As colectinas pulmonares SP-A e SP-D são marcadores específicos de doenças pulmonares. A determinação destas proteínas por ensaios imunoenzimáticos permite aos clínicos correlacionarem seu papel funcional durante o desenvolvimento do processo patológico baseado nas anormalidades de suas concentrações. Como o lavado broncoalveolar (BAL) é uma amostra que permite estudar as proteínas secretadas pelo epitélio pulmonar em quaisquer circunstâncias, foi proposto o desenvolvimento de um ELISA indireto capaz de detectar SP-A no BAL humano usando um anti-soro policlonal contra SP-A suína produzido em coelho. SP-A suína foi purificada por protocolo que acopla precipitação ácida do extrato pulmonar suíno e cromatografia de afinidade. O anti-soro reagiu com as duas espécies de SP-A testadas: humana e suína. A curva padrão foi otimizada utilizando como calibrador a SP-A purificada de pacientes com artrite reumatóide. A faixa selecionada da curva de calibração foi de 0,312 to 5,0 mg/mL usando a diluição 1:1000 do anticorpo. O limite de detecção da curva foi de 0,625 mg/mL. / The lung collectins SP-A and SP-D are specific markers for lung diseases. Determination of amounts of these proteins using polyclonal and monoclonal antibodies on ELISA assays enabled clinicians to predict their role in the course of the lung disease process based on abnormalities on their concentrations. As the bronchoalveolar lavage (BAL) is a sample that permits to study the proteins secreted by the lung epithelium at any conditions, we proposed to develop an indirect ELISA able to detect SP-A in the BAL using polyclonal rabbit antiserum, raised against porcine SP-A. Porcine SP-A was purified by a protocol that includes an acid precipitation of the porcine pulmonary extract before affinity chromatography. The antiserum reacted with the two tested species porcine and human. The calibration curve were optimized, using human SP-A purified from patients with rheumatoid arthritis as human antigen calibrator. The selected calibration curve range was 0.312 to 5.0 mg/mL using the antiboby dilution 1:1.000. The detection limit of the standard curve was 0.625 mg/mL.

Introduction: The pathogenesis and treatment of allergic bronchopulmonary aspergillosis (ABPA), severe asthma-non fungal sensitised (SANFS) and severe asthma with fungal sensitization (SAFS) is poorly understood. IL-17A, IgE and microbiome may be associated with pathogenesis of asthma, but their role in fungal-associated asthma is uncertain. Further, the efficacy of voriconazole, posaconazole and nebulised amphotericin B (NAB) in ABPA and SAFS has not been fully studied. Aims and objectives: The aim of this PhD thesis was to evaluate the role of IL-17A, IgE and lung microbiome in patients with SANFS, SAFS and ABPA. We also studied the efficacy and safety of NAB, voriconazole and posaconazole. Methods: Airway lymphocytes and peripheral blood mononuclear cells (PBMC) from patients with ABPA (n=16), SAFS (n=15), SANFS (n=11), mild asthma (MA) (n=6) and NH (n=11) were characterized by flow cytometric analysis (FACS) to determine the % of CD (+) IL-17A expressing cells. We also evaluated microbiome population using culture and PCR plus sequencing from BAL of these patients. In chapter 3, we analysed total and specific IgE in blood from adult cohorts of SAFS (n=34) and ABPA (n=48) using ImmunoCAP 100. In chapter 5 we studied the efficacy of voriconazole and posaconazole and in chapter 6; we studied the efficacy of NAB.Results: %CD4+IL-17A expressing cells were significantly higher in patients with severe asthma and correlated positively with serum neutrophil and presence of fungi in the airways. ABPA, SAFS and SANFS were similar but all were significantly higher than MA and NH. There were no differences in IL-17A expression between blood and the lung. Fungi were more frequently associated with severe asthma and low FEV1. Steroid treatment significantly increased airway fungal load. IgE against staphylococcal aureus (SE-IgE) correlated positively with FEV1 and OCS dose. Voriconazole and posaconazole improved asthma severity and radiological abnormalities. NAB was associated bronchospasm, but was extrely effective in the few patients (n=3) that took treatment for >12 months. These responders had unique characteristics. Conclusions: IL-17A, SE-IgE, and lung microbiome are associated with asthma severity. Steroid use in these patients may increase airway fungal load. Whereas voriconazole and posaconazole are efficacious, the use of NAB is associated with significant bronchospasm. SE-IgE -high asthma patients may be a distinct asthma phenotype. Larger studies are needed.

