Assuntos
Agonistas Adrenérgicos/provisão & distribuição , Anafilaxia/tratamento farmacológico , Epinefrina/provisão & distribuição , Saúde Global , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Avaliação das Necessidades , Agonistas Adrenérgicos/administração & dosagem , Anafilaxia/diagnóstico , Anafilaxia/imunologia , Anafilaxia/mortalidade , Epinefrina/administração & dosagem , Humanos , InjeçõesRESUMO
Chronic urticaria (CU) has a major effect on patients' quality of life. While there have been progressive advances regarding its pathogenesis and treatment, much remains to be done. Registries of other chronic non-communicable diseases have shown many benefits, such as additional basic knowledge and management approaches to diabetes mellitus. Standards of care as well as diagnostic approaches can be elaborated and compared from different sites, using validated instruments. Registries in allergic diseases are also becoming well recognized, and the first registry on CU, accessible from SLaai's webpage, includes parameters for identification, evaluation and management. In our vision, informatics strategies have the potential to improve care for chronic illnesses such as CU. The registry represents a valid instrument from which to obtain a sufficient sample size for epidemiological studies and/or clinical research planning, including feasibility and potential enrollment. It can also provide invaluable data for adapting guidelines to local populations, as well as diagnostic approaches and cost-effective interventions in the context of organizational efforts to improve patient care.
RESUMO
Biomarkers useful for the evaluation and management of patients with chronic spontaneous urticaria (CSU) are not currently available. A review of various clinical and laboratory markers that have been studied to assess their value for determining the severity or predicting the evolution of disease in adult patients with CSU was carried out. A search of the medical literature on PubMed and MEDLINE including the terms urticaria, chronic urticaria, chronic idiopathic urticaria, CSU, severity, prognosis and treatment was performed. Based on our review of the literature, among the clinical markers studied, higher age at onset, being female, long disease duration and aspirin/NSAID hypersensitivity may be linked to both severe CSU and a long time to spontaneous remission. In addition, a positive autologous serum skin test (ASST) may be associated with severe CSU, and comorbidity of inducible urticaria and concomitant recurrent angio-oedema may be linked to longer CSU duration. Potential biomarkers of CSU severity and/or duration include basophil numbers and susceptibility to activation, inflammatory markers, markers of activation of the extrinsic coagulation pathway, immunoglobulin E and vitamin D. Although the described markers are promising, further studies on representative and well-characterized patient populations are needed to determine the value of these clinical and biological markers for predicting the severity and course of disease in patients with CSU.
Assuntos
Indução de Remissão , Urticária/patologia , Adulto , Fatores Etários , Doença Crônica , Feminino , Humanos , Masculino , Adulto JovemRESUMO
The global allergy community strongly believes that the 11th revision of the International Classification of Diseases (ICD-11) offers a unique opportunity to improve the classification and coding of hypersensitivity/allergic diseases via inclusion of a specific chapter dedicated to this disease area to facilitate epidemiological studies, as well as to evaluate the true size of the allergy epidemic. In this context, an international collaboration has decided to revise the classification of hypersensitivity/allergic diseases and to validate it for ICD-11 by crowdsourcing the allergist community. After careful comparison between ICD-10 and 11 beta phase linearization codes, we identified gaps and trade-offs allowing us to construct a classification proposal, which was sent to the European Academy of Allergy and Clinical Immunology (EAACI) sections, interest groups, executive committee as well as the World Allergy Organization (WAO), and American Academy of Allergy Asthma and Immunology (AAAAI) leaderships. The crowdsourcing process produced comments from 50 of 171 members contacted by e-mail. The classification proposal has also been discussed at face-to-face meetings with experts of EAACI sections and interest groups and presented in a number of business meetings during the 2014 EAACI annual congress in Copenhagen. As a result, a high-level complex structure of classification for hypersensitivity/allergic diseases has been constructed. The model proposed has been presented to the WHO groups in charge of the ICD revision. The international collaboration of allergy experts appreciates bilateral discussion and aims to get endorsement of their proposals for the final ICD-11.
