RESUMO
OBJECTIVES: To compare the impact of different formulas on the occurrence of other atopic manifestations and the time of immune tolerance acquisition. STUDY DESIGN: In a 36-month prospective cohort study, the occurrence of other atopic manifestations (eczema, urticaria, asthma, and rhinoconjunctivitis) and the time of immune tolerance acquisition were comparatively evaluated in immunoglobulin E-mediated children with cow's milk allergy (CMA) treated with extensively hydrolyzed casein formula containing the probiotic L. rhamnosus GG (EHCF + LGG), rice hydrolyzed formula, soy formula, extensively hydrolyzed whey formula (EHWF), or amino acid-based formula. RESULTS: In total, 365 subjects were enrolled into the study, 73 per formula cohort. The incidence of atopic manifestations was 0.22 (Bonferroni-corrected 95% CI 0.09-0.34) in the EHCF + LGG cohort; 0.52 (0.37-0.67) in the rice hydrolyzed formula cohort; 0.58 (0.43-0.72) in the soy formula cohort; 0.51 (0.36-0.66) in the EHWF cohort; and 0.77 (0.64-0.89) in the amino acid-based formula cohort. The incidence of atopic manifestations in the rice hydrolyzed formula, soy formula, EHWF, and amino acid-based formula cohorts vs the EHCF + LGG cohort was always greater than the prespecified absolute difference of 0.25 at an alpha-level of 0.0125, with corresponding risk ratios of 2.37 (1.46-3.86, P < .001) for rice hydrolyzed formula vs EHCF + LGG; 2.62 (1.63-4.22, P < .001) for soy formula vs EHCF + LGG; 2.31 (1.42-3.77, P < .001) for EHWF vs EHCF + LGG; and 3.50 (2.23-5.49, P < .001) for amino acid-based formula vs EHCF + LGG. The 36-month immune tolerance acquisition rate was greater in the EHCF + LGG cohort. CONCLUSIONS: The use of EHCF + LGG for CMA treatment is associated with lower incidence of atopic manifestations and greater rate of immune tolerance acquisition.
Assuntos
Asma/prevenção & controle , Conjuntivite Alérgica/prevenção & controle , Dermatite Atópica/prevenção & controle , Tolerância Imunológica , Fórmulas Infantis , Hipersensibilidade a Leite/dietoterapia , Rinite Alérgica/prevenção & controle , Aminoácidos , Asma/epidemiologia , Asma/imunologia , Caseínas , Pré-Escolar , Conjuntivite Alérgica/epidemiologia , Conjuntivite Alérgica/imunologia , Dermatite Atópica/epidemiologia , Dermatite Atópica/imunologia , Feminino , Seguimentos , Humanos , Incidência , Lactente , Fórmulas Infantis/efeitos adversos , Fórmulas Infantis/química , Fórmulas Infantis/microbiologia , Lacticaseibacillus rhamnosus , Masculino , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/imunologia , Oryza , Probióticos/uso terapêutico , Estudos Prospectivos , Rinite Alérgica/epidemiologia , Rinite Alérgica/imunologia , Glycine max , Resultado do Tratamento , Soro do LeiteRESUMO
Os sintomas nasais têm impacto na vida dos pacientes com rinite alérgica. A maioria das pessoas alérgicas relata impacto negativo dos sintomas de alergia no trabalho e no desempenho escolar. Dentre todos os sintomas de alergia, o mais incômodo é a obstrução nasal, embora outros sintomas também tenham impacto na qualidade de vida dos pacientes, especialmente no sono. Os anti-histamínicos orais e corticosteroides nasais são as medicações mais frequentemente utilizadas para o tratamento de rinite, seguidos por descongestionantes orais ou intranasais. Os pacientes alérgicos frequentemente compram medicações sem prescrição médica nas farmácias, e nem sempre estão satisfeitos com o tratamento que lhes é oferecido. Os médicos devem trabalhar mais na comunicação com os pacientes alérgicos para atender às suas necessidades, abordando medo de efeitos colaterais, preocupações quanto aos sintomas de alergia e como estes interferem na qualidade de vida. Desse modo, a educação do paciente baseada em melhor comunicação pode facilitar o controle da rinite alérgica.
Nasal symptoms have an impact on the daily lives of patients with allergic rhinitis. Most allergic individuals report a negative impact of allergy symptoms on work and school performance. Among all allergy symptoms, the most bothersome is nasal congestion, although other symptoms also have an impact on patients' quality of life, especially on their sleep. Oral antihistamines and intranasal corticosteroids are the most frequently used medications for rhinitis, followed by oral or intranasal decongestants. Allergic patients frequently purchase different over-the-counter medications and sometimes are not satisfied with proposed treatments. Physicians should improve the communication with allergic patients to meet their needs, addressing fear of side effects, concerns about allergy symptoms and how they impact quality of life. Thus, educating patients through better communication may improve the control of allergic rhinitis.
