INTRODUÇÃO: A dermatite atópica é uma doença inflamatória crônica da pele que possui alta prevalência e etiopatogenia multifatorial. Os ácaros são alguns dos desencadeadores das crises desta enfermidade. OBJETIVO: avaliar a freqüência de positividade ao teste de contato, utilizando extratos do ácaro Aleuroglyphus ovatus em doentes com dermatite atópica, comparando-a à dos doentes portadores de alergia respiratória e à dos indivíduos sem atopia. MÉTODOS: Cento e vinte e quatro indivíduos (48 doentes com dermatite atópica, 47 com alergia respiratória e 29 sem atopia) foram avaliados através do teste de contato contendo extrato de Aleuroglyphus ovatus nas concentrações de 0,1%, 0,5%, 1,0%, 1,5%, 2,0%. O teste de puntura com leitura imediata (“prick test") e a dosagem da IgE sérica também foram avaliados. RESULTADOS: seis doentes com dermatite atópica, 4 com alergia respiratória e 1 indivíduo sem atopia responderam positivamente ao teste de contato alérgico com Aleuroglyphus ovatus. Não houve diferença estatística significativa entre os grupos estudados. CONCLUSÃO: O Aleuroglyphus ovatus possui papel relativo na elicitação das crises de dermatite atópica, podendo o teste de contato alérgico com Aleuroglyphus ovatus ser usado em caso de dúvida no diagnóstico etiológico. / INTRODUCTION: Atopic dermatitis is a chronic, inflammatory disease of the skin with high prevalence and complex etiopathogenesis. Mites are known to cause flares of this disease. OBJECTIVE: Evaluation of the epicutaneous test response with Aleuroglyphus ovatus antigen in patients with atopic dermatitis. METHODS: One hundred and twenty four subjects were patch tested with Aleuroglyphus ovatus antigen in concentrations of 0.1%, 0.5%, 1.0%, 1.5%, 2.0%. Forty eight patients with atopic dermatitis, 47 with respiratory allergy and 29 healthy subjects were studied. Prick test and total serum IgE were also evaluated. RESULTS: six patients with atopic dermatitis, 4 with respiratory allergy and 1 healthy subject had positive responses to Aleuroglyphus ovatus atopy patch test. No statistical differences among the studied groups were found. CONCLUSION: This mite must have a relative role in the atopic dermatitis flares and Aleuroglyphus ovatus atopy patch test should be reserved for etiopathogenic uncertainties cases.

INTRODUÇÃO: A dermatite atópica é uma doença inflamatória crônica da pele que possui alta prevalência e etiopatogenia multifatorial. Os ácaros são alguns dos desencadeadores das crises desta enfermidade. OBJETIVO: avaliar a freqüência de positividade ao teste de contato, utilizando extratos do ácaro Aleuroglyphus ovatus em doentes com dermatite atópica, comparando-a à dos doentes portadores de alergia respiratória e à dos indivíduos sem atopia. MÉTODOS: Cento e vinte e quatro indivíduos (48 doentes com dermatite atópica, 47 com alergia respiratória e 29 sem atopia) foram avaliados através do teste de contato contendo extrato de Aleuroglyphus ovatus nas concentrações de 0,1%, 0,5%, 1,0%, 1,5%, 2,0%. O teste de puntura com leitura imediata (“prick test”) e a dosagem da IgE sérica também foram avaliados. RESULTADOS: seis doentes com dermatite atópica, 4 com alergia respiratória e 1 indivíduo sem atopia responderam positivamente ao teste de contato alérgico com Aleuroglyphus ovatus. Não houve diferença estatística significativa entre os grupos estudados. CONCLUSÃO: O Aleuroglyphus ovatus possui papel relativo na elicitação das crises de dermatite atópica, podendo o teste de contato alérgico com Aleuroglyphus ovatus ser usado em caso de dúvida no diagnóstico etiológico. / INTRODUCTION: Atopic dermatitis is a chronic, inflammatory disease of the skin with high prevalence and complex etiopathogenesis. Mites are known to cause flares of this disease. OBJECTIVE: Evaluation of the epicutaneous test response with Aleuroglyphus ovatus antigen in patients with atopic dermatitis. METHODS: One hundred and twenty four subjects were patch tested with Aleuroglyphus ovatus antigen in concentrations of 0.1%, 0.5%, 1.0%, 1.5%, 2.0%. Forty eight patients with atopic dermatitis, 47 with respiratory allergy and 29 healthy subjects were studied. Prick test and total serum IgE were also evaluated. RESULTS: six patients with atopic dermatitis, 4 with respiratory allergy and 1 healthy subject had positive responses to Aleuroglyphus ovatus atopy patch test. No statistical differences among the studied groups were found. CONCLUSION: This mite must have a relative role in the atopic dermatitis flares and Aleuroglyphus ovatus atopy patch test should be reserved for etiopathogenic uncertainties cases.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, 2004. / Bibliyografya var.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 4 uppsatser.

