INTRODUÇÃO: O conhecimento da prevalência das doenças alérgicas é de fundamental importância para a instituição de medidas para sua prevenção. Vários métodos têm sido utilizados para este fim, sendo que recentemente o questionário padronizado ISAAC (International Study of Asthma and Allergies in Childhood) tem permitido a comparação dos dados epidemiológicos em várias regiões. Os OBJETIVOS deste estudo foram: avaliar a prevalência da asma, rinite e eczema atópicos e sintomas relacionados, entre escolares de 6 a 7 anos, da região oeste da cidade de São Paulo, utilizando-se o questionário escrito ISAAC e comparar os dados encontrados com aqueles obtidos na fase I do Estudo ISAAC em São Paulo, examinando tendências temporais na prevalência das doenças alérgicas. MÉTODOS: Entre junho e outubro de 2002 foi aplicado questionário escrito ISAAC em 3.312 alunos. As diferenças entre proporções foram avaliadas pelo Teste do Qui-quadrado e quando necessário o Teste Exato de Fisher, sendo também calculados a Razão das Chances (Odds Ratio OR) e intervalo de confiança 95% (IC 95%) entre os sexos e na associação das doenças alérgicas. Os valores de p < 0,05 foram considerados de significância estatística. Após obtenção dos resultados, procedeu-se a nova análise, convocando-se uma amostra dos alunos que não haviam devolvido o questionário, sendo estes novos resultados considerados na análise final. RESULTADOS: As prevalências encontradas foram: asma de 24,4%, diagnóstico médico de asma 5,7%, diagnóstico de asma provável 21,5%, rinite de 25,7%, rinoconjuntivite de 11,3% , diagnóstico médico de rinite 20%, eczema atópico de 9,2% e o diagnóstico pelo critério combinado de 5,7%. Houve associação entre asma, rinite e eczema atópico em 3,8% dos escolares. O sexo masculino foi predominante para sintomas de asma e rinite, não havendo diferença para eczema. Comparando-se os dados da fase I aos dados atuais, observou-se prevalência mais elevada dos sintomas e gravidade de asma e valores menores para sintomas de rinite e eczema. CONCLUSÕES: As prevalências de asma e rinite neste estudo mostraram valores elevados em comparação ao diagnóstico médico. A prevalência de eczema atópico foi maior que aquela avaliada pelo critério combinado. Houve predomínio do sexo masculino nas respostas positivas para asma e rinite. As associações mais freqüentes foram entre asma e rinite e entre asma e eczema, havendo associação das três doenças em pequeno número de alunos. Em comparação aos dados da Fase I na região centro-sul de São Paulo, observou-se que na região oeste houve maior prevalência dos sintomas e gravidade da asma e menor prevalência de rinite e eczema. / INTRODUCTION: The knowledge about the prevalence of allergic diseases is important to introduce prevention strategies. The written questionnaire standardized by \"International Study of Asthma and Allergies in Childhood\" - ISAAC, has been used to compare epidemiological data from different regions. The aims of the present study were: to evaluate the prevalence of asthma, rhinitis and allergic eczema and related symptoms, among students from 6 to 7 years in the west area of São Paulo city, through the written questionnaire from the ISAAC study, to compare this data with those obtained in ISAAC Phase I in São Paulo identifying temporal trends in the allergic diseases prevalence. METHODS: In the period from June to October/2002 written questionnaire were applied to 3312 students. The proportion differences were estimated by Qui-square or Fisher exact test. Odds Ratio (OR) and 95% confidence interval (IC95%) between gender and the allergic diseases were evaluated. Values of p < 0,05 were considered statistically significant. RESULTS: The prevalence found were: asthma 24,4%, medical diagnosis of asthma 5,7%, probable asthma 21,5%, rhinitis 25,7%, rhino conjunctivitis 11,3%, medical diagnosis of rhinitis 20%, atopic eczema 9,2% and the medical diagnosis by the combined criterion of eczema 5,7%. There was association among asthma, rhinitis and atopic eczema in 3,8% of the schoolchildren. Male sex was prevalent in all of the subjects regarding asthma and rhinitis, but there was no difference about gender for atopic eczema. In comparison with data from ISAAC phase I, in this study it was observed higher prevalence and severity of asthma and lower values for rhinitis and eczema symptoms. CONCLUSIONS: This study demonstrated high prevalence of asthma and rhinitis when compared to their medical diagnosis. The prevalence of atopic eczema was higher than combined criterion. The male gender predominates in all positive responses regarding asthma and rhinitis. The more frequent association was observed between asthma and rhinitis, asthma and eczema, and a low number of schoolchildren presented the three allergic diseases. Comparing with phase carried out at the south area of São Paulo city, in the west region there were higher prevalence of symptoms and severity of asthma, lower prevalence of rhinitis and eczema.