Introdução: O tratamento das peritonites difusas, apesar dos avanços alcançados, continua difícil. Diversas técnicas e protocolos vêm sendo utilizados, porém esse casos seguem com altos índices de morbidade e mortalidade . O uso de peritoneostomias foi encorajado após o surgimento da terapia a vácuo, obtendo-se resultados promissores. Porém a lavagem peritoneal contínua ainda é uma modalidade considerada tecnicamente de difícil execução e de resultados controversos. Nesse experimento desenvolvemos e propomos um novo modelo de lavagem peritoneal continua que aproveitasse a facilidade e os benefícios da peritineostomia a vácuo. Métodos: Projeto piloto com 2 porcos foi realizado para padronização do posicionamento dos materiais e confecção da peritoneostomia que melhor se adaptasse ao modelo de lavagem contínua. Outros 12 porcos anestesiados 12 porcos, mantidos sob ventilação mecânica, recebendo solução de Ringer lactato 5ml/kg/h e monitorização continua. Submetidos a laparotomia mediada, posicionado dois tubos multi-perfurados 4.8mm nos flancos, confeccionado uma peritoneostomia a vácuo (Vivano® Hartmann) e aplicada pressão negativa 125mmHg. Para avaliação da integridade do sistema e efeitos fisiológicos da lavagem peritoneal continua, 8 porcos foram divididos em 2 grupos: em 4 deles foi Infundido através dos tubos multi-perfurados solução fisiológica (SF 0,9%), e nos outros 4 foi infundido solução de diálise peritoneal com dextrose 1,5% (SDPD 1,5%). Para avaliar a eficiência do sistema em alcançar todos os espaços e recessos intra-abdominais foi infundido solução de partículas de carbono em suspensão (nanquim) diluídas em SF 0,9%, e obtido imagens de tomografia computadorizada Nos mesmos animais foi testado a eficiência do clearance de fluido utilizado na lavagem peritoneal, observando a remoção da solução de nanquim diluída através da peritoneostomia. Resultados: Exames de imagem obtidos através de tomografia computadorizada, após infusão de fluidos, mostraram que o método é capaz de ocupar todos os espaços e recessos intra-abdominais. Apresentou também um clearance de fluido abdominal adequado com remoção progressiva de partículas de carbono em suspensão. Outro resultado importante foi a estabilidade da peritoneostomia a vácuo em conjunto com a infusão continua de fluidos. Não houve vazamentos ou obstrução dos cateteres durante todo procedimento. Notou-se que liquido infundido foi praticamente reabsorvido. Parâmetros hemodinâmicos e bioquímicos se mantiveram dentro da normalidade com a utilização de SDPD 1,5%, resultado não obtido com a utilização de SF 0,9%. Conclusão: Este modelo de lavagem peritoneal contínua é tecnicamente executável e mantem parâmetros fisiológicos dentro da normalidade quando utilizado SDPD 1,5% / Background: Treatment of diffuse peritonitis remains a challenge. With the advent of vacuum therapy, the use of laparotomy to treat peritonitis has gained attraction. However maintaining a continuous peritoneal lavage is technically difficult and has controversial results. In this experiment we have developed and proposed a new model of continuous peritoneal lavage taking advantage of the features and benefits of the vacuum laparotomy. Methods: Pilot project with two pigs was performed to standardize the positioning of materials and making of laparostomy that best suited to the model of continuous peritoneal lavage. Another 12 pigs under effects of general anesthesia and permanent hemodynamic monitoring were submitted to laparotomy. Then a multi-perforated tube was placed along each flank and exteriorized in the left and right lower quadrants of the abdomen. A vacuum dressing was placed and negative pressure was maintained with it. To evaluate the integrity in the system and physiological effects of continuous peritoneal lavage, A group of 8 pigs were divided into 2 sub-groups: The first sub-group of 4 animals received through multiperforated tubes peritoneal dialysis solution with Dextrose 1,5% (PDSD 1,5%) and the second subgroup of 4 pigs received saline solution 0,9% (SS 0,9%). To asses the system\'s efficiency in reach all intra-abdominal spaces and recesses, carbon particles in suspension (China Ink) diluted in SS 0,9% was infused into the abdominal cavity in all 8 pigs, this was followed by computerized tomography (CT) images. In addition, the same pigs were used to evaluate the efficiency of the intra-abdominal fluid clearance analyzing the washing of china ink diluted in SS 0,9% that was infused into the abdominal cavity. Results: Imaging obtained by Computerized tomography after fluid infusion showed that this method has a trend towards occupy all intra-abdominal spaces and recesses. It showed also an appropriate clearance of abdominal fluid with progressive removal of carbon particles in suspension. Dressing integrity was not compromised through out the duration of the study. There were no leaks or blockage of the catheters during the procedure. It was noted that all the liquid infused was almost reabsorbed. Hemodynamic and biochemical parameters remained within normal limits when SDPD 1,5% was used. This homeostasis was not achieved with SS 0,9%. Conclusion: This model of continuous peritoneal lavage is technically feasible, maintain physiological parameters within the normal range when SDPD 1.5% is used