Introdução: A doença do refluxo gastroesofágico (DRGE) refratária pode estar relacionada à maior sensibilização a alimentos pelo dano ácido-péptico às junções intercelulares e/ou pelo aumento do pH gástrico pelos inibidores de bomba de prótons (IBPs). A falha na resposta ao tratamento da DRGE tem sido atribuída, entre outras causas, à esofagite eosinofílica (EE). Objetivo: O objetivo principal do estudo foi avaliar a sensibilização a alimentos nos pacientes com DRGE refratária. Como objetivos secundários, comparamos as características dos pacientes sensibilizados com os não sensibilizados e verificamos a resposta clínica da DRGE à dieta de restrição aos alimentos aos quais o paciente estava sensibilizado. Métodos: Os pacientes com DRGE refratária realizaram dieta de restrição baseada no resultado de teste cutâneo de leitura imediata (TCLI) e teste cutâneo de contato (TCC) com alimentos. As características dos pacientes sensibilizados foram comparadas com os não sensibilizados com relação à atopia e número de eosinófilos na mucosa esofágica. Resultados: A prevalência de sensibilização a alimentos nos pacientes com DRGE refratária foi de 27,7%, sendo 15,3% pelo TCLI e 12,3% pelo TCC. Os asmáticos apresentaram maior sensibilização a alimentos (p=0,008). Foi identificada a presença de eosinófilos na mucosa esofágica em 15,8% dos pacientes e esta correlacionou-se com maior sensibilização a alimentos (p=0,011). Foi confirmado um caso de EE. A dieta de exclusão aos alimentos identificados promoveu melhora clínica dos sintomas da DRGE (p=0,004). Conclusão: A presença de eosinófilos na mucosa esofágica associada à maior sensibilização a alimentos e a resposta à dieta de exclusão em pacientes com testes positivos sugere que a DRGE refratária pode representar um estágio inicial da EE. / Abstract: Refractory gastroesophageal reflux disease (GERD) can be related to greater sensitization to foods due to peptic acid damage to intercellular junctions and/or due to the increase in gastric pH by proton pump inhibitors (PPIs). The lack of response to treatment of GERD has been attributed to, among other causes, eosinophilic esophagitis (EE). Objective: The principal objective of the study was to evaluate the sensitization to foods in patients with refractory GERD. As secondary objectives, we compared the characteristics of sensitized patients with those non-sensitized and found a clinical response of GERD to a diet restricting foods to which the patient was sensitized. Methods: Patients with refractory GERD were put on a restriction diet based on the results of skin prick test (SPT) and atopy patch test (APT) with foods. The characteristics of the sensitized patients were compared to those non-sensitized in relation to atopia and number of eosinophils in the esophageal mucosa. Results: The prevalence of sensitization to foods in patients with refractory GERD was 27.7%, where 15.3% were determined by SPT and 12.3% by APT. