RESUMO
PURPOSE OF REVIEW: The review critically assesses the different phenotypes of angioedemas associated with NSAIDs. Angioedemas exacerbated or induced by NSAIDs have high morbidity and, when they affect the larynx, can lead to death by asphyxiation. RECENT FINDINGS: Angioedema can present as a manifestation of a syndrome such as anaphylaxis or it can be a separate entity, which comprises different forms that can be diagnosed based on specific criteria. NSAIDs are the drugs most used worldwide and they are also one of the leading causes of angioedema. SUMMARY: The manuscript addresses the pathophysiology and pharmacogenetics of angioedema, reviews its classification and assesses the diagnosis and management of angioedemas exacerbated and induced by NSAIDs.
Assuntos
Angioedema/diagnóstico , Anti-Inflamatórios não Esteroides/efeitos adversos , Asma Induzida por Aspirina/diagnóstico , Hipersensibilidade a Drogas/diagnóstico , Laringe/imunologia , Angioedema/complicações , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Asma Induzida por Aspirina/complicações , Diagnóstico Diferencial , Gerenciamento Clínico , Hipersensibilidade a Drogas/complicações , Humanos , FarmacogenéticaRESUMO
The lymphoid follicles (LF) found in the false vocal cords (FVC) protect the upper air tracts, similar to the lymphoid tissue associated to the respiratory mucosas. However, studies that characterize the phenotype of cells like larynx-associated lymphoid tissue (LALT) are lacking. We analyzed the FVC of autopsied adults according to morphometric and immunohistochemical criteria and defined their possible role as LALT. We analyzed 249 FVC. Primary antibodies, CD68+ macrophages, CD20+, CD3+, and FDC+ were used for the evaluation of inflammatory cell phenotypes. In 40.6% of the cases, there was an inflammatory reaction. In 42.2% of the cases, LF were identified in the submucosa. In 17.3% of the cases, neither LF nor mononuclear cells were identified in the FVC, and these patients were from an older age group (p=0.013). A significant increase in the number of all LF cell phenotypes was observed in patients with pulmonary inflammation; the difference in both T- and B-lymphocytes was statistically significant (p=0.010). The morphological findings of LF suggest a probable participation of the FVC in the protection of the larynx and lungs, and similarity to LALT.
Assuntos
Laringe/patologia , Tecido Linfoide/patologia , Prega Vocal/patologia , Adulto , Idoso , Antígenos CD/análise , Antígenos CD20/análise , Antígenos de Diferenciação Mielomonocítica/análise , Autopsia , Linfócitos B/imunologia , Linfócitos B/patologia , Complexo CD3/análise , Células Dendríticas Foliculares/imunologia , Células Dendríticas Foliculares/patologia , Humanos , Imunofenotipagem , Inflamação/imunologia , Inflamação/patologia , Laringe/imunologia , Tecido Linfoide/imunologia , Macrófagos/imunologia , Macrófagos/patologia , Pessoa de Meia-Idade , Fenótipo , Estudos Retrospectivos , Linfócitos T/imunologia , Linfócitos T/patologia , Prega Vocal/imunologiaRESUMO
For the detection of the synthesis in vitro of anti-Mycobacterium leprae antibodies in various tissues of leprosy patients, biopsy specimens of skin lesions, nasal mucosa, larynx, lymph nodes, and bone marrow were cultured in a medium containing 14C-labeled lysine and isoleucine. The culture fluids were analyzed by crossed immunoelectrophoresis with intermediate gel and autoradiography. The results show that synthesis of anti-M. leprae antibodies occurs at the investigated sites of leprosy patients and that the specificities of the synthesized antibodies differ between sites in individual patients. It is conceivable that these antibodies play a role in the local defense against M. leprae.