Introdução: Estudos demonstram que as alergias alimentares influenciam negativamente a qualidade de vida dos pacientes e familiares. Embora este tema seja importante, ainda há poucos estudos na literatura internacional e não existe estudos nacionais qualitativos em alergia alimentar. Objetivos: Compreender as percepções de familiares de crianças e adolescentes com alergia às proteínas do leite de vaca em relação à doença e seu tratamento. Trajetória Metodológica: Trata-se de um estudo qualitativo, em que foram entrevistados os familiares diretamente responsáveis pelos cuidados de crianças e adolescentes com alergia à proteína do leite de vaca confirmada, acompanhados no ambulatório de alergia alimentar da Unidade de Alergia e Imunologia do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo há, pelo menos, um ano. As entrevistas foram realizadas em condições de privacidade e foram propostas duas questões: \"Fale sobre a sua experiência com o tratamento da alergia à proteína do leite de vaca\" e \"O que o(a) Sr(a) espera do tratamento da doença do seu(sua) filho(a)?\". Os dados foram gravados, transcritos, avaliados utilizando-se o método de análise de conteúdo, sendo constituídas categorias e subcategorias a partir dos discursos. Resultados: Foram realizadas nove entrevistas, a maioria com mães dos pacientes. Surgiram três categorias com subcategorias: A. Tratamento e educação do paciente e familiares (experiências vividas, base do tratamento e como lidar com a doença), B. Resolução da doença (expectativa e melhora gradativa), C. Qualidade de vida (inclusão social, cotidiano familiar e custo dos alimentos). Os familiares vivenciaram dificuldades durante o início do tratamento, mas revelaram que as orientações fornecidas no seguimento tornaram as adaptações à doença mais fáceis. Eles também compararam a alergia à proteína do leite de vaca com outras doenças crônicas e destacaram a importância do acompanhamento de seus filhos na instituição para realizar um controle adequado. Além disso, enfatizaram que o seguimento também é importante para os profissionais de saúde, que aprimoram os conhecimentos sobre a doença. Os familiares comentaram sobre as dificuldades em obter a colaboração de outros membros da família em relação à dieta de exclusão, suas experiências frente a uma reação alérgica, dúvidas quanto ao tratamento e lacunas do conhecimento sobre a doença entre outros médicos e na população em geral. Alguns deles acreditavam que não havia tratamento para a alergia à proteína do leite de vaca, porque não existiam medicamentos ou vacinas, mas mantinham a esperança da descoberta de uma cura. A maioria dos familiares estava satisfeita com a melhora gradativa dos seus filhos, a qual era percebida pela redução da gravidade dos sintomas e tolerância a traços de leite. Além disso, eles comentaram sobre os esforços em proporcionar uma vida normal para seus filhos, as mudanças em suas vidas e a dificuldade em comprar alimentos especiais. Conclusão: O estudo qualitativo permitiu entender como os familiares enfrentam a doença, suas histórias e as expectativas quanto ao tratamento. Os familiares de crianças e adolescentes com alergia à proteína do leite de vaca sentem um grande impacto da doença e necessitam de apoio e orientação dos profissionais de saúde / Introduction: Some studies have shown that food allergies negatively influence on patient\'s and caregivers\' quality of life. Although this theme is important, there aren\'t many studies in the international literature and there is no national qualitative study in food allergy. Objectives: To understand the perceptions of caregivers of patients with cow\'s milk allergy regarding the disease and its treatment. Methods: Qualitative study in which caregivers of children and adolescents with confirmed cow\'s milk allergy followed, at least, for one year, were interviewed. They were recruited from the outpatient clinic of the Allergy and Immunology Division from Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. The interviews were conducted under conditions of privacy and two opened questions were proposed: \"Tell me about your experience with cow\'s milk allergy treatment\" and \"What do you expect from your child\'s disease treatment?\". Data were audio-recorded, transcribed, analyzed using the content analysis method and categories and subcategories were generated based on their speeches. Results: Nine interviews were done, mostly with mothers of the patients. Three categories with subcategories emerged: A. Treatment and education of the patient and their caregivers (life experiences, bases of treatment, coping with the disease), B. Resolution of the disease (hope, gradual improvement), C. Quality of life (social inclusion, family daily activities, costs of dietary treatment). Caregivers experienced difficulties during the initial treatment but pointed out that the guidance given during follow-up made the adjustments easier. They also compared the cow\'s milk allergy with other chronic diseases and highlighted the importance of their children follow-up in this institution for adequate control of them. Moreover, they emphasized that the follow-up is also important for medical staff, for knowledge improvement about the disease. Family members commented on the difficulties about lack of