Yes / Background: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis. Methods: We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication,and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses. Results: We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95% CI -0.63,-0.42), medication (SMD -0.37, 95% CI -0.49, -0.26), and combined symptom and medication (SMD -0.49, 95% CI -0.69, -0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores.Conclusions: AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. / EAACI and BM4SIT project (grant number601763) in the European Union’s Seventh Framework Programme FP7.

Exposure to a strong T-helper 2 (Th2)-like environment during fetal development may promote allergy development. Increased cord blood (CB) levels of the Th2-associated chemokine CCL22 were associated with allergy development during the first 2 y of life. The aim of the present study was to determine whether CB Th1- and Th2-associated chemokine levels are associated with allergy development during the first 6 y of life, allowing assessment of respiratory allergic symptoms usually developing in this period. The CB levels of cytokines, chemokines, and total IgE were determined in 56 children of 20 women with allergic symptoms and 36 women without allergic symptoms. Total IgE and allergen-specific IgE antibody levels were quantified at 6, 12, 24 mo, and 6 y of age. Increased CB CCL22 levels were associated with development of allergic sensitization and asthma and increased CCL17 levels with development of allergic symptoms, including asthma. Sensitized children with allergic symptoms showed higher CB CCL17 and CCL22 levels and higher ratios between these Th2-associated chemokines and the Th1-associated chemokine CXCL10 than nonsensitized children without allergic symptoms. A pronounced Th2 deviation at birth, reflected by increased CB CCL17 and CCL22 levels, and increased CCL22/CXCL10 and CCL17/CXCL10 ratios might promote allergy development later in life.

Introdução: nas últimas décadas, tem havido aumento na prevalência das doenças alérgicas, como também na sensibilização a aeroalérgenos ou alimentos, fenômenos caracterizados como “epidemia das doenças alérgicas”. Objetivo: determinar os fatores de risco associados a sintomas de asma (sibilância) e rinoconjuntivite, descrevendo a prevalência desses sintomas em crianças escolares do município de Passo Fundo, RS. Método: estudo transversal realizado em alunos de oito a doze anos de idade matriculados em escolas públicas e particulares do ensino fundamental, moradores da zona urbana de Passo Fundo, RS. A amostra representativa dessa população foi escolhida aleatoriamente, e seus pais ou responsáveis responderam questionário escrito padrão do International Study of Asthma and Allergies in Childhood (ISAAC), acrescido de perguntas sobre fatores de risco pessoais, familiares e ambientais (ISAAC fase II). Dessa população inicial, separou-se, aleatoriamente, um subgrupo de crianças (n=878), para realizar testes cutâneos de hipersensibilidade imediata (TCHIs) com alérgenos ambientais e coletar amostras de fezes para exame protoparasitológico. As crianças também foram pesadas, tendo sua estatura aferida e seu índice de massa corporal (IMC) calculado. Resultados: a prevalência de asma ativa foi de 31,2%; de asma diagnosticada, de 16,3%; de asma induzida por exercício, de 14,1%; de asma grave, de 7,4%; de crise aguda severa de asma, de 5,6%. A prevalência de rinite ativa foi de 53%; rinoconjuntivite, 37,6%; rinite diagnosticada, 35%; rinite polínica (hay fever), 27,9%; rinite moderada a grave, 14,7%. A prevalência de eczema ativo foi de 17,8%; de eczema em dobras, 16,8%; de eczema grave, 2,7%. Eram atópicos 487/878 (55,5%), independentemente de serem asmáticos ou não; desses, 84,4% eram polissensibilizados. A maioria (70,2%) dos que tinham asma atual era atópica, sendo somente 9% monossensibilizados. Da mesma maneira, a maioria (83,1%) dos com asma ativa também era atópica (OR = 3,16; IC95%=4,4-7,6). Além disso, os asmáticos atópicos tinham asma mais grave em relação aos não atópicos (OR = 2,39; IC95% = 2,60-7,60). Os fatores de risco siginificativamente associados à asma ativa foram: história materna de asma (OR = 1,75, IC 95%= 1,05-2,87), rinite ativa (OR = 2,07, IC 95%=1,42-3,01), compartilhar quarto no primeiro ano de vida (OR = 2,03, IC 95%= 1,36-3,04), ser atópico (OR = 1,82, IC 95%=1,26-2,50), ter contato com gato intradomiciliar no primeiro ano de vida (OR = 1,73, IC 95%=1,07-2,78), usar paracetamol mais de 12× ao ano nos últimos doze meses (OR=1,68, IC 95= 1,20-2,31)), usar antibiótico com ≤6 meses de vida (OR = 1,57, IC 95%= 1,13-2,17), ter tido bronquiolite com ≤2 anos de vida (OR = 3,11, IC 95%=2,23-4,33), ter nascido de parto prematuro (OR = 1,60, IC 95%=1,02-2,50). Em relação à rinoconjuntivite, os fatores de risco foram: história de eczema no pai (OR = 3,50, IC 95%= 1,05-10,70), rinite no pai (OR= 1,73, IC 95%=1,06-2,82), residência com mofo (OR = 2,09, IC 95%=1,16-3,74), ter morado em casa úmida no primeiro ano de vida (OR = 2,05, IC 95%=1,20-3,48), ter eczema ativo (OR = 1,97, IC 95%=1,16-3,56), ter sensibilidade alérgica a Lolium perenne (OR = 14,03, IC 95%=7,75-25,40), ter sensibilidade a ácaros da poeira doméstica (OR = 2,82, IC 95%=1,77-4,52), ter tido bronquiolite com ≤2 anos idade (OR = 1,78, IC 95%=1,10-2,90). Compartilhar quarto foi fator de proteção para rinoconjuntivite (OR = 0,50, IC 95%=0,32-0,79). Os questionários foram respondidos pelas mães em 83,9%, das quais 42% tinham baixa escolaridade (≤8 anos completos). Cerca de 25% das famílias das crianças tinham renda mensal ≤1 salário mínimo (SM) vigente na época, e 4,4%, renda ≥10 SMs. Um terço dessa população era exposto a mãe fumante, tendo 15% delas afirmado que fumaram durante a gravidez e 18%, durante o primeiro ano de vida da criança. Nasceram de parto cesariano 48,0%; 15,0% eram prematuros e 20,0% da amostra tinham baixo peso (<2,500 g) ao nascer, tendo 2% pesado <1,500 g. Um terço mamou no peito menos de seis meses. Tiveram contato com cachorro dentro de casa no primeiro ano de vida 30%, e somente 12%, com gato intradomicílio. Apenas 7,5% das crianças tiveram contato com animais de fazenda no primeiro