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Drug hypersensitivity reactions (DHR) in children have a significant impact on clinical practice and public health. Both under-diagnosis (due to under-reporting) and over-diagnosis (due to the overuse of the term "allergy") are potential issues. The aim of this narrative review is to describe the most recent findings of DHR in children/adolescents and gaps regarding epidemiology, antibiotic allergy, antiepileptic hypersensitivity, vaccine allergy, and severe cutaneous adverse reactions (SCAR) in this age group.

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Nas últimas décadas tem se observado um aumento expressivo na prevalência de alergia alimentar (AA), com frequência estimada em adultos de 3% a 8%, sendo ainda mais relevante quando se avalia a AA autodeclarada (variação de 3% a 35%). Entretanto, são poucos os dados publicados sobre a prevalência de AA em idosos, e no Brasil tais dados são inexistentes. O objetivo principal deste protocolo de estudo é conhecer a prevalência de AA autodeclarada em idosos (≥ 60 anos) brasileiros. Trata-se de estudo epidemiológico transversal que utiliza questionário padronizado e validado para a língua portuguesa. Entre os vários aspectos investigados, serão avaliados quais alimentos e sintomas são os mais relacionados à AA nestes indivíduos. Os dados obtidos serão transcritos a planilha Excel para realização da análise estatística. A obtenção dessas informações permitirá compará-las às existentes, assim como estabelecer planos de abordagem destes pacientes.

In recent decades, there has been a significant increase in the prevalence of food allergies, reaching an estimated frequency of 3% to 8% in adults and even higher in self-reports (from 3% to 35%). However, published data on the prevalence of food allergies among older adults are scarce, and in Brazil they are non-existent. The main objective of this study was to investigate the prevalence of self-reported food allergy among older Brazilians (≥ 60 years). This cross-sectional epidemiological study protocol involves a questionnaire that was developed, standardized, and validated in Portuguese. The investigated aspects will include the foods and symptoms most commonly associated with food allergy in this population. The data will be input into an Excel spreadsheet for statistical analysis. Obtaining this data will allow comparison of the results with previous data and help establish treatment plans for these patients.

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ABSTRACT Introduction: Systemic Mastocytosis comprises a group of neoplastic diseases characterized by clonal expansion and infiltration of mast cells into several organs. The diagnosis and treatment of this disease may be challenging for non-specialists. Objective: Make suggestions or recommendations in Systemic Mastocytosis based in a panel of Brazilian specialists. Method and results: An online expert panel with 18 multidisciplinary specialists was convened to propose recommendations on the diagnosis and treatment of Systemic Mastocytosis in Brazil. Recommendations were based on discussions of topics and multiple-choice questions and were graded using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Chart. Conclusion: Twenty-two recommendations or suggestions were proposed based on a literature review and graded according to the findings.

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INTRODUCTION: Although the prevalence of allergic diseases, including food allergies, has increased over recent decades, relevant information on this topic is still lacking, particularly in younger children living in small cities. OBJECTIVE: To investigate the prevalence of reported food allergies in preschoolers in Limoeiro/Pernambuco, Brazil. METHODS: This was a cross-sectional study with preschoolers. Parents/guardians of all preschoolers enrolled at municipal schools between March and June 2019 (total of 619) were invited to complete a screening questionnaire (total of 619). Another 151 questionnaires were applied on the streets of the town. For positive responses, a second, more detailed and validated questionnaire was completed. RESULTS: A total of 412 questionnaires were returned, of which, 47 presented a positive response to food allergies and only 29 (7.04%) identified a particular food. The most frequently reported food items were shrimp, mollusks, pork, fruit and milk. Of the 29 who identified foods, 22 responded to the detailed questionnaire, resulting in only 4 (0.97%) positive responses. Of these, two were later discarded through clinical examinations and an open oral provocation test, resulting in a final prevalence of 0.48% of confirmed food allergies. CONCLUSION: The prevalence of reported food allergies was lower than that described in previous studies. The most commonly mentioned foods were shrimp, mollusks and pork, with more reports of multiple food allergies, even in children who had never been previously exposed to these possible allergens, which highlights the relevance of perception in reported food allergy studies.