Over one third of the human population is currently infected by one or more species of parasitic helminth, but the immune responses elicited by these infections remain poorly defined. Studies in helminth-exposed human populations and laboratory models suggest that helminth infection elicits a range of different effector cell types and that protective immunity and resistance to immune-mediated pathology depends on the balance between these responses. The aim of this thesis was to investigate how cytokines, the molecular mediators of the immune system, can be used to characterise human immune phenotype during natural and experimental helminth infection. Cytokines associated with innate inflammatory (TNFα, IL-6 and IL-9), Thl (IFNγ, IL-2 and IL-12p70), Th2 (IL-4, IL-5 and IL-13), Th17 (IL-17A, IL-21 and IL-23) and regulatory (IL-10 and TGFβ)immune phenotypes were analysed to provide the most comprehensive analysis of cytokine responses in human helminth infection conducted to-date. Using a multivariate statistical approach cytokines were analysed as combined immune profiles to reflect their complex interactions in vivo. In the first part of the study venous blood samples collected from a cross-sectional cohort of 284 Zimbabweans (age range: 3 -86 years) endemically-exposed to Schistosoma haematobium were cultured with antigens from different stages of the parasite's life-cycle(cercariae, adult worms and eggs) and the anti-schistosome vaccine candidate antigen glutathionine-S-transferase (GST). Cytokines responses were quantified in culture supernatants via enzyme-linked immunosorbent assay (ELISA). These assays were repeated 6 weeks after clearance of infection by anti-helminthic treatment. Parasitological and demographic characterisation of the cohort before, 6 weeks, 6 and 18 months after treatment allowed cytokine responses to be related to epidemiological patterns of infection before treatment and the risk of re-infection after treatment. The main findings of this study were:Cytokine responses to the antigens of S. haematobium cercariae are more proinflammatory than those elicited by adult worms and eggs prior to treatment, reflecting the distinct proteomes and exposure patterns of the 3 life-cycle stages Young children (5-10 years old) have a more regulatory and Th17-polarised cytokine response to S. haematobium antigens than older children and adults. These responses are significantly associated with schistosome infection intensity and may contribute to the development of resistance to schistosomiasis with age and exposure to infection Anti-helminthic treatment leads to a shift in S. haematobium cercariae, egg and GST specific cytokine responses towards a more pro-inflammatory phenotype The magnitude of change in S. haematobium-specific cytokine profiles after treatment is dependent on schistosome infection intensity at the time of treatment Individuals who remain un-infected up to 18 months after treatment to clear schistosome infection have a more pro-inflammatory and IL-21-polarised response to S. haematobium antigens 6 weeks after treatment than those who become re-infected, suggesting that post-treatment cytokine profiles promote resistance to re-infection. The second part of the study assayed systemic, parasite and allergen-specific cytokine responses in 45 adults with seasonally exacerbated allergy to grass pollen who were experimentally exposed to Trichuris suis. Cytokine responses in infected individuals were compared to those of 44 un-infected controls. This aspect of the study showed that: Exposure to T. suis promotes systemic and parasite-specific Th2 and regulatory cytokine responses, but does not alter cytokine responses to environmental allergens.