ano de vida. Conclusões: a prevalência de asma e rinoconjuntivite está acima da média mundial relatada pelos centros do projeto ISAAC fase II e acima da média nacional medida pelo projeto ISAAC fase III, Brasil. Houve uma importante associação entre asma ativa com a história materna de asma e de antecedentes pessoais atópicos (rinite ativa e atopia). Ter tido bronquiolite com <2 anos de idade foi forte fator de risco para asma ativa aos dez anos de idade. Ao contrário de algumas proposições da hipótese da higiene, contato com animais (gato) dentro de casa e compartilhar dormitório no primeiro ano de vida foram fatores de risco para asma ativa, e não de proteção. Em relação à rinoconjuntivite, igualmente, houve um forte componente genético (familiar) como fator de risco, ao lado do fator ambiental (moradia úmida e com mofo). Ter sensibilidade ao pólen de Lolium perenne mostrou-se forte fator de risco para rinoconjuntivite. Por outro lado, compartilhar quarto se mostrou fator de proteção para rinoconjuntivite na faixa etária de oito a doze anos de idade. / Introduction: over the last decades the prevalence of allergic diseases has increased, as well as the sensitization to aeroallergens or food, phenomena characterized as "allergic diseases epidemic". Objective: to determine the risk factors associated to asthma symptoms (wheezing) and rhinoconjunctivitis and to describe the prevalence of these symptoms in schoolchildren from the city of Passo Fundo, RS. Method: cross sectional study performed in students from ages nine to twelve, enrolled in public and private elementary schools, residents of the urban zone of Passo Fundo, RS. The sample representing this population was randomly selected. Their parents or responsible persons answered a written questionnaire standard to the International Study of Asthma and Allergies in Childhood (ISAAC), with the addition of questions about personal, familial and environmental risk factors (ISAAC phase II). From this initial population, a subgroup of children (n=878) was selected to perform skin prick tests (SPT) with environmental allergens and to collect stool samples for the protoparasitological exam. The children were also weighed, their height was assessed, and their body mass index (BMI) was calculated. Results: the prevalence of current asthma was 31.2%; diagnosed asthma 16.3%; exercise induced asthma 14.1%; severe asthma 7.4%; severe acute asthma attack 5.6%. The prevalence of current eczema was 17.8%; eczema in folds 16.8%; severe eczema 2.7%. Regardless of being asthmatic or not, 487/878 (55.5%) were atopic; 84.4% of these were polysensitized. Most of the children (70.2%) who had current asthma were atopic and only 9% were monosensitized. Similarly, most of the children (83.1%) with active asthma were also atopic (OR = 3.155; CI 95% = 4.40-7,60). Moreover, the atopic asthmatic children presented more severe asthma compared to the non-atopic ones (OR = 2.39; CI 95% = 2.602-7.603). The factors significantley associated to current asthma were: history of maternal asthma (OR = 1.75, IC 95%=1.05-2.87), current rhinitis (OR = 2.07; IC 95%=1.42-3.0), bedroom sharing during the first year of life (OR = 2.03; IC95%=1.36-3.04), atopy (OR = 1.82; IC 95%=1.26-2.50), indoor contact with cats during the first year of life (OR = 1.73; IC 95%=1.07-2.78), paracetamol use >12× per year over the last twelve months (OR = 1.68; IC 95%=1.20-2.31), antibiotic use ≤6 months of age (OR= 1.57; IC 95%=1.13-2.17), history of bronchiolitis in the first 2 years of life (OR = 3.11; IC 95%=2.23-4.33) and premature birth (OR = 1.60; IC 95%=1.02-2.50). Regarding rhinoconjunctivitis, the risk factors were: history of paternal eczema (OR = 3.35; IC 95%=1.05-10.70), paternal rhinitis (OR = 1.73; IC 95%=1.06-2.82), house with mold (OR = 2.09; IC 95%=1.16-3.75), having lived in a humid house during the first year of life (OR = 2.05; IC 95%=1.21-3.48), having current eczema (OR = 1.97; IC 95%=1.16-3.36), allergic sensitivity to Lolium perenne (OR = 14.0; IC 95%=7.75-25.40), sensitivity to house dust mites (OR = 2.82; IC 95%=1.77-4.52), history of bronchiolitis in the first two years old (OR = 1.78; IC 95%=1.78; IC 95%=1.10-2.90). Sharing a bedroom was a protective factor to rhinoconjunctivitis (OR = 0,50; IC 95%=0.32-0.79). A total of 84.0% of the mothers answered the questionnaires, 42% of which had a low education level (≤eight years of school completed). About 25% of families had a monthly income of ≤1 national minimum wage (NMW) at the time, while 5.0%, had an income of ≥10 NMW. One third of these children were exposed to smoking mothers. Approximately 15% of the mothers affirmed to have smoked during pregnancy, and 18% during the child‟s first year. A total of 48.0% born from C-sections; 15.0% were premature, and 20.0% of the sample had low weight (<2,500 g) upon birth, where 2% weighed <1,500 g. One third was breastfed for less than six months. A total of 30% the individual had contact with dogs inside the house during the first year of life, and only 12% had contact with indoor cat over the same period. Only 7.5% had contact with farm animals during the first year of life. Conclusions: the prevalence of asthma and rhinoconjunctivitis in Passo Fundo is above the world average measured by the ISAAC phase II, and above the national average measured by the ISAAC phase III, Brazil. There is an important association between current asthma with history of maternal asthma and personal atopic background (current rhinitis and atopy). A history of bronchiolitis during the first two years of life was a strong risk factor to current asthma at ten years old. Unlike some proposals of the hygiene hypothesis, the contact with animals (cat) inside the house and sharing a bedroom during the first year of life were risk factors for current asthma, and not protective factors. Concerning rhinoconjunctivitis, there was also a strong genetic component (family) as a risk factor, as well as an environmental component (humid house with mold). Sensitivity to Lolium perenne polen represented a strong risk factor to rhinoconjunctivitis. On the other hand, sharing a bedroom represented a protective factor to rhinoconjunctivitis at eight to twelve years old.