La présente thèse traite, au travers d’une analyse fondamentale et expérimentale, l’effet de texturation par détente instantanée contrôlée (DIC) sur les phénomènes de transfert au cours des processus de séchage, d’extraction mécanique et de comportement rhéologique. Les produits concernés ont été les graines de caroube (gomme et germe) et deux variétés de graines de tournesol (linoléique et oléique). La texturation DIC permet d’agir sur la cinétique de séchage par flux d’air ce qui conduit à une intensification des processus de séchage par flux d’air tout en assurant une bonne préservation de la qualité nutritionnelle du produit fini. L’étude expérimentale a été couplée à une analyse phénoménologique de la cinétique à travers une modélisation de type CWD (coupled Washing/Diffusion). Cette dernière étude conduit à une évaluation de l’impact de la texturation sur la diffusivité effective Deff et l’accessibilité initiale δWs. D’autre part, l’étude expérimentale en vue de l’optimisation de l’opération a été réalisée à travers la méthode des plans d’expériences. La modification des paramètres opératoires fonctionnels de la DIC, à savoir la pression absolue de vapeur d’eau saturée sèche (P), et le temps de traitement thermique (t), ainsi que le nombre des cycles (c) sur l’ensemble des performances de l’opération a été établie sur le comportement rhéologique de la gomme de caroube. Une deuxième partie de la thèse a été consacrée à l’étude fondamentale et expérimentale des procédés d’extraction d’huile de tournesol des deux variétés de graines linoléiques et oléiques. Le traitement thermomécanique par détente instantanée contrôlée (DIC) permet, à travers une modification contrôlée de la structure de la matière première, d’agir sur l’extraction mécanique par presse à froid des huiles de tournesol, ainsi que sur l’extraction par solvant de l’huile à partir du tourteau résiduel. Un complément à cette opération a consisté en l’extraction par solvant (n-hexane) opérée sur l’ensemble des graines de tournesol. La texturation DIC a conduit à une grande augmentation du rendement en huile pour les variétés linoléique et oléique. La préservation de la qualité de l’huile et du tourteau prouve l’adéquation de la DIC avec l’absence pratique de la dégradation chimique. Notre étude a également concerné la définition d’un nouveau procédé de désodorisation. Il s’agit de l’utilisation de l’Autovaporisation Multi-Flash MFA sur le raffinage de l’huile de tournesol. Cette technologie innovante de désodorisation se distingue par son faible niveau de température assurant ainsi une sévérité nettement inférieure à celle des méthodes conventionnelles à haute température. / This thesis deals with a fundamental and experimental analysis of the effect of instant controlled pressure drop (DIC) on the transfer phenomena and rheological behavior, which occurs during the drying process and mechanical and solvent extraction. The products concerned were carob seeds (gum and germ) and two varieties of sunflower seeds (linoleic and oleic). DIC texturing makes it possible to greatly modify the drying kinetics, leading to an effective intensification of the drying processes while maintaining a good preservation of the nutritional quality of the finished product. The experimental study was coupled with a phenomenological kinetic model using the CWD (coupled Washing/Diffusion). This study leads to evaluate the impact of texturing on the effective diffusivity Deff and the initial accessibility δWs. On the other hand, the experimental study for the optimization of the operation was carried out through an adequate experimental design method. The impact of the DIC processing parameters, namely the absolute pressure of saturated dry water vapor (P), and the heat treatment time (t), as well as the number of cycles (c) was established on the rheological behavior of the carob bean gum. A second part of our work was devoted to the theoretical and experimental study of sunflower oil extraction processes of the two types of linoleic and oleic seeds. By acting as a controlled modification of the raw material, (DIC) texturing allowed increasing the yield of sunflower oil by both cold pressing and solvent extraction from the residual cake. DIC texturing has led to a large increase in oil yield for both linoleic and oleic varieties. The preservation of the quality of oil demonstrates that DIC was perfectly adequate with a perfect absence of chemical degradation. Our study also involved the definition of a new deodorization process. This is the use of the Multi-Flash Autovaporization MFA on the refining of sunflower oil. This innovative deodorization technology is characterized by its low temperature level, thus ensuring a much lower severity than conventional high temperature methods.

