Elevated neopterin levels in non-allergic asthma

Neopterin is synthesized by human monocyte-derived macrophages upon stimulation with interferon-gamma (IFN-gamma). Measurement of neopterin concentration is useful to monitor cell-mediated (Th1-type) immune activation. In this study, we aimed to analyze the behaviour of neopterin in long lasting asthma considering its role as a marker of the Th1 environment and to establish the distinction between patients belonging either to the allergic or the non-allergic population, particularly in the elderly where asthma is often under diagnosed. Therefore we evaluated allergic parameters such as skin prick tests, IgE and hemogram (eosinophils count), and we compared our findings with neopterin values found in an age-matched control population. A group of individuals older than 65 was selected. It included 64 asthmatic patients (mean age 72+/-5 years) and 41 healthy individuals (mean age 79+/-7 years). In our study population, 42 patients presented positive skin tests, mainly to house dust mites. All patients were clinically stable and presented an average percentage of predicted forced expiratory volume in the first second (FEV1) of 73.6+/-25.3 and predicted median expiratory flow percentage (MEF50) of 38.8+/-26.7. Blood cell counts showed statistically different mean values of eosinophils between allergic and non-allergic controls (5.42+/-4.7% versus 2.8+/-2.8%; p2.1ng/ml) presented lower mean IgE values (IgE</=336.58IU) than those with lower neopterin values (</=2.1ng/ml) who presented mean IgE values of 402.70IU. Our initial findings may lead to a better understanding of the immunoinflammatory pathways in asthma. Further studies will probably show that serum neopterin could became a useful marker for asthma classification including in elderly patients with long lasting disease

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 long-lasting 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

Substance P in Bronchial Asthma: Role in oxidant stress and in cell activation

The substance P (SP) was described in the beginning of the XXth Century, and its biological actions was recognized to have implications in neurogenic inflammation and constriction of smooth muscles. The bronchial asthma prevalence has been increasing in all developed countries. The changes associated to inflammatory chronicity can compromise the organ function reversibility. The role of neuromechanisms in the pathology of the disease has been investigated considering the hypotheses that better therapeutic approaches can be achieved. The stimulation of human cells by SP leads to their activation and to reactive oxygen species (ROS) release. Consequently a persisting inflammatory disability is observed, mainly if a decrease in the anti-oxidant defence occurs. SP is a substrate for dipeptidyl peptidase IV (DPPIV), which is a multifunctional molecule with enzymatic and proinflammatory activities. CD26 was identified as the membrane DPPIV and is considered as an activation T cell marker, as well as CD25. The aim of the present study was therefore to analyse if serum SP values in long-term asthma patients, were associated to lung function parameters, considering the role of SP in neurogenic inflammation and in bronchoconstriction. It was also proposed to analyse the relationship of SP with superoxide dismutase (SOD) and total anti-oxidation activity in serum (TAS), considering the ROS production during the inflammatory process, as well as its association to CD26 and CD25 values and their immunologic and inflammatory properties. A group of individuals older than 65 years including 64 asthmatic patients (mean age 72.4±5.1 years) and 41 healthy individuals (mean age 79.2±7.0 years) was selected. Both subgroups were submitted to clinical observation, to skin prick tests and to SP, TAS and SOD. T cell CD26 and CD25 typing was also performed. Lung function tests were done to all patients. Among patients studied, 42 presented positive skin tests, mainly to house dust mites. Asthmatic patients presented significant increased values of SP (116.2±138.9 vs 39.5±17.9 pg/ml) when compared to controls and a significant decrease of TAS (.85±.13 vs .91±.10 mM) and SOD (588.1±156.l vs 822.9±179.5 U/gHb). All patients have clinical stability and presented forced expiratory volume in one second (FEV1) values of 73.6±25.3 l/s and peak expiratory flow (PEF50) of 38.8±26.7l. The CD25 expression was significantly increased in disease (14.3±5.9 vs 22.4±7.8) while CD26 was only slightly increased (41.9±10.2 vs 39.4±11.4). These results confirm the role of SP in the respiratory pathology studied and give a contribution for a better knowledge of the network of immunoinflammatory pathway, associated to this chronic disorder. A final goal for these studies would be a better diagnostic and therapeutic approach in this pathology