cooperation from other family members regarding the restrictive diet, their experience coping with the allergic reaction, doubts about the treatment and gaps on knowledge about the disease by other physicians and people. Some of them believed that there is no treatment for the disease, because there are no drugs or vaccines, but they were waiting for cure. The majority of relatives were satisfied with the gradual improvement of patients observed by reduction on the severity of symptoms and tolerance of milk traces within foods. In addition, they commented on the efforts to give a normal life for their children, the changes in their daily lives and the difficulty to buy special products. Conclusion: This qualitative study allowed us to understand how families cope with the disease, their histories and expectations about the treatment. The relatives of children and adolescents with cow\'s milk allergy feel a great burden of the disease and need support and orientation from health professionals

Esofagite Eosinofílica é uma doença inflamatória crônica restrita ao esôfago e imune mediada por antígenos. Sua prevalência descrita varia desde 0,4%, numa população geral, até 15% em pacientes com sintomas de disfagia. Já se conhece sua associação com doenças atópicas, anafilaxia e alergia alimentar, sendo o leite de vaca um dos principais alimentos envolvidos. Existem relatos recentes de casos em que pacientes foram diagnosticados com esofagite eosinofílica após serem submetidos à imunoterapia oral com o alimento causador de sua alergia alimentar mediada por IgE. Porém, em nenhum destes casos foi avaliado previamente se os mesmos pacientes já não apresentavam eosinofilia esofágica latente e/ou sintomas subjetivos sugestivos da doença. Considerando que, atualmente, um dos tratamentos mais promissores para alergia alimentar é a imunoterapia oral, justificou-se a necessidade de entender se esofagite eosinofílica seria de fato uma complicação do tratamento, ou se seria uma condição pré ou coexistente. Portanto, o objetivo deste trabalho foi avaliar a frequência de eosinofilia esofágica em pacientes com anafilaxia à proteína do leite de vaca. Foram analisados 89 pacientes matriculados no ambulatório de alergia alimentar do HC-FMUSP, com mediana de idade de 8 anos e que apresentavam anafilaxia ao leite de vaca. Todos foram submetidos à endoscopia digestiva alta com biópsias de esôfago, estomago e duodeno. Dados demográficos, comorbidades atópicas, uso de medicações e sintomas gastrointestinais foram analisados e comparados. A frequência de eosinofilia esofágica foi de 38,2% (34 de 89 pacientes). Em 15 dos 34 pacientes com eosinofilia esofágica, foi completada a investigação para esofagite eosinofílica com uso de inibidor de bomba de prótons em dose plena por 8 semanas antes de uma segunda endoscopia. Identificou-se, portanto, cinco pacientes (7,1%) com eosinofilia esofágica responsiva a inibidor de bomba de prótons e 10 pacientes com esofagite eosinofílica (14,2%). No grupo total de pacientes com eosinofilia esofágica (n=34) encontrou-se 29,4% de pacientes com quadro clínico gastrointestinal ausente; 23,5% oligossintomáticos, e apenas 47% com sintomas sugestivos de disfunção esofágica e, destes últimos, nem todos apresentavam sintomas esofágicos persistentes. Pode-se concluir que a frequência de esofagite eosinofílica descrita no grupo estudado foi significativamente superior à estimada na população geral e uma das mais altas descritas em grupos de pacientes com fatores de risco específicos. Também foi observada uma grande parcela de pacientes com eosinofilia esofágica, sendo muitos assintomáticos ou oligossintomáticos, surgindo o questionamento se esta não seria uma doença latente, de início precoce, insidioso e não relacionada diretamente como complicação de tratamentos atuais / Eosinophilic esophagitis is a chronic inflammatory disease, which occurs in the esophagus and is immune mediated by antigens. Its observed prevalence varies between 0.4% in the general population to 15% in patients with dysphagia. Its association with atopic diseases, anaphylaxis and food allergy has already been recognized. Cow\'s milk is one of the main food sources involved. There are recent reports of cases in which patients were diagnosed with eosinophilic esophagitis after being submitted to oral immunotherapy with the food that causes the IgE mediated allergy. However, in none of these cases was it previously determined if the same patients did not already present latent esophageal eosinophilia and/or subjective symptoms suggestive of the disease. Considering that, currently, one of the most promising treatment for food allergy is oral immunotherapy, the need to understand if eosinophilic esophagitis could be a treatment complication, or if it is a coexistent or preexistent condition, is justified. Therefore, the objective of this study was to evaluate esophageal eosinophilia frequency in patients with anaphylaxis to cow\'s milk protein. We analyzed eighty-nine patients registered in the Food Allergy Unit of the HCFMUSP, with a median age of 8 years, who presented cow\'s milk anaphylaxis. All of them were submitted to digestive endoscopy as well as esophagus, stomach, and duodenum biopsies. We also analyzed and compared demographic data, atopic comorbidities, use