Assuntos
Humanos , Pacientes , Rinite Alérgica , Rinite Alérgica/prevenção & controle , Hipersensibilidade , Médicos , Qualidade de Vida , Sinais e Sintomas , Terapêutica , Descongestionantes Nasais , Obstrução Nasal , Educação de Pacientes como Assunto , Corticosteroides , Relatório de Pesquisa , Antagonistas dos Receptores HistamínicosRESUMO
BACKGROUND: Little is known about synergistic effects of several risk factors on asthma. We developed a risk score in Puerto Rican children, and then used this score to estimate the combined effects of multiple risk factors on asthma at school age in Puerto Rican and Swedish children. METHODS: Case-control study in 609 Puerto Rican children (aged 6-14 years) and longitudinal birth cohort study of 2290 Swedish children followed up to age 12 years (The Children, Allergy, Milieu, Stockholm, Epidemiological Survey [BAMSE] Study). In both cohorts, there was data on parental asthma, sex, obesity, allergic rhinitis, and early-life second-hand smoke (SHS); data on diet and (in children ≥9 years) lifetime exposure to gun violence were also available in the Puerto Rico study. Asthma was defined as physician-diagnosed asthma and ≥1 episode of wheeze in the previous year. RESULTS: In a multivariable analysis in Puerto Rican children, male sex, parental asthma, allergic rhinitis, early-life SHS, an unhealthy diet and (in children ≥9 years) gun violence were each significantly associated with asthma. We next created a risk score using these variables (range, 0 to 5-6 in Puerto Rico and 0 to 4 in BAMSE). Compared with Puerto Rican children without any risk factors (i.e. a score of 0), Puerto Rican children with 2, 3, and at least 4 risk factors had 3.6 times (95% CI = 1.4-9.2), 10.4 times (95% CI = 4.0-27.0), and 21.6 times (95% CI = 7.2-64.9) significantly higher odds of asthma, respectively. In BAMSE, the presence of 2, 3, and at least 4 risk factors was significantly associated with 4.1 times (95% CI = 2.3-7.4), 6.3 times (95% CI = 3.0-13.3), and 17.2 times (95% CI = 4.1-73.2) increased odds of asthma at age 12 years. CONCLUSIONS: Our findings emphasize the multifactorial etiology of asthma, and suggest that concurrent eradication or reduction of several modifiable risk factors may better prevent or reduce the burden of childhood asthma.
Assuntos
Asma/etiologia , Obesidade/prevenção & controle , Rinite Alérgica/prevenção & controle , Instituições Acadêmicas/estatística & dados numéricos , Poluição por Fumaça de Tabaco/prevenção & controle , Adolescente , Asma/epidemiologia , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Obesidade/complicações , Obesidade/epidemiologia , Pais , Porto Rico/epidemiologia , Rinite Alérgica/complicações , Rinite Alérgica/epidemiologia , Fatores de Risco , Suécia/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Violência/etnologia , Violência/prevenção & controleRESUMO
BACKGROUND: The Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) assesses asthma and allergic rhinitis control in children younger than 12 years. OBJECTIVE: To validate the Brazilian Portuguese version of the CARATKids and to define the cutoff values for identifying uncontrolled disease. METHODS: Children aged 6 to 12 years with asthma and allergic rhinitis were studied (n = 102). CARATKids, childhood Asthma Control Test (cACT), total nasal symptom score (TNSS), and visual analog scale (VAS) scores were obtained at baseline and after 4 to 6 weeks. Internal consistency, test-retest reliability, responsiveness, and validity of the Brazilian CARATKids were assessed according to the Consensus-based Standards for the Selection of Health Measurements Instruments checklist. The minimal clinically important difference (MCID) was evaluated using distribution and anchor methods. Spearman correlations were used to compare CARATKids scores with external measures of control. Receiver operating characteristic curve analysis was performed to establish cutoff values. RESULTS: Fifty children completed both visits. The Cronbach α and intraclass correlation coefficient of CARATKids were 0.81 and 0.85, respectively. The Guyatt responsiveness index was -1.34, and within-patient change in clinically unstable patients (n = 31) was significant (P = .02). As for cross-sectional and longitudinal validity, correlation coefficients ranged from 0.58 to 0.77 (P < .001) and 0.30 to 0.57 (P < .05), respectively. The estimated MCID for CARATKids was 3. The optimal cutoffs (sensitivity and specificity) to exclude uncontrolled and controlled disease were 3 or less (97% and 67%) and 6 or greater (56% and 96%), respectively. CONCLUSION: CARATKids is a reliable and valid tool to assess asthma and allergic rhinitis control in Brazilian children. A score of 6 or higher on CARATKids identifies uncontrolled disease, and a score of 3 or lower excludes poor disease control.