Assuntos
Alergia e Imunologia , Consenso , Crowdsourcing , Hipersensibilidade/classificação , Classificação Internacional de Doenças , HumanosRESUMO
BACKGROUND: A subset of patients with chronic spontaneous urticaria (CSU) experience disease exacerbations after receiving non-steroidal anti-inflammatory drugs (NSAIDs). This condition has been designated as Aspirin-Exacerbated Cutaneous Disease (AECD). OBJECTIVES: The purpose of this study was twofold: (i) Investigate the demographic and clinical features of patients affected by AECD; (ii) To compare patients with AECD and NSAID-tolerant CSU patients for those characteristics. METHODS: Patients with AECD and a group of unselected CSU patients tolerant to NSAIDs were studied. Demographic and clinical data were obtained by direct questioning and physical examination. Laboratory investigations and allergen skin prick tests were performed only in selected patients, as guided by the medical history. RESULTS: Of 423 CSU patients admitted in the clinics, 52 (12.2%) had AECD. Compared with NSAID-tolerant CSU patients, AECD patients had significantly longer disease duration (57.7 ± 118.4 vs. 24.4 ± 36.6 months, P < 0.05), higher prevalence of angio-oedema (72.7 vs. 30.9%, P < 0.05) and atopy (83.8% vs. 58.4%, P < 0.05) and more frequent involvement of the face and upper respiratory tract (54.5% vs. 29.6%, P < 0.05). CONCLUSIONS: AECD is a distinct phenotype that should be considered for inclusion as a separate subtype of chronic spontaneous urticaria.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Progressão da Doença , Toxidermias/etiologia , Urticária/induzido quimicamente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioedema/induzido quimicamente , Criança , Pré-Escolar , Doença Crônica , Dermatoses Faciais/induzido quimicamente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Doenças Respiratórias/induzido quimicamente , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Urticaria is a common cause for consultation in general and specialised medical practices. There is scarce information on the characteristics of patients suffering acute urticaria in Latin America. OBJECTIVES: To investigate demographic and clinical features of patients with acute urticaria attending two allergy clinics in Caracas, Venezuela. METHODS: A prospective study of all new patients who consulted during a three-year period because of acute urticaria. Information on age, gender, symptom duration, previous medical history, body distribution of wheals and angio-oedema, laboratory investigations, skin prick tests, and pharmacological treatment, was collected. Patients were classified according to their age as children/adolescents and adults. RESULTS: Two hundred and forty eight patients (177 adults and 71 children) were studied. Acute urticaria was more frequent in middle-aged atopic female patients. Lesions more often involved upper and lower limbs and head, and 31% of patients exhibited generalised urticaria. Laboratory investigations, performed only in selected cases, did not contribute to the final diagnosis. Most frequent subtypes of acute urticaria were spontaneous, dermographic, papular, and drug-induced urticaria. Most patients were treated with non-sedating antihistamines, with increased use of cetirizine and levocetirizine in children, while 5.6% of children and 20.3% of adults required the addition of short courses of systemic corticosteroids. CONCLUSIONS: Acute urticaria is a frequent cause of consultation for allergists, affecting more often middle-aged female atopic patients. The use of extensive complementary tests does not seem to be cost-effective for this clinical condition. Spontaneous, dermographic, papular and drug-induced urticaria are the most common subtypes.
Assuntos
Urticária/epidemiologia , Urticária/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Venezuela/epidemiologia , Adulto JovemRESUMO
Chronic urticaria (CU) is one of the most puzzling clinical entities confronted by the medical profession. It is a common motive for consultation, and in a sizable proportion of patients no identifiable cause is evident. Since there are relatively few publications regarding CU in developing countries, we performed a prospective 3-year study on the demographic and clinical features of patients with CU. Four hundred and twenty-three subjects were studied, 52 children and 371 adults, 295 females (69.7%), with a mean age of 38.4 ± 17.8 years. More often, wheals and angioedema (AE) were present on the head, upper and lower limbs and the trunk. AE was present in 162 patients (38.4%). The most frequent subtypes were chronic spontaneous urticaria, aspirin-exacerbated cutaneous disease, dermographic urticaria, and combinations of various subtypes. A better understanding of the characteristics of patients suffering CU is helpful for clinicians dealing with this ailment, and provides guidance for new investigations on its pathogenesis, which will hopefully result in a better management of this vexing condition.
Assuntos
Urticária/classificação , Adolescente , Criança , Pré-Escolar , Doença Crônica , Feminino , Humanos , Hipersensibilidade , Masculino , Estudos Prospectivos , Urticária/etiologiaRESUMO
Nonsedating antihistamines are the first-choice treatment for all forms of urticaria. In patients with recalcitrant urticaria who do not respond to conventional doses of antihistamines, current guidelines recommend increasing doses by up to 4 times in order to obtain better control of the disease. Although few studies have been conducted, there are convincing data from controlled trials for cetirizine, levocetirizine, and desloratadine that support the use of increased doses of such drugs in unresponsive patients. The use of higher doses of antihistamines has not been associated with increased adverse effects or somnolence. More studies with other second-generation antihistamines are required in order to improve the treatment of patients with severe, recalcitrant urticaria.
