identify the major studies that have applied measures pre and post intervention for asthma education. We applied the logic of searching the databases: PubMed, Lilacs, Scopus, ScienceDirect, and Cochrane. Articles were included after complete description of the applicability of the measures, their answers and conclusions for the outcome in asthma education programs for children and adolescents. RESULTS: Twelve studies were included in the review. Among the interventions found, four were considered the most advisable for presenting satisfactory results in an enhanced understanding of the various aspects of asthma. CONCLUSIONS: Asthma education is essential both for the compliance with home care as for effective self-control of the disease. Therefore, it is strongly recommended that in order to achieve the goals of the best possible quality of life and self-control of the disease, the educational process should be individualized, continuous, progressive, dynamic and sequential. The program of asthma control needs to be not only timely, but also regular, to have a greater impact on health indicators and quality of life