of medication, and gastrointestinal symptoms. The frequency of esophageal eosinophilia was 38.2% (34 of 89 patients). In 15 of the 34 patients with esophageal eosinophilia, full investigation for the disease was carried out using a proton pump inhibitor at full dose for eight weeks prior to a second endoscopy. From this, five patients (7.1%) had the proton pump inhibitor-responsive esophageal eosinophilia phenotype, and ten patients were diagnosed with eosinophilic esophagitis (14.2%). In the whole group of patients with esophageal eosinophilia (n = 34), it was found 29.4% of patients with an absent gastrointestinal clinical condition, 23.5% were oligosymptomatic, and only 47% had symptoms suggestive of esophagic dysfunction. Of these, not all presented persistent esophagic symptoms. It is possible to conclude that the frequency of eosinophilic esophagitis observed in this group was significantly higher than the estimated for the general population, and one of the highest observed in groups of patients with specific risk factors. A large portion of patients with esophageal eosinophilia were oligosymptomatic or asymptomatic, raising the question if this would not in fact be a latent disease, with a precocious beginning, insidious and not directly related to current treatments complications

Lui, Kit Yee. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 150-157). / Abstracts and questionnaire in English and Chinese. / Title --- p.1 / Abstract --- p.2 / Acknowledgement --- p.7 / Table of contents --- p.8 / List of tables --- p.11 / List of figures --- p.12 / Glossary of terms and abbreviations --- p.13 / Chapter Section I: --- Overview --- p.14 / Chapter Chapter 1: --- Introduction --- p.15 / Chapter 1.1 --- Prevalence of food allergy in children --- p.15 / Chapter 1.1.1 --- Methodologies for studying food allergy --- p.18 / Chapter 1.1.2 --- Skin Prick Test and its mechanism --- p.19 / Chapter 1.1.3 --- Measurement of serum specific IgE levels --- p.21 / Chapter 1.1.4 --- Gold standard for diagnosis of food allergy --- p.22 / Chapter 1.2 --- Aim of Study --- p.25 / Chapter Chapter 2: --- Plan of Study --- p.26 / Chapter Section II: --- Literature Review --- p.28 / Chapter Chapter 3: --- Epidemiology of food allergy --- p.30 / Chapter 3.1 --- Prevalence of food allergy in children in western countries --- p.30 / Chapter 3.2 --- Prevalence of atopic allergies in children in rural areas --- p.34 / Chapter 3.3 --- Euro Prevail - A standardized methodology in studying food allergies --- p.38 / Chapter 3.4 --- Epidemiology of adverse food reaction in Hong Kong pre-school children --- p.40 / Chapter Chapter 4: --- Diagnosis of food allergies --- p.44 / Chapter 4.1 --- History --- p.44 / Chapter 4.2 --- Use of Skin Prick Test for diagnosis --- p.45 / Chapter 4.3 --- Use of serum specific IgE level for diagnosis --- p.47 / Chapter 4.4 --- Use of double-blind placebo-controlled food challenge for diagnosis --- p.49 / Chapter 4.5 --- Factors affecting precise diagnosis of food allergies --- p.51 / Chapter 4.5.1 --- Procedure-related Factors --- p.51 / Chapter 4.5.1.1 --- Performance of skin prick test --- p.51 / Chapter 4.5.1.2 --- Cross-reactivity of serum specific IgE --- p.52 / Chapter 4.5.1.3 --- Different diagnostic decision points in different populations --- p.53 / Chapter 4.5.1.4 --- Sensitization and allergy --- p.54 / Chapter 4.5.1.5 --- False negative oral food challenges --- p.55 / Chapter 4.5.2 --- Patient Factors --- p.56 / Chapter 4.5.2.1 --- Age of subjects --- p.56 / Chapter 4.5.2.2 --- Diet before tests --- p.57 / Chapter 4.5.2.3 --- Anti-histamine medications --- p.57 / Chapter 4.5.2.4 --- Skin sensitivity of subjects --- p.58 / Chapter Chapter 5: --- Risk factors for development of food allergies --- p.59 / Chapter 5.1 --- Factors associated with development of food allergies --- p.59 / Chapter 5.2 --- Food allergy and asthma --- p.62 / Chapter 5.3 --- Food allergy and eczema --- p.63 / Chapter Section III: --- Original Study --- p.64 / Chapter Chapter 6: --- Methodology --- p.65 / Chapter 6.1 --- Study Population --- p.65 / Chapter 6.1.1 --- Sample size calculation --- p.66 / Chapter 6.2 --- The EuroPrevall Study --- p.67 / Chapter 6.3 --- EuroPrevall Questionnaires --- p.68 / Chapter 6.4 --- Standardized Approach for Answering Questions in the Field --- p.69 / Chapter 6.5 --- Anthropometric Measurements and Ethics Approval --- p.70 / Chapter 6.6 --- Skin Prick Testing --- p.71 / Chapter 6.7 --- Measurement of serum specific IgE level --- p.72 / Chapter 6.8 --- Classification of Subjects --- p.74 / Chapter 6.9 --- Statistical Analysis --- p.75 / Chapter Chapter 7: --- Results --- p.76 / Chapter 7.1 --- Subjects and Demography --- p.76 / Chapter 7.2 --- Reported Symptoms in Chinese Children --- p.80 / Chapter 7.3 --- Food allergen sensitization in Chinese Children --- p.81 / Chapter 7.4 --- Association between food sensitization and allergic symptoms --- p.89 / Chapter 7.5 --- Prevalence of Food Allergy in Chinese Schoolchildren --- p.93 / Chapter Chapter 8: --- Discussion --- p.96 / Chapter Chapter 9: --- Conclusion and Further Studies --- p.102 / Appendix 1 Screening questionnaire (Chinese Version) --- p.106 / Appendix 2 Screening questionnaire (English Version) --- p.109 / Appendix 3 Case-control questionnaire (Chinese Version) --- p.111 / Appendix 4 Case-control questionnaire (English Version) --- p.132 / References --- p.150