Assuntos
Antagonistas não Sedativos dos Receptores H1 da Histamina/administração & dosagem , Urticária/tratamento farmacológico , Doença Crônica , HumanosRESUMO
In this paper, the transfer of IgE-mediated food allergy by means of autologous stem cell transplantation in a 24-years old male patient is reported.
Assuntos
Hipersensibilidade Alimentar/etiologia , Hipersensibilidade Alimentar/imunologia , Doença de Hodgkin/terapia , Imunoglobulina E/imunologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/imunologia , Transplante de Células-Tronco/efeitos adversos , Adulto , Animais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Hipersensibilidade Alimentar/diagnóstico , Doença de Hodgkin/cirurgia , Humanos , Imunoglobulina E/sangue , Masculino , Estadiamento de Neoplasias , Palaemonidae , Complicações Pós-Operatórias/diagnóstico , Indução de Remissão , Frutos do Mar/efeitos adversos , Testes Cutâneos , Transplante Autólogo/efeitos adversosRESUMO
BACKGROUND: An increased prevalence of atopy has been observed in patients with intolerance of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). OBJECTIVE: To investigate total and mite-specific immunoglobulin (Ig) E in serum from patients with hypersensitivity to NSAIDs and healthy controls. METHODS: Patients who reacted to 2 or more chemically unrelated NSAIDs with urticaria and angioedema, confirmed by a double-blinded provocation test with aspirin, were skin tested with inhalant allergens. Total and specific IgE to Dermatophagoides pteronyssinus (Dp) and Blomia tropicalis (Bt) in the serum was quantified by enzyme-linked immunosorbent assay (ELISA) in patients and a control group of healthy blood donors. RESULTS: One-hundred-and-fourteen patients and 74 controls were studied. Skin tests were positive in 95 patients (83.3%). Total mean IgE levels were 107.1 (91.3) IU/mL in controls and 161.0 (150.8) IU/mL in patients (P = .006). Mean (SD) levels of IgE to Dp were 0.210 (0.17) optical density (OD) units in controls and 0.473 (0.65) OD units in patients (P = .001). Levels of specific IgE to Bt were 0.230 (0.20) OD units in controls and 0.522 (0.8) OD units in patients (P =.0001). Positive ELISA results for IgE to Dp were found for 29.6% of controls and 70.4% of patients (P =.0001); the corresponding percentages for Bt were 32.4% of controls and 67.6 % of patients (P = .0001). CONCLUSIONS: Cross-reactive patients with NSAID-induced urticaria and angioedema exhibit an increased prevalence of sensitization to Dp and Bt and increased total serum IgE. Further research is necessary to determine the reasons for this association.
Assuntos
Antígenos de Dermatophagoides/imunologia , Aspirina/efeitos adversos , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade Imediata/epidemiologia , Adulto , Angioedema , Animais , Comorbidade , Reações Cruzadas , Dermatophagoides pteronyssinus/imunologia , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/fisiopatologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Hipersensibilidade Imediata/diagnóstico , Hipersensibilidade Imediata/imunologia , Hipersensibilidade Imediata/fisiopatologia , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Masculino , Prevalência , Testes Cutâneos , UrticáriaRESUMO
BACKGROUND: Cysteinyl leukotriene production seems to be dysregulated in patients with hypersensitivity to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). However, the underlying pathogenic mechanisms of these reactions are poorly understood. Previous studies have suggested a role for the A-444C polymorphism on the leukotriene C4 synthase gene (LTC4S) in aspirin-induced urticaria (AIU), but the results are controversial. OBJECTIVE: To evaluate in a case-control study whether the A-444C polymorphism in the promoter region of LTC4S is associated with AIU and atopic phenotypes in a Venezuelan population. METHODS: One hundred ten patients with AIU and 165 nonallergic controls were included. AIU was diagnosed by clinical history and confirmed by double-blind placebo-controlled oral provocation tests with NSAIDs. Genotyping of A-444C was performed by real-time polymerase chain reaction using Taqman probes. Atopy was defined as a positive skin test result to any of the 25 aeroallergens tested. Total and mite-specific immunoglobulin (Ig) E levels in serum were quantified using an enzyme-linked immunosorbent assay RESULTS: A-444C was associated with AIU. The C allele was more frequent in patients with the cutaneous pattern of AIU and in patients with low skin reactivity to histamine. There was no association between A-444C and asthma, atopy, or total IgE levels. CONCLUSION: The C allele of the A-444C polymorphism is a risk factor for AIU in our population and could be a genetic marker for this phenotype. Furthermore, this single-nucleotide polymorphism is mainly associated with the cutaneous clinical pattern and with low skin response to histamine.