A pressão positiva contínua nas vias aéreas (CPAP) é o tratamento de escolha para pacientes com Apnéia Obstrutiva do Sono, mas muitos sintomas nasais conseqüentes da terapia são relatados. Vazamentos aéreos pela boca e alterações do epitélio respiratório são importantes no desenvolvimento de sintomas nasais e a umidificação aquecida é utilizada no alívio destes sintomas. O objetivo deste trabalho foi o de investigar os efeito agudos do nCPAP e o impacto da umidificação aquecida e vazamento aéreo no transporte mucociliar e inflamação nasal de indivíduos sadios. Para este fim avaliamos o transporte mucociliar nasal in vivo (através do Teste da Sacarina), a transportabilidade in vitro do muco nasal (através do Método Palato de Rã), lavado nasal e sintomas respiratórios (através de uma Escala Visual Analógica) de dezesseis indivíduos sadios antes e após aplicação aguda do CPAP sobre diferentes condições: CPAP com e sem umidificação aquecida e CPAP com e sem vazamento aéreo. O transporte mucociiar nasal in vivo aumentou significativamente após todas as intervenções com CPAP. Não houve diferença significativa da transportabilidade do muco, contagem total e diferencial de células inflamatórias provenientes do lavado nasal após nenhuma das intervenções com o CPAP. Houve um aumento significante da percepção subjetiva dos sintomas respiratórios estudados após o uso do CPAP sem umidificação e com vazamento aéreo. Concluimos que o uso agudo do CPAP independente da umidificação ou vazamento aéreo, aumenta significativamente o transporte mucociliar nasal in vivo, não altera significativamente a transportabilidade do muco nasal nem a composição celular de amostras de lavado nasal. Já o uso do CPAP sem umidificação e com vazamento aéreo causa aumento significativo dos sintomas de ressecamento nasal e de garganta, coriza e obstrução nasal. / Continuous positive airway pressure (CPAP) is the treatment of choice for patients with Obstructive Sleep Apnea but yet nasal symptoms are often reported. Air leaks and changes of the respiratory epithelium are important in the development of nasal symptoms and heated humidification is used to alleviate these symptoms. The aim of this study was to investigate the acute effects of CPAP and the impact of heated humidification and air leak on the nasal mucociliary clearance and nasal inflammation of healthy volunteers. To this end we evaluated nasal mucociliary clearance in vivo (through the Saccharin Test), in vitro nasal mucus transportability (through the Frog Palate Model), nasal lavage and respiratory symptoms (through a Visual Analogue Scale) of sixteen healthy volunteers before and after acute CPAP application under different conditions: CPAP with and without heated humidification and with and without air leak. In vivo nasal mucociliary clearance increased significantly after all CPAP interventions. There was no significant difference in mucus transportability, total or differential inflammatory cell count from the nasal lavage after any CPAP intervention. There was a significant increase in the subjective perception of the respiratory symptoms studied after the use of CPAP without humidification and with air leak. We conclude that the acute use of CPAP independently of humidification or air leak significantly increases in vivo nasal mucociliary clearance, doesn\'t change mucus transportability and total or differential cell count. However, the use o CPAP without humidification and with air leak significantly increased nasal and throat dryness, coryza and nasal obstruction subjective perception.