A alergia alimentar tem se tornado um problema crescente de saúde pública em muitos países e pode ser desencadeada por qualquer alimento. Em crianças os alimentos considerados mais alergênicos são leite de vaca e ovo e em adultos há uma alta frequência de alergia a frutos do mar, sendo camarão o marisco considerado mais alergênico. Clinicamente a alergia a camarão pode se manifestar em diferentes formas como dermatite atópica, angioedema ou até mesmo anafilaxia. Com base na história clínica e avaliação de resultados de exames complementares foram selecionados 18 indivíduos alérgicos a camarão e 9 não alérgicos como grupo controle. Foram realizados testes in vitro para dosagem de IgE especifica no soro e teste cutâneo. Para reações ocorridas há mais de um ano foi realizada provocação oral para confirmação diagnóstica. O soro de todos os indivíduos do estudo foram testados em Western Blotting 1D e 2D com extrato de carne de camarão e casca separadamente da espécie Xiphopenaeus kroyeri, que possui grande importância por ser altamente consumida em nosso país além de estar entre as dez estirpes mais capturadas no mundo. Ainda assim não está presente em nenhum teste comercial disponível e não há nenhum alérgeno descrito para o mesmo. A caracterização de suas moléculas alergênicas é importante para melhor auxilio no diagnóstico e tratamento de pacientes alérgicos. As proteínas que apresentaram reatividade IgE especifica foram submetidas a espectrometria de massas para identificação. Foi possível identificar alguns homólogos de alérgenos de outras espécies de camarão como, tropomiosina, arginina quinase, proteína sarcoplasmática de ligação ao cálcio, actina, cadeia leve e pesada de miosina e hemocianina. Encontramos um possível novo alérgeno denominado como citocromo c oxidase (subunidade I) que não foi descrito anteriormente como proteína alergênica. Analisando sensibilidade e valor preditivo positivo das nossas proteínas sugerimos que algumas delas podem ser boas candidatas como futuros marcadores diagnósticos para alergia a camarão. Quando comparamos o perfil de proteínas reativas em carne e casca de camarão não observamos diferenças significativas entre elas. Essa é a primeira descrição de alergia para a espécie de camarão X. kroyeri, popularmente conhecido como camarão sete barbas, mostrando reatividade a IgE especifica em pacientes alérgicos a camarão / Food allergy has become a growing problem of public health in many countries, and can be triggered by any food. In children the most allergenic foods are cow\'s milk and egg; in adults there are high frequencies of allergy to seafood, and shrimps are considered the most allergenic seafood. Clinically, shrimp allergy can manifest itself in different forms, such as atopic dermatitis, angioedema or even anaphylaxis. Based on the clinical history and evaluation of the tests, we selected eighteen subjects that were allergic to shrimp, and nine non-allergic to shrimp as a control group. In vitro tests were performed to IgE specific dosage and cutaneous test with commercial extract. When reactions occurred more than one year before oral provocation test was performed for diagnostic confirmation. The serum of all individuals were tested in Western Blotting 1D and 2D with the shrimp meat and shell extracts separately from the species Xiphopenaeus kroyeri, which has great importance since is highly consumed in the Southeast region of our country and is among the top ten captured species in the world. Nevertheless, there are no commercial clinical tests available for it, and there is no specific allergen described, both of them would help the diagnosis and treatment of allergic patients. Proteins that showed specific IgE reactivity were submitted to mass spectrometry for identification. We identified some homologues allergens from other shrimp species such as tropomyosin, arginine kinase, calcium-binding sarcoplasmic protein, actin, myosin heavy chain and hemocyanin. We founded a possible new allergen called cytochrome c oxidase (subunit I), that was never previously described as an allergenic protein. Analyzing sensitivity and positive predictive value of our proteins we suggest that some of them may be good candidates as future diagnostic markers for shrimp allergy. When comparing the reactive proteins profile in shrimp meat and shell, we did not observe significant differences between them. This is the first description showing reactivity to specific IgE for shrimp species X. kroyeri, popularly known as shrimp seven beards, in patients allergic to shrimp

Diss. Linköping : Univ., 2004.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