Introdução: nas últimas décadas, tem havido aumento na prevalência das doenças alérgicas, como também na sensibilização a aeroalérgenos ou alimentos, fenômenos caracterizados como “epidemia das doenças alérgicas”. Objetivo: determinar os fatores de risco associados a sintomas de asma (sibilância) e rinoconjuntivite, descrevendo a prevalência desses sintomas em crianças escolares do município de Passo Fundo, RS. Método: estudo transversal realizado em alunos de oito a doze anos de idade matriculados em escolas públicas e particulares do ensino fundamental, moradores da zona urbana de Passo Fundo, RS. A amostra representativa dessa população foi escolhida aleatoriamente, e seus pais ou responsáveis responderam questionário escrito padrão do International Study of Asthma and Allergies in Childhood (ISAAC), acrescido de perguntas sobre fatores de risco pessoais, familiares e ambientais (ISAAC fase II). Dessa população inicial, separou-se, aleatoriamente, um subgrupo de crianças (n=878), para realizar testes cutâneos de hipersensibilidade imediata (TCHIs) com alérgenos ambientais e coletar amostras de fezes para exame protoparasitológico. As crianças também foram pesadas, tendo sua estatura aferida e seu índice de massa corporal (IMC) calculado. Resultados: a prevalência de asma ativa foi de 31,2%; de asma diagnosticada, de 16,3%; de asma induzida por exercício, de 14,1%; de asma grave, de 7,4%; de crise aguda severa de asma, de 5,6%. A prevalência de rinite ativa foi de 53%; rinoconjuntivite, 37,6%; rinite diagnosticada, 35%; rinite polínica (hay fever), 27,9%; rinite moderada a grave, 14,7%. A prevalência de eczema ativo foi de 17,8%; de eczema em dobras, 16,8%; de eczema grave, 2,7%. Eram atópicos 487/878 (55,5%), independentemente de serem asmáticos ou não; desses, 84,4% eram polissensibilizados. A maioria (70,2%) dos que tinham asma atual era atópica, sendo somente 9% monossensibilizados. Da mesma maneira, a maioria (83,1%) dos com asma ativa também era atópica (OR = 3,16; IC95%=4,4-7,6). Além disso, os asmáticos atópicos tinham asma mais grave em relação aos não atópicos (OR = 2,39; IC95% = 2,60-7,60). Os fatores de risco siginificativamente associados à asma ativa foram: história materna de asma (OR = 1,75, IC 95%= 1,05-2,87), rinite ativa (OR = 2,07, IC 95%=1,42-3,01), compartilhar quarto no primeiro ano de vida (OR = 2,03, IC 95%= 1,36-3,04), ser atópico (OR = 1,82, IC 95%=1,26-2,50), ter contato com gato intradomiciliar no primeiro ano de vida (OR = 1,73, IC 95%=1,07-2,78), usar paracetamol mais de 12× ao ano nos últimos doze meses (OR=1,68, IC 95= 1,20-2,31)), usar antibiótico com ≤6 meses de vida (OR = 1,57, IC 95%= 1,13-2,17), ter tido bronquiolite com ≤2 anos de vida (OR = 3,11, IC 95%=2,23-4,33), ter nascido de parto prematuro (OR = 1,60, IC 95%=1,02-2,50). Em relação à rinoconjuntivite, os fatores de risco foram: história de eczema no pai (OR = 3,50, IC 95%= 1,05-10,70), rinite no pai (OR= 1,73, IC 95%=1,06-2,82), residência com mofo (OR = 2,09, IC 95%=1,16-3,74), ter morado em casa úmida no primeiro ano de vida (OR = 2,05, IC 95%=1,20-3,48), ter eczema ativo (OR = 1,97, IC 95%=1,16-3,56), ter sensibilidade alérgica a Lolium perenne (OR = 14,03, IC 95%=7,75-25,40), ter sensibilidade a ácaros da poeira doméstica (OR = 2,82, IC 95%=1,77-4,52), ter tido bronquiolite com ≤2 anos idade (OR = 1,78, IC 95%=1,10-2,90). Compartilhar quarto foi fator de proteção para rinoconjuntivite (OR = 0,50, IC 95%=0,32-0,79). Os questionários foram respondidos pelas mães em 83,9%, das quais 42% tinham baixa escolaridade (≤8 anos completos). Cerca de 25% das famílias das crianças tinham renda mensal ≤1 salário mínimo (SM) vigente na época, e 4,4%, renda ≥10 SMs. Um terço dessa população era exposto a mãe fumante, tendo 15% delas afirmado que fumaram durante a gravidez e 18%, durante o primeiro ano de vida da criança. Nasceram de parto cesariano 48,0%; 15,0% eram prematuros e 20,0% da amostra tinham baixo peso (<2,500 g) ao nascer, tendo 2% pesado <1,500 g. Um terço mamou no peito menos de seis meses. Tiveram contato com cachorro dentro de casa no primeiro ano de vida 30%, e somente 12%, com gato intradomicílio. Apenas 7,5% das crianças tiveram contato com animais de fazenda no primeiro ano de vida. Conclusões: a prevalência de asma e rinoconjuntivite está acima da média mundial relatada pelos centros do projeto ISAAC fase II e acima da média nacional medida pelo projeto ISAAC fase III, Brasil. Houve uma importante associação entre asma ativa com a história materna de asma e de antecedentes pessoais atópicos (rinite ativa e atopia). Ter tido bronquiolite com <2 anos de idade foi forte fator de risco para asma ativa aos dez anos de idade. Ao contrário de algumas proposições da hipótese da higiene, contato com animais (gato) dentro de casa e compartilhar dormitório no primeiro ano de vida foram fatores de risco para asma ativa, e não de proteção. Em relação à rinoconjuntivite, igualmente, houve um forte componente genético (familiar) como fator de risco, ao lado do fator ambiental (moradia úmida e com mofo). Ter sensibilidade ao pólen de Lolium perenne mostrou-se forte fator de risco para rinoconjuntivite. Por outro lado, compartilhar quarto se mostrou fator de proteção