L'objectif principal de ce travail est l'étude de la résistance au lavage des connections faites par fils électriques développées pour la réalisation de textiles intelligents. Cette étude est basée sur l'utilisation de trois différents fils électriques par la technique de broderie ; deux différents fils métalliques (M-1& M-2) et un fil enduit par de l'argent (S.C). Les échantillons ont été préparés en utilisant une machine industrielle de broderie et en utilisant un point de type 300, plus précisément un point 302 (zigzag) en faisant varié l'intervalle entre deux points successifs (1,2 et 3rnm). Ces échantillons devant pouvoir s'intégrer au sein d'un vêtement, leur« confectionnabilité »a été testés au travers des tests KES (Kawabata Evaluation System) en se concentrant sur les propriétés de flexion et de cisaillement de l'étoffe ainsi « instrumenté » conformément aux recommandations trouvées dans la littérature. Cette étude a été menée sur les échantillons initiaux mais aussi sur les échantillons ayant subis 1, 5 et 10 lavages. En parallèle avec ces caractérisations mécaniques, une étude électrique de ces derniers a été entreprise. Ont été testées, l'impédance de la connexion et aussi sa réponse en fréquence (de 100Hz à 11Mhz). L'analyse des résultats a mis en évidence un comportement en transmission du signal de type «second ordre », avec une évolution de la fréquence propre du filtre ainsi constitué vers les fréquences plus basses. Tous les échantillons ont ensuite été soumis à un lavage. Ces tests ont été répétés après chaque lavage jusqu'au 10ème. A partir des résultats obtenus nous avons pu établir un modèle de comportement et mettre en évidence une complexification du réseau de connexion surtout dans le cas des fils métalliques utilisés. Toutes ces expériences et modèles proposés, nous ont permis de conclure quant au potentiel important de ces types de technique de connexion et de proposer une série d'extension de ces travaux dans le cadre de travaux futur. / Main objective of this work is to study the washing behavior of textile based connections developed by using conductive threads. Two metallic threads (M-l & M-2) and one silver coated thread (S.C) have been used to make samples. The samples have been fabricated with different numbers of stitches per cm by using these conductive threads. After several tests it has been concluded to use the metallic thread in the bobbin of Jock stitch machine or embroidery machine. Embroidery machine has been used to make the samples. The embroidery has been done with zigzag stitch and samples were made. Three different distances between two consecutive stitches have been used that are 1mm, 2mm and 3mm. Samples have been characterized for mechanical (shear & bending) properties, using a KAWABATA testing instrument. Considerable differences have been observed among three types of threads. Graphical representation made it easy to highlight the behavioural aspects of each type. Then at other series of samples have been produced having different stitch densities. These samples then analyzed for electric properties by using mulitmeter, teraohm meter. Samples were also analyzed for signal transmission properties with the help of a frequency generator and an oscilloscope. The attenuation and phase angles were calculated at different frequencies ranging from 100Hz to 11MHz. Very interesting behaviour of the circuits have been observed and discussed in detail. AIL the samples are then subjected to washing and were again tested for all properties (shearing, bending, electric, and signal transmission).The tests have been repeated after each wash and observed the changes. In the final part of thesis all the results have been discussed, reasons have been identified and conclusion has been made.