Assuntos
Aspirina/efeitos adversos , Glutationa Transferase/genética , Urticária/genética , Adolescente , Adulto , Aspirina/imunologia , Estudos de Casos e Controles , Criança , DNA/química , DNA/genética , Método Duplo-Cego , Feminino , Genótipo , Glutationa Transferase/imunologia , Humanos , Imunoglobulina E/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo de Nucleotídeo Único , Testes Cutâneos , Urticária/induzido quimicamente , Urticária/enzimologia , Urticária/imunologia , Adulto JovemAssuntos
Antígenos de Dermatophagoides/efeitos adversos , Asma/imunologia , Dermatophagoides pteronyssinus/imunologia , Proteínas de Insetos/efeitos adversos , Rinite/imunologia , Adolescente , Adulto , Alérgenos/administração & dosagem , Alérgenos/efeitos adversos , Animais , Antígenos de Dermatophagoides/administração & dosagem , Testes de Provocação Brônquica , Criança , Pré-Escolar , Exposição Ambiental/efeitos adversos , Humanos , Imunização , Proteínas de Insetos/administração & dosagem , Fatores de Risco , Testes CutâneosRESUMO
Based on the clinical picture and triggering drugs, allergic and pseudoallergic adverse reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) can be classified in four patterns : respiratory, cutaneous, mixed and systemic. This categorization is useful for the purpose of describing patient populations included in studies about NSAID adverse reactions as well as for the routine management of the patient in the clinical setting.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Angioedema/induzido quimicamente , Asma/induzido quimicamente , Humanos , Respiração/efeitos dos fármacos , Urticária/induzido quimicamenteRESUMO
BACKGROUND: The safety of new anti-inflammatory drugs in patients intolerant to classic cyclooxygenase (COX) inhibitors with urticaria and angioedema has not been determined. OBJECTIVES: To investigate the clinical tolerance to COX-2 inhibitors in patients with cutaneous symptoms attributable to classic nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS: Patients with urticaria or angioedema triggered by NSAIDs were challenged with COX-2 inhibitors by the single-blinded, placebo-controlled oral method. RESULTS: One hundred ten NSAID-sensitive patients were submitted to 184 oral challenges with COX-2 inhibitors. Eighty-two patients (74.5%) were cross-reactors and 28 patients (25.4%) were single reactors. Reaction rates for COX-2 inhibitors were 21.3% for nimesulide, 17.3% for meloxicam, 33.3% for celecoxib, and 3.0% for rofecoxib. CONCLUSIONS: Some COX-2 inhibitors, such as rofecoxib, are relatively safe in NSAID-sensitive patients with urticaria or angioedema. However, the tolerance profile varies with the drug, which might be related to a differential selectivity of the drug for COX-1 and COX-2. COX-1 inhibition would represent a major mechanism for cutaneous adverse reactions to NSAIDs. Controlled oral provocation with new NSAIDs is useful for the proper management of patients sensitive to classic NSAIDs requiring analgesic and anti-inflammatory treatment.
Assuntos
Inibidores de Ciclo-Oxigenase/efeitos adversos , Hipersensibilidade/etiologia , Administração Oral , Adolescente , Adulto , Idoso , Criança , Inibidores de Ciclo-Oxigenase/administração & dosagem , Tolerância a Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pele/imunologiaRESUMO
Epidemiological data for drug reactions in pediatric medical literature as well as in specialized periodicals are scarce. A relationship between nonsteroidal antiinflammatory drugs (NSAIDs), facial angioedema and atopic status has been described in adults. A 10-year retrospective random review of 1,007 charts of atopic children (60.9% male) attending an allergy clinic for management of asthma and/or rhinitis was carried out. Careful attention was given to the written history of NSAID facial angioedema reactions (41 out of 1007, 4.07%) and atopy was confirmed if the patient had a family history and at least one positive skin prick test (>3 mm wheal compared to glycerosaline control) to aeroallergens. Telephone recall was performed when available. Patients were classified into four age groups as follows: a) 0-5 years old; b) 6-10 years old; c) 11-15 years old; and d) 16-21 years old. NSAID facial angioedema rates were as follows: group a 10/493 (2.0%), group b 14/361 (3.8%), group c 10/121 (8.2%), and group d 7/32 (21.8%). Aspirin was the most commonly reported NSAID, and less common were pyrazolones and ibuprofen. Of the 41 patient with chart-reported reactions, 27 (66%) could be contacted by telephone. Of these, 17 patients confirmed the facial angioedema NSAID reaction occurring once or more due to inadvertent exposure. No reactions were reported in the remaining 10 patients since no other NSAID, except acetaminophen, had been used for fever or pain. In conclusion, our data show the age dependency of these reactions and its rather frequent occurrence in such selected pediatric atopic populations. Since NSAIDs are used more frequently in younger children, exposure would not be a plausible explanation for these observations.