Este trabalho teve como objetivos a avaliação da cavidade nasal, através de rinoscopia, de cães portadores de afecção nasal crônica, identificando o tipo e a localização das lesões, correlacionando-as com os achados clínicos e radiográficos; verificar a epidemiologia segundo a raça, idade, peso e sexo dos; e definir o resultado qualitativo da biópsia. Foram utilizados 38 cães com sinais clínicos e alterações radiográficas compatíveis com afecção nasal crônica. Sobre a epidemiologia das afecções nasais, tivemos maior ocorrência de cães sem raça definida (SRD), adultos, macho, de porte médio e grande. As alterações mais encontradas em cavidade nasal foram as tumorais, sendo a afecção de maior ocorrência o TVT, representado em sua maioria pelo SRD adulto e macho, seguido de neoplasia de origem mesenquimal, neoplasia de origem epitelial, pólipo, rinite crônica, corpo estranho e aspergilose. A biópsia guiada por rinoscopia foi efetiva, com exceção dos tumores de origem mesenquimal. A rinoscopia neste estudo comprovou ser um meio diagnóstico efetivo, não invasivo complementar aos exames físico e radiográfico, que permite, pela técnica anterógrada associada à retrógrada, ampla visibilização da cavidade nasal, escolha do local de biópsia e colheita de material para cultivo, e em casos de corpos estranhos permite sua remoção, servindo como método diagnóstico e terapêutico. / The aim of this study was to evaluate the nasal cavity of dogs, presented with chronic nasal disease, through rhinoscopy. In addition to checking the reliability of nasal biopsy results, rhinoscopy was used to identify the type and location of lesions and to relate them to the clinical and radiographic findings. Furthermore, we also gathered epidemiology data related to breed, age, weight and gender. For the purpose of this study we used 38 dogs that presented clinical signs and radiographic alterations compatible with chronic nasal disease. Regarding the epidemiology, the highest incidence of nasal diseases was noticed in mixed breed dogs. Also, nasal disease was more frequent in adult, male, large or medium sized dogs. The majority of nasal diseases were due to tumors, and in this regard the transmissible venereal tumor (TVT) was the most frequent and was mainly diagnosed in mixed breed, male, adult dogs. Mesenchymal neoplasia were the second most frequent alteration of the nasal cavity, followed by, epithelial neoplasia, polyps, chronic rhinitis, foreign bodies and aspergillosis. Rhinoscopy guided biopsy proved to be effective except in the case of mesenchymal tumors. The results of this study prove that rhinoscopy is an effective non-invasive diagnostic tool, which complements physical and radiological examination. Moreover, this study also shows that the association of anterior and posterior rhinoscopy techniques, allow for a wide visualization of the nasal cavity and determination of the biopsy location and collection of samples for culture. In additional, rhinoscopy is a useful tool for diagnosis and removal of foreign bodies.

Diferentes estudos têm demonstrado uma maior prevalência de rinite alérgica nas áreas urbanas, sugerindo um efeito decorrente da exposição à poluentes. Por esta razão, resolvemos estudar a relação da poluição atmosférica com os achados do citológico nasal em 11 pacientes com rinite alérgica nas quatro estações do ano e compará-los a 12 indivíduos normais. No verão, observamos um aumento significante de eosinófilos no grupo alérgico (p = 0,007) e um predomínio de células ciliadas no grupo controle (p = 0,021). No outono, houve um predomínio de neutrófilos no grupo controle (p = 0,027). No inverno, ocorreu um aumento de neutrófilos (p = 0,015) no grupo controle. Houve um aumento das células caliciformes (p = 0,019) no grupo alérgico. Na primavera, ocorreu um aumento dos neutrófilos (p = 0,025) no grupo controle / Different studies have demonstrated an increase in the prevalence of allergic rhinitis in urban areas, suggesting an effect resulting from exposure to pollutants. Therefore, we studied the relationship between atmospheric pollution and nasal cytological findings in 11 patients with allergic rhinitis during the four seasons of the year compared to 12 normal individuals. In summer, a significant increase in eosinophils was observed in the allergic group (p = 0.007) and there was a predominance of ciliated cells in the control group (p = 0.021). In autumn, neutrophils predominated in the control group (p = 0.027), and an increase in neutrophils (p = 0.015) was observed in winter. An increase in goblet cells (p = 0.019) was observed in the allergic group. In spring, there was an increase of neutrophils (p = 0.025) in the control group