para rinoconjuntivite na faixa etária de oito a doze anos de idade. / Introduction: over the last decades the prevalence of allergic diseases has increased, as well as the sensitization to aeroallergens or food, phenomena characterized as "allergic diseases epidemic". Objective: to determine the risk factors associated to asthma symptoms (wheezing) and rhinoconjunctivitis and to describe the prevalence of these symptoms in schoolchildren from the city of Passo Fundo, RS. Method: cross sectional study performed in students from ages nine to twelve, enrolled in public and private elementary schools, residents of the urban zone of Passo Fundo, RS. The sample representing this population was randomly selected. Their parents or responsible persons answered a written questionnaire standard to the International Study of Asthma and Allergies in Childhood (ISAAC), with the addition of questions about personal, familial and environmental risk factors (ISAAC phase II). From this initial population, a subgroup of children (n=878) was selected to perform skin prick tests (SPT) with environmental allergens and to collect stool samples for the protoparasitological exam. The children were also weighed, their height was assessed, and their body mass index (BMI) was calculated. Results: the prevalence of current asthma was 31.2%; diagnosed asthma 16.3%; exercise induced asthma 14.1%; severe asthma 7.4%; severe acute asthma attack 5.6%. The prevalence of current eczema was 17.8%; eczema in folds 16.8%; severe eczema 2.7%. Regardless of being asthmatic or not, 487/878 (55.5%) were atopic; 84.4% of these were polysensitized. Most of the children (70.2%) who had current asthma were atopic and only 9% were monosensitized. Similarly, most of the children (83.1%) with active asthma were also atopic (OR = 3.155; CI 95% = 4.40-7,60). Moreover, the atopic asthmatic children presented more severe asthma compared to the non-atopic ones (OR = 2.39; CI 95% = 2.602-7.603). The factors significantley associated to current asthma were: history of maternal asthma (OR = 1.75, IC 95%=1.05-2.87), current rhinitis (OR = 2.07; IC 95%=1.42-3.0), bedroom sharing during the first year of life (OR = 2.03; IC95%=1.36-3.04), atopy (OR = 1.82; IC 95%=1.26-2.50), indoor contact with cats during the first year of life (OR = 1.73; IC 95%=1.07-2.78), paracetamol use >12× per year over the last twelve months (OR = 1.68; IC 95%=1.20-2.31), antibiotic use ≤6 months of age (OR= 1.57; IC 95%=1.13-2.17), history of bronchiolitis in the first 2 years of life (OR = 3.11; IC 95%=2.23-4.33) and premature birth (OR = 1.60; IC 95%=1.02-2.50). Regarding rhinoconjunctivitis, the risk factors were: history of paternal eczema (OR = 3.35; IC 95%=1.05-10.70), paternal rhinitis (OR = 1.73; IC 95%=1.06-2.82), house with mold (OR = 2.09; IC 95%=1.16-3.75), having lived in a humid house during the first year of life (OR = 2.05; IC 95%=1.21-3.48), having current eczema (OR = 1.97; IC 95%=1.16-3.36), allergic sensitivity to Lolium perenne (OR = 14.0; IC 95%=7.75-25.40), sensitivity to house dust mites (OR = 2.82; IC 95%=1.77-4.52), history of bronchiolitis in the first two years old (OR = 1.78; IC 95%=1.78; IC 95%=1.10-2.90). Sharing a bedroom was a protective factor to rhinoconjunctivitis (OR = 0,50; IC 95%=0.32-0.79). A total of 84.0% of the mothers answered the questionnaires, 42% of which had a low education level (≤eight years of school completed). About 25% of families had a monthly income of ≤1 national minimum wage (NMW) at the time, while 5.0%, had an income of ≥10 NMW. One third of these children were exposed to smoking mothers. Approximately 15% of the mothers affirmed to have smoked during pregnancy, and 18% during the child‟s first year. A total of 48.0% born from C-sections; 15.0% were premature, and 20.0% of the sample had low weight (<2,500 g) upon birth, where 2% weighed <1,500 g. One third was breastfed for less than six months. A total of 30% the individual had contact with dogs inside the house during the first year of life, and only 12% had contact with indoor cat over the same period. Only 7.5% had contact with farm animals during the first year of life. Conclusions: the prevalence of asthma and rhinoconjunctivitis in Passo Fundo is above the world average measured by the ISAAC phase II, and above the national average measured by the ISAAC phase III, Brazil. There is an important association between current asthma with history of maternal asthma and personal atopic background (current rhinitis and atopy). A history of bronchiolitis during the first two years of life was a strong risk factor to current asthma at ten years old. Unlike some proposals of the hygiene hypothesis, the contact with animals (cat) inside the house and sharing a bedroom during the first year of life were risk factors for current asthma, and not protective factors. Concerning rhinoconjunctivitis, there was also a strong genetic component (family) as a risk factor, as well as an environmental component (humid house with mold). Sensitivity to Lolium perenne polen represented a strong risk factor to rhinoconjunctivitis. On the other hand, sharing a bedroom represented a protective factor to rhinoconjunctivitis at eight to twelve years old.