Assuntos
Asma/diagnóstico , Testes Diagnósticos de Rotina , Rinite Alérgica/diagnóstico , Corticosteroides/uso terapêutico , Asma/epidemiologia , Asma/prevenção & controle , Brasil , Criança , Pré-Escolar , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Curva ROC , Valores de Referência , Reprodutibilidade dos Testes , Rinite Alérgica/epidemiologia , Rinite Alérgica/prevenção & controle , Autorrelato , Inquéritos e QuestionáriosRESUMO
Studies suggest that children who start solid foods early are at risk for developing food allergies. Herein, we evaluated the effects of the introduction of peanuts to the diets of children on emerging peanut allergies. Children with allergic rhinitis and asthma were enrolled in the present study and evaluated in four stages. In the first stage, a clinical history was completed for all participants. In the second stage, skin tests were conducted to detect the sensitization to peanuts. In the third stage, the parents were interviewed about the peanut-eating habits of their children. In the fourth stage, children with a convincing history of allergy or a positive peanut skin test result were subjected to an open oral food challenge (OOFC). Three hundred children in four groups were included, 58.2% of the subjects were male, and the mean age was 7.3±3.9 years. The median age of first exposure to peanuts in patients with peanut allergies was greater than that in children without peanut allergies (2 years versus 1 year; p=0.009). The multivariate analysis, including only those children subjected to the OOFC, revealed that the consumption of peanuts after the age of ≥2 years is a risk factor for developing a peanut allergy (odds ratio=8.0, 95% confidence interval 1.3-50.0, p=0.026). The results of the present study showed that the late introduction of peanuts to children increases the risk of developing a peanut allergy.
Assuntos
Arachis/efeitos adversos , Asma/epidemiologia , Dermatite Atópica/epidemiologia , Dieta/efeitos adversos , Hipersensibilidade a Amendoim/epidemiologia , Rinite Alérgica/epidemiologia , Fatores Etários , Arachis/imunologia , Asma/diagnóstico , Asma/imunologia , Asma/prevenção & controle , Criança , Pré-Escolar , Estudos Transversais , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Dermatite Atópica/prevenção & controle , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , México/epidemiologia , Análise Multivariada , Razão de Chances , Hipersensibilidade a Amendoim/diagnóstico , Hipersensibilidade a Amendoim/imunologia , Hipersensibilidade a Amendoim/prevenção & controle , Prevalência , Fatores de Proteção , Rinite Alérgica/diagnóstico , Rinite Alérgica/imunologia , Rinite Alérgica/prevenção & controle , Fatores de Risco , Testes CutâneosRESUMO
BACKGROUND: Allergen-specific immunotherapy is a proven, highly effective treatment for IgE-mediated diseases. However, ultra-rush immunotherapy is prescribed infrequently because of the perception that accelerated immunotherapy buildup leads to a higher rate of systemic reactions. OBJECTIVE: To evaluate the frequency of adverse reactions in patients with IgE-mediated diseases receiving house dust mite (HDM) ultra-rush immunotherapy. METHODS: A retrospective, observational study was conducted for patients with IgE-mediated diseases receiving allergen-specific immunotherapy. Subcutaneous immunotherapy with depigmented polymerized mites extract was administered in two refracted doses of 0.2 and 0.3 ml at first injection, and in single 0.5 ml doses in subsequent monthly injections. A 30 min observation time was required after each injection. Systemic reactions were graded using the World Allergy Organisation grading system. RESULTS: 575 patients were included. The age range was 1-83 years. Most patients had respiratory diseases (544) and 101 patients had atopic dermatitis. A total of 27 patients (4.6%) experienced 139 reactions (reactions/injections: 1.9%); 22 patients (3.8%) experienced 134 local reactions (local reactions/injections: 1.8%). Eight patients (1.3%) experienced eight systemic reactions (systemic reactions/injections: 0.1%). Five systemic reactions were grade 2 and three grade 1. Two systemic reactions were reported during buildup. There were no fatalities. CONCLUSION: Taking into account the possible bias for the retrospective design of this study we observed that immunotherapy for patients with IgE-mediated diseases using a depigmented polymerized mites extract, with an ultra-rush buildup, has similar frequency of systemic reactions than that seen in slower buildup immunotherapy in other studies. Accelerated buildup could improve patients' adherence and reduce dropout rates.