La réponse tissulaire des patients soumis à une radiothérapie, malgré des protocoles de traitement identiques, est variable avec des extrêmes importants. Une des questions posées à la radiobiologie est d'expliquer ces variations (approche a posteriori) et si possible de les prévoir (approche a priori). La réponse d'un organisme et de tissus complexes à la radiothérapie est la résultante de nombreux déterminants. Certains appartiennent à la dynamique et à l'homéostasie tissulaire (inflammation, cytokines, etc.) d'autre à la sensibilité et à la réponse cellulaire (sensibilité intrinsèque, réparation de l'ADN, régulation de la mort cellulaire, etc.). Concernant les déterminants cellulaires, l'Equipe d'Accueil a proposé de classer les humains en 3 groupes de radiosensibilités différentes, le premier considéré comme normal est de loin le plus important (près de 75% des individus), le groupe II de radiosensibilité intermédiaire représente la majeure partie des individus pour lesquels une réponse anormale est constatée après radiothérapie. Le groupe III rassemble des pathologies particulièrement rares associées à une hyper-radiosensibilité marquée, voire très marquée. Les patients du groupe II présentent donc une réponse thérapeutique inattendue et / ou des effets secondaires précoces ou tardifs sévères à des doses d'irradiation dont on attend une tolérance normale. Les patients du groupe II peuvent aussi être caractérisés par une forte prédisposition au cancer et aux tumeurs radio induites. Il existe une variabilité intrinsèque liée à des facteurs endogènes tels que la qualité de réparation de l'ADN, ou la production spontanée de micronoyaux ; et des facteurs exogènes. A cet égard, certaines médications sont susceptibles de modifier la réponse cellulaire à la radiothérapie, telles que les statines, les anticoagulants ou les antiagrégants plaquettaires. Approche a posteriori : par une étude clinique unicentrique de 65 patients atteints de cancers de la prostate et traités par le même radiothérapeute dans les mêmes conditions, la fréquence et la gravité des effets secondaires rectaux par rapport à la prise ou non de statines ont été étudiées : un effet radioprotecteur des statines vis-à-vis de la rectite radique a été mis en évidence in vivo sur des arguments statistiques pertinents. Approche a priori : par l'étude de la réponse cellulaire et moléculaire aux radiations de fibroblastes humains (notamment issus de tissus intestinaux sains). Ont été étudiés : la réparation et la signalisation des cassures double-brin de l'ADN par l'analyse des foci nucléaires H2AX et pATM ; le transit radioinduit de la protéine ATM du cytoplasme vers le noyau a été observé pour la première fois sur des fibroblastes humains rectaux. Les statines semblent accélérer ce transit, produisant un effet modérateur de la sévérité des rectites. L’étude des différents produits antioxydants et stimulateurs de la réparation de l’ADN a permis de montrer que les statines ont effet non équivoqué sur la réparation cellulaire après irradiation. Ces résultats ouvrent des perspectives pour des études plus approfondies de l'usage de médications facilement accessibles capables de moduler la gravité des effets secondaires de la radiothérapie. / The tissue response of patients undergoing radiotherapy, despite identical treatment protocols, could have important variations. One of the questions asked to the radiobiology is to explain these variations (a posteriori approach) and if possible to predict it (a priori approach). The response of an organism and complex tissues to radiotherapy is the result of many determinants. Some belong to the tissue dynamics and homeostasis (inflammation, cytokines, etc.) and others to the sensitivity and cellular response (intrinsic sensitivity, DNA repair, regulation of cell death, etc.). About cellular determinants, our research team proposed to classify humans into three groups of different radiosensitivity levels, the first considered as normal is by far the largest (almost 75% of individuals), group II of intermediate radiosensitivity represents the majority of individuals having an abnormal response to radiotherapy. Group III gathers extremely rare conditions associated with marked or very marked hyper-radiosensitivity which are usually life threatening. Therefore patients in group II show either unexpected therapeutic response or severe radiation early or late side effects after doses for which normal tolerance is expected. Patients in group II can also be characterized by a strong predisposition to cancer and radiation-induced tumors. There is an inherent variability related to endogenous factors, such as the quality of DNA repair, or the spontaneous production of micronuclei; and exogenous factors. In this regard, certain medications may alter the cellular response to radiation therapy, such as statins, antiplatelet agents or anticoagulants. A posteriori approach: a single-center clinical study of 68 patients with prostate cancer treated by the same radiation oncologist in the same conditions, the frequency and severity of rectal side effects are compared to the use or not of statins : a radioprotective effect of statins toward radiation proctitis cannot be excluded. A priori approach: by studying the cellular and molecular radiation response in human fibroblasts (especially from healthy bowel tissue). Were studied: signaling and repair of DNA double-strand breaks by analysis of nuclear foci of MRE11; H2AX and pATM; radiation induced ATM protein transit from the cytoplasm to the nucleus was observed for the first time in rectal tissue fibroblasts. Statins appear to speed up this transit, making possible a radioprotective effect. These results open perspectives for further studies for the use of medications readily available that can modulate the severity of side effects of radiotherapy.

Made available in DSpace on 2015-07-22T20:50:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-06-30 / Introdução: A alergia ao látex é responsável por inúmeras reações alérgicas em indivíduos sensibilizados. Objetivos: Avaliar a prevalência de sensibilização e alergia ao látex e a alimentos em crianças e adolescentes com mielomeningocele e identificar os possíveis fatores de risco a eles associados. Métodos: Participaram do estudo 55 crianças e adolescentes com diagnóstico prévio de mielomeningocele atendidos no ambulatório de Neurocirurgia do Hospital São Paulo, UNIFESP-EPM. Os pacientes foram avaliados através de questionário padrão, testes cutâneos de hipersensibilidade imediata para aeroalérgenos, látex total e alimentos e determinação de IgE sérica total e específica ao látex total e suas frações recombinates. Resultados: Encontramos taxas de 45% e 20% para sensibilização e alergia ao látex respectivamente, com 14,5% de sensibilização a alimentos, sem casos de alergia alimentar. Vinte e quatro (43,6%) eram atópicos e a média de idade do primeiro episódio de reação ao látex foi 44,5 meses, sendo reação cutânea a mais freqüente relatada (72,7%). A sensibilização alimentar ocorreu para os seguintes alimentos: batata, mamão, mandioca, jaca, manga, abacaxi, pêra, tomate, castanha portuguesa e abacate. Níveis séricos de IgE total superiores a 200 KU/l foram mais freqüentes no grupo de pacientes alérgicos e no de sensibilizados. A concordância pelo teste de kappa entre teste cutâneo para látex e IgE sérica específica para látex total foi forte e entre teste cutâneo para látex ou IgE sérica específica para látex total e as frações rHev b1, 3, 5, 6.01 e 6.02 foram moderada ou boa. As frações IgE séricas específica para látex detectada em mais de 50% dos pacientes alérgicos ao látex foram rHev b1, 3, 5, 6.01 e 6.02. Estatisticamente houve diferença entre o grupo de alérgicos e sensibilizados quando comparado ao de não sensibilizados para as seguintes variáveis: atopia, rinite atual, angioedema, número médio de cirurgias, pacientes com quatro ou mais cirurgias, uso de DVP, presença de pelo menos um teste cutâneo positivo para aeroalérgeno, presença de pelo menos um teste cutâneo para alimentos e IgE total maior que 200 KU/l. A análise multivariada revelou como significante: asma atual, angioedema, atopia e número de cirurgias submetidas. Conclusões: Nosso estudo documentou serem elevadas as prevalências de sensibilização e alergia ao látex. Apesar de freqüente a presença de anticorpos IgE específicos a alimentos, não se confirmou a presença da síndrome látex-fruta. O teste cutâneo com extrato de látex total padronizado se mostrou seguro e confiável para o diagnóstico de alergia ao látex. A análise comparativa entre os testes cutâneos de hipersensibilidade imediata e a determinação de IgE sérica específica ao látex total revelou concordância total entre eles. IgE sérica específica às frações rHev b1, 3, 5, 6.01 e 6.02 foram detectadas em mais de 50% das crianças e adolescentes com mielomeningocele alérgicos ao látex. O número de cirugias a que os pacientes foram submetidos determinou níveis mais elevados de IgE sérica específica, sobretudo de rHev b5 e 6.01. A história de asma atual, angioedema prévio, atopia e ter sido submetido a quatro ou mais cirurgias foram fatores independentes identificados para alergia ao látex. / Background: Latex allergy is responsible for numerous allergic reactions in sensitized individuals. Objectives: To evaluate the prevalence of sensitization and latex allergy and food in children and adolescents with myelomeningocele and to identify possible risk factors associated with them. Methods: The study included 55 children and adolescents previously diagnosed with myelomeningocele treated in the neurosurgery clinic of the Hospital São Paulo, UNIFESP-EPM. Patients were assessed using standard questionnaire, skin prick tests for aeroallergens, total latex, and food and determination of serum total and specific IgE to total latex and its recombinant fractions. Results: We found rates of 45% and 20% for sensitization and latex allergy, respectively, with 14.5% of sensitization to food, with no cases of food allergy. Twenty-four (43.6%) were atopic and the average age of first episode of reaction to latex was 44.5 months, with skin reaction the most frequent reported (72.7%). The food sensitization occurred for the following foods: potatoes, papaya, manioc, jackfruit, mango, pineapple, pear, tomato, avocado and chestnut. Serum total IgE greater than 200 KU/l were more frequent in patients allergic and sensitized. The agreement using the kappa test between latex skin test and specific IgE to total latex was strong and between skin test to latex or total latex specific IgE and fractions rHev b1, 3, 5, 6:01 and 6:02 were moderate or good. The fraction of specific IgE to latex detected in more than 50% of patients were rHev b1 (16/25 - 64%) followed by rHev b6.02 (14/25 - 56%). Statistically significant difference was found between the group of allergic and sensitive when compared to non-sensitized to the following variables: atopy, current rhinitis, angioedema, average number of surgeries, patients with four or more surgeries, use of valvule, presence of at least one test positive aeroallergen skin, presence of at least one skin test for food and total IgE greater than 200 KU/l. Multivariate analysis showed as significant: current asthma, angioedema, atopy and number of surgeries undergone. Conclusions: Our study documented high leves of sensitization and latex allergy. Despite the frequent presence of specific IgE antibodies to food, the presence of latex-fruit syndrome was not confirmed. The skin test with a standardized latex extract was safe and reliable for the diagnosis of latex allergy. The comparative analysis between the skin prick tests and determination of specific IgE to total latex showed total agreement between them. Specific IgE to fractions rHev b1, 3, 5, 6:01 and 6:02 were detected in more than 50% of children and adolescents with myelomeningocele allergic to latex. The number of surgeries for which patients underwent determined higher levels of specific IgE, especially rHev b5 and 6.01. The history of current asthma, prior angioedema, atopy and having undergone four or more surgeries were independent factors identified for latex allergy. / TEDE / BV UNIFESP: Teses e dissertações

A alergia alimentar tem se tornado um problema crescente de saúde pública em muitos países e pode ser desencadeada por qualquer alimento. Em crianças os alimentos considerados mais alergênicos são leite de vaca e ovo e em adultos há uma alta frequência de alergia a frutos do mar, sendo camarão o marisco considerado mais alergênico. Clinicamente a alergia a camarão pode se manifestar em diferentes formas como dermatite atópica, angioedema ou até mesmo anafilaxia. Com base na história clínica e avaliação de resultados de exames complementares foram selecionados 18 indivíduos alérgicos a camarão e 9 não alérgicos como grupo controle. Foram realizados testes in vitro para dosagem de IgE especifica no soro e teste cutâneo. Para reações ocorridas há mais de um ano foi realizada provocação oral para confirmação diagnóstica. O soro de todos os indivíduos do estudo foram testados em Western Blotting 1D e 2D com extrato de carne de camarão e casca separadamente da espécie Xiphopenaeus kroyeri, que possui grande importância por ser altamente consumida em nosso país além de estar entre as dez estirpes mais capturadas no mundo. Ainda assim não está presente em nenhum teste comercial disponível e não há nenhum alérgeno descrito para o mesmo. A caracterização de suas moléculas alergênicas é importante para melhor auxilio no diagnóstico e tratamento de pacientes alérgicos. As proteínas que apresentaram reatividade IgE especifica foram submetidas a espectrometria de massas para identificação. Foi possível identificar alguns homólogos de alérgenos de outras espécies de camarão como, tropomiosina, arginina quinase, proteína sarcoplasmática de ligação ao cálcio, actina, cadeia leve e pesada de miosina e hemocianina. Encontramos um possível novo alérgeno denominado como citocromo c oxidase (subunidade I) que não foi descrito anteriormente como proteína alergênica. Analisando sensibilidade e valor preditivo positivo das nossas proteínas sugerimos que algumas delas podem ser boas candidatas como futuros marcadores diagnósticos para alergia a camarão. Quando comparamos o perfil de proteínas reativas em carne e casca de camarão não observamos diferenças significativas entre elas. Essa é a primeira descrição de alergia para a espécie de camarão X. kroyeri, popularmente conhecido como camarão sete barbas, mostrando reatividade a IgE especifica em pacientes alérgicos a camarão / Food allergy has become a growing problem of public health in many countries, and can be triggered by any food. In children the most allergenic foods are cow\'s milk and egg; in adults there are high frequencies of allergy to seafood, and shrimps are considered the most allergenic seafood. Clinically, shrimp allergy can manifest itself in different forms, such as atopic dermatitis, angioedema or even anaphylaxis. Based on the clinical history and evaluation of the tests, we selected eighteen subjects that were allergic to shrimp, and nine non-allergic to shrimp as a control group. In vitro tests were performed to IgE specific dosage and cutaneous test with commercial extract. When reactions occurred more than one year before oral provocation test was performed for diagnostic confirmation. The serum of all individuals were tested in Western Blotting 1D and 2D with the shrimp meat and shell extracts separately from the species Xiphopenaeus kroyeri, which has great importance since is highly consumed in the Southeast region of our country and is among the top ten captured species in the world. Nevertheless, there are no commercial clinical tests available for it, and there is no specific allergen described, both of them would help the diagnosis and treatment of allergic patients. Proteins that showed specific IgE reactivity were submitted to mass spectrometry for identification. We identified some homologues allergens from other shrimp species such as tropomyosin, arginine kinase, calcium-binding sarcoplasmic protein, actin, myosin heavy chain and hemocyanin. We founded a possible new allergen called cytochrome c oxidase (subunit I), that was never previously described as an allergenic protein. Analyzing sensitivity and positive predictive value of our proteins we suggest that some of them may be good candidates as future diagnostic markers for shrimp allergy. When comparing the reactive proteins profile in shrimp meat and shell, we did not observe significant differences between them. This is the first description showing reactivity to specific IgE for shrimp species X. kroyeri, popularly known as shrimp seven beards, in patients allergic to shrimp