Introdução: nas últimas décadas, tem havido aumento na prevalência das doenças alérgicas, como também na sensibilização a aeroalérgenos ou alimentos, fenômenos caracterizados como “epidemia das doenças alérgicas”. Objetivo: determinar os fatores de risco associados a sintomas de asma (sibilância) e rinoconjuntivite, descrevendo a prevalência desses sintomas em crianças escolares do município de Passo Fundo, RS. Método: estudo transversal realizado em alunos de oito a doze anos de idade matriculados em escolas públicas e particulares do ensino fundamental, moradores da zona urbana de Passo Fundo, RS. A amostra representativa dessa população foi escolhida aleatoriamente, e seus pais ou responsáveis responderam questionário escrito padrão do International Study of Asthma and Allergies in Childhood (ISAAC), acrescido de perguntas sobre fatores de risco pessoais, familiares e ambientais (ISAAC fase II). Dessa população inicial, separou-se, aleatoriamente, um subgrupo de crianças (n=878), para realizar testes cutâneos de hipersensibilidade imediata (TCHIs) com alérgenos ambientais e coletar amostras de fezes para exame protoparasitológico. As crianças também foram pesadas, tendo sua estatura aferida e seu índice de massa corporal (IMC) calculado. Resultados: a prevalência de asma ativa foi de 31,2%; de asma diagnosticada, de 16,3%; de asma induzida por exercício, de 14,1%; de asma grave, de 7,4%; de crise aguda severa de asma, de 5,6%. A prevalência de rinite ativa foi de 53%; rinoconjuntivite, 37,6%; rinite diagnosticada, 35%; rinite polínica (hay fever), 27,9%; rinite moderada a grave, 14,7%. A prevalência de eczema ativo foi de 17,8%; de eczema em dobras, 16,8%; de eczema grave, 2,7%. Eram atópicos 487/878 (55,5%), independentemente de serem asmáticos ou não; desses, 84,4% eram polissensibilizados. A maioria (70,2%) dos que tinham asma atual era atópica, sendo somente 9% monossensibilizados. Da mesma maneira, a maioria (83,1%) dos com asma ativa também era atópica (OR = 3,16; IC95%=4,4-7,6). Além disso, os asmáticos atópicos tinham asma mais grave em relação aos não atópicos (OR = 2,39; IC95% = 2,60-7,60). Os fatores de risco siginificativamente associados à asma ativa foram: história materna de asma (OR = 1,75, IC 95%= 1,05-2,87), rinite ativa (OR = 2,07, IC 95%=1,42-3,01), compartilhar quarto no primeiro ano de vida (OR = 2,03, IC 95%= 1,36-3,04), ser atópico (OR = 1,82, IC 95%=1,26-2,50), ter contato com gato intradomiciliar no primeiro ano de vida (OR = 1,73, IC 95%=1,07-2,78), usar paracetamol mais de 12× ao ano nos últimos doze meses (OR=1,68, IC 95= 1,20-2,31)), usar antibiótico com ≤6 meses de vida (OR = 1,57, IC 95%= 1,13-2,17), ter tido bronquiolite com ≤2 anos de vida (OR = 3,11, IC 95%=2,23-4,33), ter nascido de parto prematuro (OR = 1,60, IC 95%=1,02-2,50). Em relação à rinoconjuntivite, os fatores de risco foram: história de eczema no pai (OR = 3,50, IC 95%= 1,05-10,70), rinite no pai (OR= 1,73, IC 95%=1,06-2,82), residência com mofo (OR = 2,09, IC 95%=1,16-3,74), ter morado em casa úmida no primeiro ano de vida (OR = 2,05, IC 95%=1,20-3,48), ter eczema ativo (OR = 1,97, IC 95%=1,16-3,56), ter sensibilidade alérgica a Lolium perenne (OR = 14,03, IC 95%=7,75-25,40), ter sensibilidade a ácaros da poeira doméstica (OR = 2,82, IC 95%=1,77-4,52), ter tido bronquiolite com ≤2 anos idade (OR = 1,78, IC 95%=1,10-2,90). Compartilhar quarto foi fator de proteção para rinoconjuntivite (OR = 0,50, IC 95%=0,32-0,79). Os questionários foram respondidos pelas mães em 83,9%, das quais 42% tinham baixa escolaridade (≤8 anos completos). Cerca de 25% das famílias das crianças tinham renda mensal ≤1 salário mínimo (SM) vigente na época, e 4,4%, renda ≥10 SMs. Um terço dessa população era exposto a mãe fumante, tendo 15% delas afirmado que fumaram durante a gravidez e 18%, durante o primeiro ano de vida da criança. Nasceram de parto cesariano 48,0%; 15,0% eram prematuros e 20,0% da amostra tinham baixo peso (<2,500 g) ao nascer, tendo 2% pesado <1,500 g. Um terço mamou no peito menos de seis meses. Tiveram contato com cachorro dentro de casa no primeiro ano de vida 30%, e somente 12%, com gato intradomicílio. Apenas 7,5% das crianças tiveram contato com animais de fazenda no primeiro ano de vida. Conclusões: a prevalência de asma e rinoconjuntivite está acima da média mundial relatada pelos centros do projeto ISAAC fase II e acima da média nacional medida pelo projeto ISAAC fase III, Brasil. Houve uma importante associação entre asma ativa com a história materna de asma e de antecedentes pessoais atópicos (rinite ativa e atopia). Ter tido bronquiolite com <2 anos de idade foi forte fator de risco para asma ativa aos dez anos de idade. Ao contrário de algumas proposições da hipótese da higiene, contato com animais (gato) dentro de casa e compartilhar dormitório no primeiro ano de vida foram fatores de risco para asma ativa, e não de proteção. Em relação à rinoconjuntivite, igualmente, houve um forte componente genético (familiar) como fator de risco, ao lado do fator ambiental (moradia úmida e com mofo). Ter sensibilidade ao pólen de Lolium perenne mostrou-se forte fator de risco para rinoconjuntivite. Por outro lado, compartilhar quarto se mostrou fator de proteção