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INTRODUCTION: Systemic Mastocytosis comprises a group of neoplastic diseases characterized by clonal expansion and infiltration of mast cells into several organs. The diagnosis and treatment of this disease may be challenging for non-specialists. OBJECTIVE: Make suggestions or recommendations in Systemic Mastocytosis based in a panel of Brazilian specialists. METHOD AND RESULTS: An online expert panel with 18 multidisciplinary specialists was convened to propose recommendations on the diagnosis and treatment of Systemic Mastocytosis in Brazil. Recommendations were based on discussions of topics and multiple-choice questions and were graded using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Chart. CONCLUSION: Twenty-two recommendations or suggestions were proposed based on a literature review and graded according to the findings.

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Asthma is the most frequent chronic condition in childhood and a current concern exists about asthma in the pediatric population and its risk for severe SARS-CoV-2 infection. Although all ages can be affected, SARS-CoV-2 infection has lower clinical impact on children and adolescents than on adults. Fever, cough and shortness of breath are the most common symptoms and signs in children; wheezing has not been frequently reported. Published studies suggest that children with asthma do not appear to be disproportionately more affected by COVID-19. This hypothesis raises two issues: is asthma (and/or atopy) an independent protective factor for COVID-19? If yes, why? Explanations for this could include the lower IFN-α production, protective role of eosinophils in the airway, and antiviral and immunomodulatory proprieties of inhaled steroids. Additionally, recent evidence supports that allergic sensitization is inversely related to ACE2 expression. Obesity is a known risk factor for COVID-19 in adults. However, in the childhood asthma-obesity phenotype, the classic atopic Th2 pattern seems to predominate, which could hypothetically be a protective factor for severe SARS-CoV-2 infection in children with both conditions. Finally, the return to school activities raises concerns, as asymptomatic children could act as vectors for the spread of the disease. Although this is still a controversial topic, the identification and management of asymptomatic children is an important approach during the SARS-CoV-2 epidemic. Focus on asthma control, risk stratification, and medication adherence will be essential to allow children with asthma to return safely to school.

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INTRODUCTION: Prevalence of diseases associated with ageing is rising; among these are the rhinologic problems. Chronic rhinitis appears as one of the most common worrisome nasal disorders in this age group. At the same time, the allergic form diminishes because of the immunosenescence. OBJECTIVE: This study aimed to evaluate the effect of a corticosteroid nasal spray (mometasone furoate) over nasal patency and the severity of rhinitis and its impacts on quality of life as compared with the saline nasal spray. METHODS: This open label-trial randomized subjects ≥60y with chronic rhinitis (allergic and nonallergic rhinitis) with mometasone spray 100mcg/d and isotonic saline nasal spray or saline alone for two weeks. The primary endpoint was the improvement in nasal patency evaluated by the peak nasal inspiratory flow (PNIF). Secondary outcomes included the severity of symptoms and the quality of life assessed by a visual analogic scale (VAS) and the sinonasal outcome test (SNOT-22), respectively. RESULTS: Forty patients underwent randomization, in equal number in each group of treatment, either with allergic (AR) and nonallergic rhinitis (NAR). At week 2, the mean PNIF score was 79.5 in the corticosteroid (CE) plus saline group and 82.0 in the saline group (p = 0.37). Also, SNOT-22 and VAS were not improved with the addition of mometasone furoate. CONCLUSIONS: Treatment with mometasone furoate nasal spray plus isotonic saline is not superior to saline alone in elderly patients with rhinitis in respect of improving nasal patency, quality of life, and reducing the intensity of symptoms. TRIAL REGISTRATION: The trial is registered at the Brazilian Clinical Trials Registry (ReBEC) #RBR-498bnq. Registered 05 July 2017.

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The prevalence of coronary artery disease in young adults (<45 years of age) has been increasing steadily in recent decades. Although traditional cardiovascular risk factors can be identified in most cases, newly recognized associations are becoming progressively more relevant. The relationship between the factor V Leiden mutation and atherosclerosis has been a matter of debate due to conflicting data presented in previous studies. Presently described is the case of a previously asymptomatic 37-year-old woman with a significant family history of coronary artery disease who developed rapidly progressive angina within 1 month. After a positive non-invasive evaluation, coronary angiography demonstrated a significant obstruction in the proximal left anterior descending artery. Optical coherence tomography revealed a highly vulnerable lipid-rich atherosclerotic plaque. Coronary angioplasty followed by the implantation of 1 drug-eluting stent was successfully performed. A subsequent thrombophilia screening identified a heterozygous factor V R506Q mutation (factor V Leiden). Since there was no history of thromboembolic events, the patient was discharged using only aspirin, clopidogrel, atorvastatin, and atenolol. Further studies are needed to define the most appropriate management of young patients who manifest clinically significant atherosclerotic disease in association with hereditary thrombophilia.