Aim: The aim of this project was to study the age and sex specific occurrence of atopic and non-atopic asthma and other atopic manifestations in a nationwide sample of Swedish pre-school children. Methods: All 70 allergen avoidance day-care centres (AADC) with 84 sections and 140 matched ordinary day-care centres with 440 sections in 62 municipalities across Sweden were sampled. In 2000 the staff at each section responded to a questionnaire on indoor and outdoor environment at the section. In 2002 parents of 5,886 children attending the AADCs and ODCs responded to a postal questionnaire regarding symptoms indicating prevalent asthma, allergic rhinitis, eczema, and food, furred pet and pollen allergy and other data in their children. In 2007, parents of 4255 children responded to an almost identical follow-up questionnaire. Results: The AADCs had far more strict rules than ODCs on furred pets and smoking at home and on perfume use, and the indoor environment was better, owing to better cleaning. The age specific asthma prevalence was curvilinear with a peak at age 3 of 11.4% among boys and 9.8% among girls. In addition the prevalence increased by municipality population density, a proxy for degree of urbanisation. There was a highly significant co-occurrence between all asthma-atopic manifestations, but there was no evidence of ordered sequence of manifestation onset. The asthma incidence was highly dependent on presence or absence of co-occurrence variables. Given the variable mix in the present study population, the annual asthma incidence ranged from 0.6% to 1.2%. Conclusions: AADCs had more strict rules and a better indoor environment than ODCs. The asthma prevalence was affected by age, sex and degree of urbanisation. There was close co-occurrence between all asthma and atopic manifestations but no evidence of ordered sequence of onsets. The annual asthma incidence was strongly dependent of co-occurrence conditions.

No description available.

One of the most common reasons people seek primary care and emergency care is to reduce the symptoms of allergies, such as hay fever. To meet this high demand, several recent FDA-approved methods for treating seasonal and perennial allergies have been developed, including sublingual immunotherapy tablets. Furthermore, no longer must a patient endure allergy shots; this can now be delivered sublingually. Although this method has been shown to have high safety and efficacy, very few clinicians actually utilize this form of therapy. The purpose of this paper is describe the use of sublingual immunotherapy among Nurse Practitioners (NPs) and discuss barriers that may prevent its use. Nurse Practitioners working in primary care settings were surveyed regarding their use of sublingual immunotherapy. Although many nurse practitioners treat patients with allergic disease, not one participant reported using sublingual immunotherapy. This discussion outlines some of the reasons NPs are not currently utilizing this method of allergy treatment and the findings are compared with the extant literature. This paper culminates in an evidence-based algorithm to outline best practices for utilizing sublingual immunotherapy to reduce allergy symptoms.

The present thesis explores the relationship between occupational rhinitis and occupational asthma under the postulates of the "united airways disease" concept that refers to the multiple links observed between rhinitis and asthma. Accordingly, the main objective of this thesis is to demonstrate the concomitant expression of significant changes in nasal patency and bronchial calibre following exposure to occupational agents during specific inhalation challenges, complementing the assessment with the investigation of changes in markers of airways inflammation in nasal lavage. To achieve the objectives, we set up a protocol to diagnose occupational rhinitis and conducted a study from January 2005 to January 2007 at Hopital du Sacre-Coeur de Montreal in subjects undergoing investigation for occupational asthma. The reliability of the main research tools---acoustic rhinometry and nasal lavage---used to investigate occupational rhinitis was tested by analyzing the reproducibility of the methods. Both methods proved sufficiently reproducible to be included in our investigative protocol. The results presented in this thesis demonstrate a joint reaction of the nose and the lungs in a group of study subjects after performing specific inhalation challenge. This supports the concept of a "united airways disease" and its applicability to rhinitis and asthma of occupational origin. However, the results also show that although occupational rhinitis frequently coexists with occupational asthma it can also be present without occupational asthma. The assessment of upper airways inflammation in a subgroup of study subjects by the nasal lavage method allows us to observe significant changes in eosinophils counts after the challenge that correlates with the decrease in nasal patency observed in the same subjects.