para rinoconjuntivite na faixa etária de oito a doze anos de idade. / Introduction: over the last decades the prevalence of allergic diseases has increased, as well as the sensitization to aeroallergens or food, phenomena characterized as "allergic diseases epidemic". Objective: to determine the risk factors associated to asthma symptoms (wheezing) and rhinoconjunctivitis and to describe the prevalence of these symptoms in schoolchildren from the city of Passo Fundo, RS. Method: cross sectional study performed in students from ages nine to twelve, enrolled in public and private elementary schools, residents of the urban zone of Passo Fundo, RS. The sample representing this population was randomly selected. Their parents or responsible persons answered a written questionnaire standard to the International Study of Asthma and Allergies in Childhood (ISAAC), with the addition of questions about personal, familial and environmental risk factors (ISAAC phase II). From this initial population, a subgroup of children (n=878) was selected to perform skin prick tests (SPT) with environmental allergens and to collect stool samples for the protoparasitological exam. The children were also weighed, their height was assessed, and their body mass index (BMI) was calculated. Results: the prevalence of current asthma was 31.2%; diagnosed asthma 16.3%; exercise induced asthma 14.1%; severe asthma 7.4%; severe acute asthma attack 5.6%. The prevalence of current eczema was 17.8%; eczema in folds 16.8%; severe eczema 2.7%. Regardless of being asthmatic or not, 487/878 (55.5%) were atopic; 84.4% of these were polysensitized. Most of the children (70.2%) who had current asthma were atopic and only 9% were monosensitized. Similarly, most of the children (83.1%) with active asthma were also atopic (OR = 3.155; CI 95% = 4.40-7,60). Moreover, the atopic asthmatic children presented more severe asthma compared to the non-atopic ones (OR = 2.39; CI 95% = 2.602-7.603). The factors significantley associated to current asthma were: history of maternal asthma (OR = 1.75, IC 95%=1.05-2.87), current rhinitis (OR = 2.07; IC 95%=1.42-3.0), bedroom sharing during the first year of life (OR = 2.03; IC95%=1.36-3.04), atopy (OR = 1.82; IC 95%=1.26-2.50), indoor contact with cats during the first year of life (OR = 1.73; IC 95%=1.07-2.78), paracetamol use >12× per year over the last twelve months (OR = 1.68; IC 95%=1.20-2.31), antibiotic use ≤6 months of age (OR= 1.57; IC 95%=1.13-2.17), history of bronchiolitis in the first 2 years of life (OR = 3.11; IC 95%=2.23-4.33) and premature birth (OR = 1.60; IC 95%=1.02-2.50). Regarding rhinoconjunctivitis, the risk factors were: history of paternal eczema (OR = 3.35; IC 95%=1.05-10.70), paternal rhinitis (OR = 1.73; IC 95%=1.06-2.82), house with mold (OR = 2.09; IC 95%=1.16-3.75), having lived in a humid house during the first year of life (OR = 2.05; IC 95%=1.21-3.48), having current eczema (OR = 1.97; IC 95%=1.16-3.36), allergic sensitivity to Lolium perenne (OR = 14.0; IC 95%=7.75-25.40), sensitivity to house dust mites (OR = 2.82; IC 95%=1.77-4.52), history of bronchiolitis in the first two years old (OR = 1.78; IC 95%=1.78; IC 95%=1.10-2.90). Sharing a bedroom was a protective factor to rhinoconjunctivitis (OR = 0,50; IC 95%=0.32-0.79). A total of 84.0% of the mothers answered the questionnaires, 42% of which had a low education level (≤eight years of school completed). About 25% of families had a monthly income of ≤1 national minimum wage (NMW) at the time, while 5.0%, had an income of ≥10 NMW. One third of these children were exposed to smoking mothers. Approximately 15% of the mothers affirmed to have smoked during pregnancy, and 18% during the child‟s first year. A total of 48.0% born from C-sections; 15.0% were premature, and 20.0% of the sample had low weight (<2,500 g) upon birth, where 2% weighed <1,500 g. One third was breastfed for less than six months. A total of 30% the individual had contact with dogs inside the house during the first year of life, and only 12% had contact with indoor cat over the same period. Only 7.5% had contact with farm animals during the first year of life. Conclusions: the prevalence of asthma and rhinoconjunctivitis in Passo Fundo is above the world average measured by the ISAAC phase II, and above the national average measured by the ISAAC phase III, Brazil. There is an important association between current asthma with history of maternal asthma and personal atopic background (current rhinitis and atopy). A history of bronchiolitis during the first two years of life was a strong risk factor to current asthma at ten years old. Unlike some proposals of the hygiene hypothesis, the contact with animals (cat) inside the house and sharing a bedroom during the first year of life were risk factors for current asthma, and not protective factors. Concerning rhinoconjunctivitis, there was also a strong genetic component (family) as a risk factor, as well as an environmental component (humid house with mold). Sensitivity to Lolium perenne polen represented a strong risk factor to rhinoconjunctivitis. On the other hand, sharing a bedroom represented a protective factor to rhinoconjunctivitis at eight to twelve years old.