Assuntos
Angioedema/induzido quimicamente , Anti-Inflamatórios não Esteroides/efeitos adversos , Adolescente , Adulto , Criança , Pré-Escolar , Face , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
BACKGROUND: It has been proposed that Trichophyton infection is associated with atopy and allergy. OBJECTIVES: Our purpose was (1) to confirm whether atopy predisposes to chronic dermatophytosis and (2) to investigate whether Trichophyton infection induces atopic disease. METHODS: Patients attending dermatology clinics and suspected of having dermatomycosis underwent in a prospective manner fungal culture and Trichophyton and inhalant skin tests, and blood serum was collected for total IgE and Trichophyton radioallergosorbent testing. Personal and family history of atopic diseases was also investigated. RESULTS: According to mycologic culture, atopic history, and inhalant skin test results, patients were classified into 4 groups: (1) atopy plus mycosis (n = 28), (2) atopy (n = 26), (3) mycosis (n = 35), and (4) no atopy, no mycosis (n = 33). Patients with active mycosis (groups 1 and 3) demonstrated significantly increased positivity of Trichophyton skin tests compared with patients without fungal infection (groups 2 and 4), regardless of their atopic status, whereas atopic patients (those in groups 1 and 2) had significantly increased levels of total serum IgE compared with nonatopic subjects. Trichophytosis was not more prevalent in atopic than in nonatopic subjects, and atopic diseases were not more frequent in culture-positive than in culture-negative patients. CONCLUSIONS: Our results indicate that Trichophyton -specific IgE is observed in patients with trichophytosis regardless of atopy.
Assuntos
Poluição do Ar/análise , Dermatomicoses/imunologia , Imunoglobulina E/imunologia , Trichophyton/imunologia , Adolescente , Adulto , Anticorpos Antifúngicos/sangue , Especificidade de Anticorpos , Feminino , Humanos , Hipersensibilidade Imediata/diagnóstico , Hipersensibilidade Imediata/epidemiologia , Hipersensibilidade Imediata/imunologia , Imunoglobulina E/sangue , Masculino , Prevalência , Teste de Radioalergoadsorção , Sensibilidade e Especificidade , Testes CutâneosRESUMO
BACKGROUND: There is scarce information in the literature about a possible association between atopy and certain clinical manifestations of NSAID sensitivity. OBJECTIVES: (1) To evaluate the prevalence of atopy in patients proved to be sensitive to cyclooxygenase inhibitors. (2) To assess cross-reactivity to two alternative NSAIDs, paracetamol (acetaminophen) and nimesulide. METHODS: NSAID-sensitive patients attending an allergy clinic and unselected controls were prick tested with inhalant allergens. Oral challenges with NSAIDs were carried out by the single-blinded (SBOC) method. Clinical data about personal and family history of allergic and atopic diseases were obtained by a careful review of the medical records and by direct questioning by experienced allergists. RESULTS: Fifty patients had positive SBOCs to the suspected NSAID and only these were studied. A personal history of atopic diseases was present in 41 patients (82%) and 7 controls (14.5%), and a family history in 24 patients (48%) and 6 controls (12.5%). Prick skin tests with aeroallergens were positive in 39 of 45 patients tested (86.6%) and in 14 of 48 controls (29.1%), (P = .0001). Skin test positivity rates were higher in patients with cutaneous challenge reactions who responded to only one NSAID (single reactors) in comparison to cross-reactors (P = .04). The most frequent clinical manifestations of NSAID sensitivity were (1) cutaneous (angioedema, urticaria) in 34 patients, (2) blended (cutaneous plus respiratory) in 12, (3) respiratory in 3, and (4) anaphylactoid in 1. Aspirin, pyrazolone, paracetamol, and ibuprofen were the drugs more frequently implicated in these reactions. Cross-sensitivity with paracetamol and nimesulide were 32% and 25%, respectively. CONCLUSIONS: The prevalence of atopy is increased in challenge-proven NSAID-intolerant patients. The atopic condition may represent an important risk factor for developing reactions to these drugs. Paracetamol and nimesulide are relatively safe alternative choices in those patients, although their use still carries some risk of unwanted reactions.