Prevalence and classification of rhinitis in the elderly: a nationwide survey in Portugal

BACKGROUND: Nationwide epidemiologic data on rhinitis in the elderly do not exist. This study aimed to estimate the prevalence of rhinitis in the population aged 65 years or above in mainland Portugal and to characterize and classify rhinitis in this age group. METHODS: Cross-sectional, nationwide, population-based survey of citizens aged 65 years or above, living in mainland Portugal. Current rhinitis (CR) was defined as the presence of at least two symptoms: 'repeated sneezing and itchy nose', 'blocked nose for more than one whole hour', or 'runny nose when not having a cold or flu', either usually or in the last 12 months. Rhinitis severity was assessed using a visual analogue scale; rhinitis was classified according to ARIA. RESULTS: Data were obtained from 3678 responders (92.5% response rate). The prevalence of CR was 29.8% (95% confidence interval (CI): 28.4%-31.3%): 49.1% had mild intermittent, 7.0% mild persistent, 27.5% moderate-severe intermittent, and 16.4% moderate-severe persistent rhinitis. Only 38.6% of patients with CR had been physician diagnosed and 38.7% were under treatment for this disease in the previous year. Allergic conjunctivitis symptoms were referred by 68.6% of subjects with CR (rhinoconjunctivitis population prevalence, 20.5% (95% CI: 19.2%-21.8%)). CONCLUSIONS: Rhinitis and rhinoconjunctivitis are common but underdiagnosed and undertreated diseases in the geriatric population. This was the first nationwide epidemiological survey classifying rhinitis according to ARIA guidelines in this age group. More than 40% of old-age patients presented moderate-severe disease

A New Terminal Nonsense Mutation of the Cathepsin C Gene in a Patient With Atypical Papillon-Lefèvre Syndrome

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Allergenic Airborne Pollen in Portugal 2002-2004

Os calendários polínicos constituem instrumentos fundamentais para a orientação clínica de doentes alérgicos. Em Portugal, a sua elaboração de forma sistematizada teve início em 2002. Para tal foram colocados polinómetros volumétricos Burkard em cinco cidades do país: Porto, Coimbra, Lisboa, Évora e Portimão. O registo das contagens foi efectuado por método estandardizado. As contagens polínicas diárias expressam a concentração média por m3. Estas contagens foram objecto de análise descritiva e comparativa. O período de incidência polínica máxima decorre entre Março e Julho, sendo o pólen de Poaceae e de ervas silvestres os mais frequentemente identificados. Em Janeiro, Fevereiro e Dezembro existem níveis elevados de pólen de árvores em todo o território nacional. O Sul do país apresenta indicadores de polinização mais intensa

Estudo da Variação Intradiária das Concentrações de Pólen de Gramíneas na Atmosfera de Portugal Continental