Esofagite Eosinofílica é uma doença inflamatória crônica restrita ao esôfago e imune mediada por antígenos. Sua prevalência descrita varia desde 0,4%, numa população geral, até 15% em pacientes com sintomas de disfagia. Já se conhece sua associação com doenças atópicas, anafilaxia e alergia alimentar, sendo o leite de vaca um dos principais alimentos envolvidos. Existem relatos recentes de casos em que pacientes foram diagnosticados com esofagite eosinofílica após serem submetidos à imunoterapia oral com o alimento causador de sua alergia alimentar mediada por IgE. Porém, em nenhum destes casos foi avaliado previamente se os mesmos pacientes já não apresentavam eosinofilia esofágica latente e/ou sintomas subjetivos sugestivos da doença. Considerando que, atualmente, um dos tratamentos mais promissores para alergia alimentar é a imunoterapia oral, justificou-se a necessidade de entender se esofagite eosinofílica seria de fato uma complicação do tratamento, ou se seria uma condição pré ou coexistente. Portanto, o objetivo deste trabalho foi avaliar a frequência de eosinofilia esofágica em pacientes com anafilaxia à proteína do leite de vaca. Foram analisados 89 pacientes matriculados no ambulatório de alergia alimentar do HC-FMUSP, com mediana de idade de 8 anos e que apresentavam anafilaxia ao leite de vaca. Todos foram submetidos à endoscopia digestiva alta com biópsias de esôfago, estomago e duodeno. Dados demográficos, comorbidades atópicas, uso de medicações e sintomas gastrointestinais foram analisados e comparados. A frequência de eosinofilia esofágica foi de 38,2% (34 de 89 pacientes). Em 15 dos 34 pacientes com eosinofilia esofágica, foi completada a investigação para esofagite eosinofílica com uso de inibidor de bomba de prótons em dose plena por 8 semanas antes de uma segunda endoscopia. Identificou-se, portanto, cinco pacientes (7,1%) com eosinofilia esofágica responsiva a inibidor de bomba de prótons e 10 pacientes com esofagite eosinofílica (14,2%). No grupo total de pacientes com eosinofilia esofágica (n=34) encontrou-se 29,4% de pacientes com quadro clínico gastrointestinal ausente; 23,5% oligossintomáticos, e apenas 47% com sintomas sugestivos de disfunção esofágica e, destes últimos, nem todos apresentavam sintomas esofágicos persistentes. Pode-se concluir que a frequência de esofagite eosinofílica descrita no grupo estudado foi significativamente superior à estimada na população geral e uma das mais altas descritas em grupos de pacientes com fatores de risco específicos. Também foi observada uma grande parcela de pacientes com eosinofilia esofágica, sendo muitos assintomáticos ou oligossintomáticos, surgindo o questionamento se esta não seria uma doença latente, de início precoce, insidioso e não relacionada diretamente como complicação de tratamentos atuais / Eosinophilic esophagitis is a chronic inflammatory disease, which occurs in the esophagus and is immune mediated by antigens. Its observed prevalence varies between 0.4% in the general population to 15% in patients with dysphagia. Its association with atopic diseases, anaphylaxis and food allergy has already been recognized. Cow\'s milk is one of the main food sources involved. There are recent reports of cases in which patients were diagnosed with eosinophilic esophagitis after being submitted to oral immunotherapy with the food that causes the IgE mediated allergy. However, in none of these cases was it previously determined if the same patients did not already present latent esophageal eosinophilia and/or subjective symptoms suggestive of the disease. Considering that, currently, one of the most promising treatment for food allergy is oral immunotherapy, the need to understand if eosinophilic esophagitis could be a treatment complication, or if it is a coexistent or preexistent condition, is justified. Therefore, the objective of this study was to evaluate esophageal eosinophilia frequency in patients with anaphylaxis to cow\'s milk protein. We analyzed eighty-nine patients registered in the Food Allergy Unit of the HCFMUSP, with a median age of 8 years, who presented cow\'s milk anaphylaxis. All of them were submitted to digestive endoscopy as well as esophagus, stomach, and duodenum biopsies. We also analyzed and compared demographic data, atopic comorbidities, use of medication, and gastrointestinal symptoms. The frequency of esophageal eosinophilia was 38.2% (34 of 89 patients). In 15 of the 34 patients with esophageal eosinophilia, full investigation for the disease was carried out using a proton pump inhibitor at full dose for eight weeks prior to a second endoscopy. From this, five patients (7.1%) had the proton pump inhibitor-responsive esophageal eosinophilia phenotype, and ten patients were diagnosed with eosinophilic esophagitis (14.2%). In the whole group of patients with esophageal eosinophilia (n = 34), it was found 29.4% of patients with an absent gastrointestinal clinical condition, 23.5% were oligosymptomatic, and only 47% had symptoms suggestive of esophagic dysfunction. Of these, not all presented persistent esophagic symptoms. It is possible to conclude that the frequency of eosinophilic esophagitis observed in this group was significantly higher than the estimated for the general population, and one of the highest observed in groups of patients with specific risk factors. A large portion of patients with esophageal eosinophilia were oligosymptomatic or asymptomatic, raising the question if this would not in fact be a latent disease, with a precocious beginning, insidious and not directly related to current treatments complications