Über eine lange Zeit galt die Merzung der gesamten Herde und die Repopulation aus von toxinogenen Pasteurella multocida (Pmt) freien Herkünften als der einzig sichere Weg zur Eradikation des Erregers und so zur Verhinderung klinischer Erkrankungen der Progressiven Rhinitis atrophicans (PRa). Die Selektion infizierter Tiere schien nur in seltenen Ausnahmefällen erfolgreich zu verlaufen. In früheren Versuchen (GEIGER et al. 1992, DE JONG et al. 1994, ALT et al. 1996, SCHNÜLL 2001) wurde ein Sanierungserfolg in der Regel in kleinen, manchmal akut infizierten Herden mit weniger als 100 Sauen und / oder durch die Kombination der selektiven Diagnostik mit organisatorischen, medikamentösen und / oder immunprophylaktischen Maßnahmen erreicht. Im Unterschied zu diesen Beispielen wurde hier versucht, die Keime aus einer latent infizierten, geschlossenen Zuchtherde mit etwa 500 produktiven Sauen und Eigenremontierung an nur einem Standort ohne ein Frühabsetzen, Medikation oder Vakzinierung bei laufender Produktion allein durch die Selektion der Keimträger zu eradikieren. Der Bestand, der Mastläufer, Jungsauen für die Eigenremontierung und Zuchteberferkel für eine Besamungseberstation produziert, ist in 4 Stalleinheiten (Belegstall, Wartestall, Abferkel- und Absetzläuferstall, Jungsauenaufzuchtstall) untergebracht. Anlass für den Versuch waren klinische Erscheinungen der PRa bei gelieferten Mastläufern. In der Untersuchungsherde selbst aber traten nie klinische Symptome der Krankheit auf. Der Versuch lief in 4 zeitlichen Phasen ab: 1. Nachweis der Pmt, 2. Reagentenselektion nach gruppenweiser serologischer und bakteriologischer Untersuchung im Enzym linked immunosorbent assay (ELISA), 3. Selektion der Keimträger nach bakteriologischen Gesamtbestandsuntersuchungen durch Nasen- und Rachentupferproben mit der Polymerase-Kettenreaktion (PCR) und 4. Kontrolle und Überwachung des Sanierungserfolgs. Zu Beginn wurden eine serologische Prävalenz von 4,8 % und eine bakteriologische Nachweishäufigkeit von 7,7 % im ELISA ermittelt. Nach einer Erregerreduzierung betrug der Anteil der Pmt-Nachweise mit der PCR anfangs noch 6,2 %. Durch die Selektion infizierter Tiere konnte der Erreger aus der Herde eliminiert werden, was regelmäßige klinische, bakteriologische und serologische Kontrollen bestätigten. Im eigenen Mastbestand wurden keine Symptome der PRa beobachtet. Aus dem Versuch ist zu schlussfolgern: Die Sanierung größerer Zuchtherden auf dem beschriebenen Weg ist möglich. Neben guten Umwelt- und arbeitsorganisatorischen Bedingungen sind dazu ein hoch sensitives Verfahrens zur Erkennung der infizierten Tiere und kurze Untersuchungsperioden notwendig. Zur Diagnostik eignen sich die Entnahme von Nasen- und Rachentupferproben und ihre Untersuchungen in der PCR. Der Sanierungserfolg kann nur nach einer längeren Periode (ca. 2 Jahre) regelmäßiger klinischer, bakteriologischer und serologischer Kontrollen als sicher betrachtet werden.

Diss. (sammanfattning) Stockholm : Karol inst., 2004. / Härtill 5 uppsatser.