Introdução: O pólen da família das Poaceae (gramíneas) é uma das principais fontes de aeroalergénios no mundo, particularmente na Europa Mediterrânica. Representa, por isso, um importante factor de risco de asma, rinite e/ou conjuntivite alérgica e constitui a principal causa de polinose em Portugal. Objectivo: Analisar a variação intradiária das concentrações de pólen de gramíneas na atmosfera das 5 estações de monitorização continentais da Rede Portuguesa de Aerobiologia (RPA): Porto, Coimbra, Lisboa, Évora e Portimão. Métodos: Neste estudo utilizaram -se os dados diários e horários das monitorizações de pólen de gramíneas das cinco estações de monitorização continentais da RPA, ao longo de 7 anos (2002 -2008). Resultados: Entre as localidades encontraram -se diferenças significativas, em termos de Estudo da variação intradiária das concentrações de pólen de gramíneas na atmosfera de Portugal Continental O pólen atmosférico de gramíneas constitui a principal causa de rinite, asma, conjuntivite e eczema nos indivíduos alérgicos ao pólen na área Mediterrânica1,2, nomeadamente em Portugal3,4. Dado que o pólen, particularmente o pólen de gramíneas, é um factor de risco para as doenças alérgicas respiratórias exercendo um impacto negativo sobre a qualidade de vida dos indivíduos sensibilizados, é de particular interesse, quer dos profissionais de saúde, quer do doente conhecer a sua distribuição intradiária, ou seja a variação horária das concentrações de pólen de gramíneas ao longo do dia, de modo a adequar de forma mais eficaz medidas de evicção e de intervenção terapêutica. curvas horárias. O pólen encontrou -se presente na atmosfera durante 24 horas em todas as localidades, e os valores das concentrações horárias variaram ao longo do dia e de ano para ano. As concentrações mais baixas registaram -se entre as 22 e as 6 horas e as mais elevadas, entre as 7 e as 21 horas, as quais em Évora ultrapassaram os 30 grãos de pólen/m3/hora. Em geral, registaram -se 2 picos de concentrações máximas, um de manhã (9 -10 horas) ou à tarde (12 -13 horas) e outro no final da tarde / início da noite (19 -20 horas). Conclusões: O ritmo diurno difere muito de local para local. Cada localidade tem o seu próprio padrão de variação das concentrações horárias do pólen atmosférico de gramíneas que se pode dever, quer às diferentes espécies presentes, quer às diferentes condições ambientais. O risco de exposição variou de localidade para localidade e ao longo do dia, sendo o Porto a localidade onde este é menor, enquanto Évora apresenta o maior risco

Anaphylaxis in an emergency department: a retrospective 10-year study in a tertiary hospital

Background. Anaphylaxis is a potentially fatal medical emergency. The frequency of hospital admissions for anaphylaxis seems to be increasing in the recent decades. Objective. Characterize the patients admitted for anaphylaxis to the adult emergency department (ED) of a tertiary care hospital over a 10-year period, discriminating aetiologies, clinical features and therapy administered. Methods. Retrospective, descriptive and inferential study, evaluating age, sex, Manchester triage system, suspected allergen, site of allergen exposure, comorbidities, cofactors, clinical findings and symptoms, treatment and management. Patients admitted between January 2007 and December 2016 were included. Results. Forty-three patients were enrolled: 23 males, mean age 54.3 ± 16.2 years, n = 22 had history of allergic disease. Two patients were triaged as non-urgent. The most frequently suspected causes of anaphylaxis were: drugs (33%, n = 14), Hymenoptera venoms (23%, n = 10), foods (21%, n = 9) and iodinated contrast products (12%, n = 5). Adrenaline was used in 88% of the episodes (n = 38), 55% of which (n = 21) intramuscularly. Mortality was registered in one case. At discharge, adrenaline auto-injector was prescribed in 7% (n = 3) of the patients, and Allergy and Clinical Immunology consultation (ACIC) was requested in 65% of the episodes (n = 28). Statistically significant associations (p minor 0.05) were established: a, anaphylaxis to drugs associated with a low intramuscular adrenaline use and with frequent oxygen therapy; b, anaphylaxis to food associated with intramuscular adrenaline administration; c, anaphylaxis to Hymenoptera venom associated with male sex; and d, anaphylaxis to iodinated contrasts associated with referral to ACIC and with shock. All obese patients developed shock. Conclusions. Anaphylaxis is a life-threatening condition that requires early recognition. Although most patients received adrenaline, administration was not always performed by the recommended route and only a few patients were prescribed adrenaline auto-injector.info:eu-repo/semantics/publishedVersio

Strengths of breath-triggered inhalers in asthma management

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The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing Policies

The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma.info:eu-repo/semantics/publishedVersio