Nous avons mis au point une méthode de lavage broncho-alvéolaire permettant d'effectuer des mesures répétées (toutes les 15 min. pendant 3h30.) de la perméabilité capillaro-alvéolaire à une macromolécule (FITC-dextran). Après une lésion à l'acide oléique (AO) on observe, en 30 minutes un pic de perméabilité au FITC-dextran. La perméabilité décroît ensuite lentement jusqu'à la fin de l'expérience.<br />Nous avons testé les effets de la terbutaline, un β2-agoniste réputé réduire in vitro l'augmentation de perméabilité dans les lésions pulmonaires inflammatoires. Une perfusion de terbutaline débutée 10 min. après la lésion à l'AO ne modifie pas l'évolution de la perméabilité. Une perfusion tardive de terbutaline (90 min. après la lésion) aggrave la perméabilité. Comme l'index cardiaque et la pression capillaire augmentent au cours de la perfusion de terbutaline, nous supposons que la terbutaline recrute des capillaires lésés et aggrave la perméabilité à la phase tardive de la lésion à l'AO.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

A pressão positiva contínua nas vias aéreas (CPAP) é o tratamento de escolha para pacientes com Apnéia Obstrutiva do Sono, mas muitos sintomas nasais conseqüentes da terapia são relatados. Vazamentos aéreos pela boca e alterações do epitélio respiratório são importantes no desenvolvimento de sintomas nasais e a umidificação aquecida é utilizada no alívio destes sintomas. O objetivo deste trabalho foi o de investigar os efeito agudos do nCPAP e o impacto da umidificação aquecida e vazamento aéreo no transporte mucociliar e inflamação nasal de indivíduos sadios. Para este fim avaliamos o transporte mucociliar nasal in vivo (através do Teste da Sacarina), a transportabilidade in vitro do muco nasal (através do Método Palato de Rã), lavado nasal e sintomas respiratórios (através de uma Escala Visual Analógica) de dezesseis indivíduos sadios antes e após aplicação aguda do CPAP sobre diferentes condições: CPAP com e sem umidificação aquecida e CPAP com e sem vazamento aéreo. O transporte mucociiar nasal in vivo aumentou significativamente após todas as intervenções com CPAP. Não houve diferença significativa da transportabilidade do muco, contagem total e diferencial de células inflamatórias provenientes do lavado nasal após nenhuma das intervenções com o CPAP. Houve um aumento significante da percepção subjetiva dos sintomas respiratórios estudados após o uso do CPAP sem umidificação e com vazamento aéreo. Concluimos que o uso agudo do CPAP independente da umidificação ou vazamento aéreo, aumenta significativamente o transporte mucociliar nasal in vivo, não altera significativamente a transportabilidade do muco nasal nem a composição celular de amostras de lavado nasal. Já o uso do CPAP sem umidificação e com vazamento aéreo causa aumento significativo dos sintomas de ressecamento nasal e de garganta, coriza e obstrução nasal. / Continuous positive airway pressure (CPAP) is the treatment of choice for patients with Obstructive Sleep Apnea but yet nasal symptoms are often reported. Air leaks and changes of the respiratory epithelium are important in the development of nasal symptoms and heated humidification is used to alleviate these symptoms. The aim of this study was to investigate the acute effects of CPAP and the impact of heated humidification and air leak on the nasal mucociliary clearance and nasal inflammation of healthy volunteers. To this end we evaluated nasal mucociliary clearance in vivo (through the Saccharin Test), in vitro nasal mucus transportability (through the Frog Palate Model), nasal lavage and respiratory symptoms (through a Visual Analogue Scale) of sixteen healthy volunteers before and after acute CPAP application under different conditions: CPAP with and without heated humidification and with and without air leak. In vivo nasal mucociliary clearance increased significantly after all CPAP interventions. There was no significant difference in mucus transportability, total or differential inflammatory cell count from the nasal lavage after any CPAP intervention. There was a significant increase in the subjective perception of the respiratory symptoms studied after the use of CPAP without humidification and with air leak. We conclude that the acute use of CPAP independently of humidification or air leak significantly increases in vivo nasal mucociliary clearance, doesn\'t change mucus transportability and total or differential cell count. However, the use o CPAP without humidification and with air leak significantly increased nasal and throat dryness, coryza and nasal obstruction subjective perception.