Σύμφωνα με τα ευρήματα τεσσάρων καταγραφών που έγιναν στην Πάτρα κατά την περίοδο 1978-2003, ο επιπολασμός του πρόσφατου (διαγνωσμένου στα 2 τελευταία χρόνια) και του οποτεδήποτε διαγνωσμένου κατά τη διάρκεια της ζωής συριγμού/άσθματος παιδιών σχολικής ηλικίας έχει αυξηθεί, αν και με επιβραδυνόμενο ρυθμό. Ανάλογη αύξηση παρατηρήθηκε και στον επιπολασμό της ρινοεπιπεφυκίτιδας και του εκζέματος όπως καταγράφηκε σε τρεις αποτυπώσεις στο διάστημα 1991-2003. Σκοπός: Διερευνήθηκε ο επιπολασμός του συριγμού/άσθματος, της ρινοεπιπεφυκίτιδας και του εκζέματος στο ίδιο αστικό περιβάλλον το 2008. Μέθοδος: Χρησιμοποιώντας πανομοιότυπη μεθοδολογία με τις προηγούμενες συγχρονικές αποτυπώσεις, μοιράσθηκε γραπτό ερωτηματολόγιο που απευθυνόταν στους γονείς παιδιών Τρίτης και Τετάρτης τάξης Δημοτικού Σχολείου (8-9 ετών) το 2008 και υπολογίσθηκε ο πρόσφατος και ο οποτεδήποτε διαγνωσμένος κατά τη διάρκεια της ζωής επιπολασμός των τριών νοσημάτων. Τα ευρήματα συγκρίθηκαν με εκείνα των προηγούμενων καταγραφών (1978: N=3003, 1991: N=2417, 1998: N=3076 και 2003: N=2725). Αποτελέσματα: Ο επιπολασμός του πρόσφατου άσθματος κατά τα έτη 1978, 1991, 1998, 2003 και 2008 (Ν=2688) ήταν 1.5%, 4.6%, 6.0%, 6.9% και 6.9% αντίστοιχα (p τάσης διακύμανσης διορθωμένο ως προς το φύλο <0.001). Οι αντίστοιχες τιμές για συριγμό/άσθμα οποτεδήποτε κατά τη διάρκεια της ζωής στις καταγραφές της περιόδου 1991-2008 ήταν 8.0%, 9.6%, 12.4% και 12.6% (p τάσης διακύμανσης διορθωμένο ως προς το φύλο <0.001). Ανεξαρτήτως φύλου, το διαγνωσμένο άσθμα ελαττώθηκε στα παιδιά με πρόσφατο συριγμό/άσθμα κατά 17% (p <0.001) την περίοδο 2003-2008, όμως δε συνέβη το ίδιο σε εκείνα με αποδραμόντα συριγμό/άσθμα (6.6%, p=0.16). Ο επιπολασμός της ρινοεπιπεφυκίτιδας οποτεδήποτε κατά τη διάρκεια της ζωής τα έτη 1991, 1998, 2003 και 2008 ήταν 2.1%, 3.4%, 4.6% και 5.1% αντίστοιχα (p τάσης διακύμανσης διορθωμένο ως προς το φύλο <0,001). Οι αντίστοιχες τιμές για έκζεμα οποτεδήποτε κατά τη διάρκεια της ζωής ήταν 4.5%, 6.3%, 9.5% και 10.8% (p τάσης διακύμανσης διορθωμένο ως προς το φύλο <0.001). Η αναλογία αγόρια:κορίτσια του πρόσφατου και οποτεδήποτε κατά τη διάρκεια της ζωής συριγμού/άσθματος, ρινοεπιπεφυκίτιδας και εκζέματος αυξήθηκε κατά τη διάρκεια των 30 ετών παρακολούθησης του άσθματος και των 17 ετών παρακολούθησης της αλλεργίας (p τάσης διακύμανσης <0.001). Επίσης παρατηρήθηκε αύξηση της ρινοεπιπεφυκίτιδας και του εκζέματος στα παιδιά με πρόσφατο συριγμό/άσθμα (p τάσης διακύμανσης διορθωμένο ως προς το φύλο <0.001) κατά την περίοδο 1991-2008. Το ποσοστό του συριγμού/άσθματος που μπορεί να αποδοθεί στην αλλεργία (πρόσφατος συριγμός/άσθμα με ρινοεπιπεφυκίτιδα ή/και έκζεμα οποτεδήποτε στη διάρκεια της ζωής) αυξήθηκε περαιτέρω κατά την περίοδο 2003-2008 (p <0.05, p τάσης διακύμανσης <0.001 για την περίοδο 1991-2008). Συμπεράσματα: Ο επιπολασμός του συριγμού και του άσθματος κορυφώθηκε κατά την περίοδο 2003-2008 στην Πάτρα, ενώ η αναλογία αγόρια:κορίτσια αυξήθηκε. Αντίθετα, παρατηρήθηκε συνεχής αύξηση του επιπολασμού των αλλεργικών εκδηλώσεων –ρινοεπιπεφυκίτιδα και έκζεμα– στο διάστημα 1991-2008. Η συχνότητα του συριγμού/άσθματος που μπορεί να αποδοθεί στην αλλεργία, μετά από μια απότομη κλιμάκωση κατά την περίοδο 1991-2003, συνέχισε να αυξάνεται στο διάστημα 2003-2008, αλλά με βραδύτερο ρυθμό, παρά τη διατήρηση του επιπολασμού του συριγμού/άσθματος σταθερού στη διάρκεια αυτής της πενταετίας. / According to four surveys conducted in the city of Patras, Greece, during 1978-2003, the prevalence of current (diagnosed in the last 2 years) and lifetime wheeze/asthma at schoolage has risen, albeit at a decelerating rate. A similar increase occurred in the prevalence of lifetime rhinoconjunctivitis and eczema in the three more recent surveys during 1991-2003. Aim: We examined the prevalence of wheeze/asthma, rhinoconjunctivitis and eczema in the same urban environment in 2008. Methods: Using identical methodology with the previously conducted cross-sectional surveys, a parental written questionnaire was distributed in 2008 to Third and Fourth grade schoolchildren (8-9 year-old) and the current and lifetime sex-specific prevalence of the three diseases was calculated and compared with the findings of the previous surveys (1978: N=3003; 1991: N=2417; 1998: N=3076; and 2003: N=2725). Results: The prevalence rates of current wheeze/asthma in 1978, 1991, 1998, 2003 and 2008 (N=2688) were 1.5%, 4.6%, 6.0%, 6.9% and 6.9%, respectively (sex-adjusted p for trend <0.001). Respective values for lifetime (ever had) wheeze/asthma in the 1991-2008 surveys were 8.0%, 9.6%, 12.4% and 12.6% (sex-adjusted p for trend <0.001). Irrespective of sex, diagnosed asthma declined during 2003-2008 among current wheezers by 17% (p<0.001); however, this was not the case among non-current wheezers (6.7%, p=0.16). The prevalence rates of lifetime rhinoconjunctivitis in 1991, 1998, 2003 and 2008 were 2.1%, 3.4%, 4.6% and 5.1%, respectively (sex-adjusted p for trend <0.001). The respective values for lifetime eczema were 4.5%, 6.3%, 9.5% and 10.8% (sex-adjusted p for trend <0.001). The male:female ratio of current and lifetime