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Objetivo: Abordar alguns aspectos da poluição do ar e sua influênciasobre a saúde dos indivíduos, dando maior ênfase aos efeitos sobre oaparelho respiratório.Fontes de dados: Artigos originais, revisões e consensos indexadosnos bancos de dados PubMed, Medline e SciELO nos últimos 30 anos,assim como a linha de pesquisa desenvolvida pelos autores no LaboratórioMultidisciplinar da Universidade Federal do Rio de Janeiro para aelaboração de suas Teses de Doutorado.Síntese dos dados: Crescentes evidências demonstram que aexposição a certos poluentes aéreos pode aumentar a resposta a alérgenos,fazendo com que indivíduos com doenças respiratórias (asmae/ou rinite) sejam especialmente susceptíveis ao impacto dos poluentesintra ou extradomiciliares.Comentários: O conhecimento dos mecanismos através dos quaisa poluição agrava os sintomas da rinite e da asma e sua provável relaçãocom o aumento da prevalência dessas doenças é fundamental naimplementação de medidas apropriadas de prevenção.

Objective: To discuss some aspects of the air pollution and theinfluence on the population’s health, giving more emphasis on therespiratory tract effects.Sources: Original articles, reviews and consensus indexed inPubMed, MEDLINE and SciELO databases in the last 30 years. In addition,the results of the research that was developed by the authors in theMultidisciplinary Laboratory of the Federal University of Rio de Janeirofor the development of their PhD thesis.Results: Growing evidences show that the air pollutants exposurecan increase the reaction to allergens, making individuals with respiratorydiseases (asthma and/or rhinitis) more susceptible to the impact ofindoor or outdoor pollution.Comments: Knowledge of the mechanisms through them thepollution get worse the symptoms of rhinitis and asthma and the probablerelation with the increased prevalence of these diseases is fundamentalfor appropriate prevent measures implementation.

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INTRODUÇAO: A asma é considerada a doença crônica mais comum na infância. Entretanto, há poucos estudos sobre sua prevalência em nosso meio. OBJETIVO: Avaliar prevalência e gravidade de sintomas de asma em escolares e adolescentes de Duque de Caxias (RJ). MÉTODO: Estudo transversal utilizando o questionário do International Study of Asthma and Allergies in Childhood. A amostra foi composta por alunos de 6, 7, 13 e 14 anos. RESULTADOS: Foram avaliados 4.040 alunos de 13 e 14 anos e 2.334 de 6 e 7 anos. A freqüência de sibilos nos últimos doze meses foi de 27,7 por cento entre os mais jovens e de 19 por cento entre os adolescentes (p < 0,0001). No primeiro grupo houve predomínio do sexo masculino (29,9 por cento vs 25,6 por cento, p = 0,01) e no segundo do feminino (21,9 por cento vs 15,8 por cento, p < 0,0001). Não existiram diferenças entre as faixas etárias relacionadas ao diagnóstico prévio de asma (cerca de 10 por cento). Sibilância aos exercícios físicos foi mais prevalente entre os adolescentes (21,4 por cento vs 7,8 por cento, p < 0,0001). A gravidade dos sintomas foi maior entre as adolescentes (asma grave: 6,6 por cento vs 4,4 por cento, p = 0,001), não havendo diferenças entre gêneros aos 6 e 7 anos. CONCLUSAO: A prevalência de asma em Duque de Caxias é alta, comparável à de outros municípios brasileiros e latino-americanos. Os valores são superiores aos 6 e 7 anos, quando os sintomas predominam no sexo masculino. Entre os adolescentes, a prevalência e a gravidade dos sintomas são maiores no gênero feminino, fato de observação recente e que parece representar novo comportamento epidemiológico da asma.