A rinite alérgica (RA) é a mais comum doença mediada por IgE, que afeta aproximadamente 500 milhões de pessoas em todo o mundo. A RA é a expressão clínica da ligação entre anticorpos do tipo IgE e antígenos na mucosa nasal resultando em inflamação. Estes anticorpos foram detectados na secreção nasal de pacientes com rinite alérgica. Na abordagem da doença, temos a imunoterapia específica (IT) como único tratamento imunomodulatório antígeno específico. Foi demonstrado que IT gera uma diminuição da resposta tardia ao alérgeno tanto na pele como na mucosa do trato respiratório e esta redução se correlaciona com diminuição no número de células infiltrando os tecidos e na quantidade de mediadores inflamatórios. Objetivo: Determinar a resposta local de IgE específica e IgG4 específica no lavado nasal de pacientes com rinite alérgica antes e após o tratamento com imunoterapia alérgeno específica para Dermatophagoides pteronyssinus por um período de 6 meses; determinar a resposta inflamatória padrão Th1/ Th2/ Th17 e avaliar escore de sintomas e contagem de células no lavado nasal. Método: Selecionamos pacientes sensibilizados ao Dermatophagoides pteronissinus com diagnóstico de rinite alérgica persistente. Realizamos as analises de sintomas nasais através da escala NIS e antes de iniciar o tratamento estes indivíduos realizaram provocação nasal com alérgeno e coleta de lavado nasal. Após 6 meses de tratamento IT e placebo estes pacientes foram reavaliados. Realizamos a analise de Imunoglobulinas (IgE especifica para Der p1 e 2, IgE total, e IgG4 especifica para Der p 1), contagem de células totais, citocinas padrão Th1/Th2 e Th17. Resultados: Analisamos 19 pacientes no grupo imunoterapia e 17 no grupo placebo. A avaliação dos sintomas pela escala NIS após 6 meses de intervenção, demonstrou diferença significativa nos grupos placebo e imunoterapia, em favor da IT. A concentração do extrato utilizado na provocação nasal foi maior no grupo imunoterapia após os 6 meses de tratamento mas sem significância estatística. Quanto a dosagem das imunoglobulinas observamos diminuição da IgE total após a intervenção assim como da contagem de células totais no lavado nasal. A dosagem das citocinas livres no lavado nasal não sofreram alterações significativas. Na provocação nasal observamos aumento de IL-13, IL-10 em ambos os grupos, independente da fase de tratamento. Conclusão: Não observamos nenhuma resposta local de IgE específica e IgG4 específica no lavado nasal de pacientes com rinite alérgica antes e após o tratamento com imunoterapia alérgeno específica para Dermatophagoides pteronyssinus por um período de 6 meses. Houve melhora no escore de sintomas e diminuição da IgE total e da contagem de células no lavado nasal / Allergic rhinitis (AR) is the most common disease mediated by IgE, affecting approximately 500 million people worldwide. The AR is the clinical expression of the link between the IgE-antibodies and antigens in the nasal mucosa resulting in inflammation. Such antibodies were detected in nasal secretions of allergic rhinitis patients. As treatment for this morbidity there is specific immunotherapy (IT) as only immunomodulatory specific antigen approach. It was demonstrated that IT generates a decrease in the late response to the allergen both in the skin and in the mucosa of the respiratory tract and this reduction correlates with the decrease in the number of infiltrating cells and in the amount of inflammatory mediators. Objective: To determine the local response of specific IgE and IgG4 in nasal lavage fluids of patients with allergic rhinitis before and after treatment with specific allergen immunotherapy to house dust mite for a period of 6 months; determine the standard inflammatory response of Th1 / Th2 / Th17 and evaluate symptom score and cell counts in nasal lavage. Method: We selected patients sensitized to Dermatophagoides pteronissinus diagnosed with persistent allergic rhinitis. Nasal symptoms were assessed by Nasal Index Score, and before treatment, allergen nasal challenge and collection of nasal lavage fluid were performed. After 6 months of treatment or placebo, the patients were reevaluated. IgE specific for Der p 1 and 2, total IgE and IgG4 specific for Der p 1, total cell count were determined as well as Th1 / Th2 and Th17 cytokines. Results: We analyzed 19 patients in the immunotherapy group and 17 in the placebo group. The evaluation of symptoms by NIS scale after 6 months of intervention showed significant differences in favor of the immunotherapy group. The concentration of the extract used in the nasal challenge was higher in the immunotherapy group after 6 months of treatment but without statistical significance. The total IgE decreased after the intervention as well as the total cell count in nasal lavage. The dosage of the free cytokines in nasal lavage fluid did not change significantly. In the nasal provocation we observe an increasing in IL-13 and IL-10 in both treatment groups. Conclusion: We observed no local changes in specific IgG4 or specific IgE response in nasal lavage fluid of patients with allergic rhinitis before and after treatment with specific allergen immunotherapy to house dust mite for a period of 6 months. There was an improvement in symptom scores and a decreased of total IgE and cell counts in nasal lavage