wheeze/asthma, rhinoconjunctivitis and eczema increased during the 30-year surveillance period of wheeze/asthma and the 17-year surveillance period for allergic disease (p for trend <0.001). Among current wheezers/asthmatics there was an increase in lifetime rhinoconjunctivitis and lifetime eczema (sex-adjusted p for tend <0.001) over the period 1991-2008. The proportion of wheeze/asthma attributable to allergy (current wheeze/asthma with lifetime rhinoconjunctivitis and/or eczema) increased further during 2003-2008 (p <0.05, p for trend during 1991-2008 <0.001). Conclusions: Childhood wheeze and asthma have reached plateau during the 2003-2008 period in Patras, Greece. The diagnosis of asthma declined among schoolage but not preschool wheezers during the same period, while the male:female ratio increased. On the other hand, there was a continuous increase in the prevalence of allergic manifestations, i.e. rhinoconjunctivitis and eczema, during 1991-2008. The frequency of wheeze/asthma attributable to allergy, after a steep rise in 1991-2003, continued to increase during 2003-2008 –albeit at a decelerating rate–despite the wheeze/asthma plateau which occurred over this 5-year period.

Asthma and rhinitis epidemiology has wide variations around the world. The aim of this review was verify the prevalence of asthma and rhinitis in South America and report differences from other regions of the world. We reviewed studies with International Study of Asthma and Allergies in Childhood (ISAAC) methodology in South America, Phases I and III. In South America the ISAAC Phase I ranked four countries among top ten in prevalence of asthma and three countries among top ten in prevalence of rhinoconjunctivitis. ISAAC Phase III showed little changes in asthma and rhinitis prevalence in South American countries. The prevalence increases of asthma and rhinitis in South American centers indicate that the burden of both is continuing to rise, but the differences in prevalence are lessening. / Revisión por pares

In this investigation of immunotherapy (IT) children 6-16 years old with rhinoconjunctivitis due to birch polli­nosis were included. I. Methodological studies. To monitor IT a reliable provocation test is desirable. The conjunctival provocation test (CPT) was evaluated in 20 children with four repeated challenges. The test was found to have a good preci­sion, it was simple and appeared to be clinically safe. After repeated tests the levels of IgE antibodies against birch increased considerably in three children, indicating an immunological response. A pollen peak affects the symptoms of an atopic individual for several days. Thus pollen counts for previous days must be taken into account when relating symptom scores with the counts. A dynamic time series model was therefore developed by which groups of atopic patients could be compared when exposed to different amounts of pollens. II: Cross-reactivity between deciduous trees during IT. Immunotherapy with pollen allergen preparations made from either birch (B) or a mixture of birch, alder and hazel (M) were compared. As measured with symptom scores the children in the M group improved at least as much as those in the B group. In the B group but not in the M group the improvement correlated with immunochemical findings before IT or early during the treatment, probably an unsignificant finding. Otherwise there was little difference between the two groups. Analysis of sera with crossed radioimmunoelectrophoresis in 20 children revealed that 60% of the children below 13 years had de­veloped IgE antibodies during IT against allergens against which they had not been allergic before IT. This had no appearent clinical implications. III: Oral immunotherapy (OIT). A pilot study of 18 children treated with high doses of a birch pollen allergen preparation in enteric coated capsules and 8 untreated controls indicated that OIT was effective as shown by lower symptom scores, less conjuctival sensitivity and increased levels of IgE antibodies against birch. However, the gastrointestinal side-effects were pronounced. Therefore a second double-blind study, in 30 children, was performed reducing the side-effects through a different dose schedule. Compared with the placebo group, the ac­tively treated children had lower symptom scores (p = 0.04), reduced skin sensitivity (p = 0.01), increasing levels of IgE (p = 0.001) and IgG (p = 0.007) antibodies against birch before the birch pollen season and a suppression of the seasonal increase in levels of IgE antibodies against birch (p &lt;0.001). After three months of OIT but not after ten months they also had a lower sensitivity in CPT than the controls (p = 0.01). The intestinal permeability as assessed by the urinary recovery of differently-sized polyethyleneglycols was studied in 24 of the children during IT. No changes were seen in the group of actively treated children. In two ad­ditional children openly treated with OIT small bowel biopsies were taken with normal morphological findings. Thus OIT did not result in a generalized inflammation of the small bowel. / digitalisering@umu