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Objetivo: Rever a literatura a respeito do conceito de marcha atópica, suas bases teóricas e evidências clínicas. Tal conhecimento é importante no entendimento e aplicação dos princípios de prevenção primária e secundária das doenças atópicas. Fontes dos dados: Pesquisa bibliográfica em base eletrônica de dados, limitando a busca a artigos publicados nos últimos 15 anos, referentes a pesquisas ou estudos clínicos em seres humanos e estudos experimentais, escritos em português ou inglês. Referências a livros pertinentes ao tema também foram incluídas. Foram selecionados os artigos mais citados e com metodologia e discussão melhor estruturados dentro do tema dermatite atópica / marcha atópica. Síntese dos dados: O conceito de marcha atópica é uma tentativa de se explicar a inter-relação entre as doenças atópicas, assim como as características da história natural de cada uma delas. Tal conceito baseia-se em estudos clínicos que demonstraram que, em cerca de 50% dos indivíduos predispostos, as doenças atópicas ocorrem de forma seqüencial, sendo a dermatite atópica considerada como o primeiro passo desta marcha. Conclusões: A partir de dados coletados em estudos sobre prevalência de doenças atópicas e os possíveis fatores determinantes envolvidos no desenvolvimento das mesmas, princípios de prevenção primária e secundária podem ser recomendados e implementados.

Objective: To review the literature on atopic march concept, its theoretical basis and clinicai evidences. This knowledge is important to understand and to apply the principies of primary and secondary atopic diseases prevention. Data sources: A bibliographic search was done in electronic database, limited to articles published in the last 15 years, related to human research or experimental research, written in Portuguese or English. Some book relevant references were also included. The articles about atopic dermatitis and atopic march were selected according to the number of citation and the better methodology and discussion. Data synthesis: The atopic march concept is a trial to explain the relationship between the atopic diseases and the natural evolution of each one. Clinicai researches have demons¬trated that in something about 50% of predisposed individual, the atopic diseases occurred in a sequence way, being the atopic dermatitis the first step in this marcho Conclusions: Principies of primary e secondary prevention can be recommended and implemented after review the data collected in studies about prevalence of atopic diseases and the factors involved in the development of such diseases.

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BACKGROUND: Air pollutants have been associated with the exacerbation of respiratory diseases. They may intensify the inflammatory allergic response and airways reactivity to inhaled allergens. However, it is still not clear if air pollution contributes to the increased prevalence of asthma. OBJECTIVE: To investigate if different levels of air pollution exposure can be related to differences in the prevalence of asthma. METHODS: The International Study of Asthma and Allergies in Childhood (ISAAC) protocol was used to determine and compare the prevalence of asthma among schoolchildren in 2 cities of the metropolitan region of Rio de Janeiro, Brazil, Duque de Caxias (DC) and Seropédica (SR), which have different levels of atmospheric pollution. The research involved 4,064 students aged 13 to 14 years from 49 schools in DC and 1,129 from 17 schools in SR. Air pollution was evaluated by the concentration of inhalable particulate matter (PM10). RESULTS: ISAAC's written questionnaire was answered by 4,040 students aged 13 to 14 years in DC and 1,080 in SR. Between 1998 and 2000, the PM10 annual arithmetic mean was 124 microg/m3 in DC and 35 microg/m3 in SR (acceptable level is up to 50 microg/m3). The prevalence of wheezing ever was 35.1% in DC and 29.9% in SR (P = .001), and the prevalence of wheezing in the last 12 months was 19.0% in DC and 15.0% in SR (P = .002). In DC, 14.5% of the adolescents presented 1 to 3 crises of wheezing in the last year, whereas in SR only 11.0% presented 1 to 3 crises (P = .003). CONCLUSIONS: In this study, the prevalence of asthma in adolescents was directly related to atmospheric pollution.

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Objetivos: Rever os conhecimentos sobre sinusite fúngica alérgica, fornecendo uma atualizaçao sobre o tema. Método: Utilizando como fontes de referências bibliográficas o MEDLINE e o LILACS, foi realizada uma pesquisa abrangendo os últimos dez anos. Resultados: Desde as primeiras observaçoes de McCarthy e Pepys na década de 70 muito se descobriu a respeito da história natural e da patogênese das sinusites fúngicas. A sinusite fúngica alérgica é uma forma de sinusite descrita mais recentemente. O uso da tomografia computadorizada, da ressonância nuclear magnética e da cirurgia endoscópica vêm permitindo um diagnóstico e acompanhamento mais adequados. Conclusao: A sinusite fúngica alérgica vem sendo reconhecida como uma importante causa de sinusite crônica. Novos estudos sao necessários para definir a melhor terapêutica.

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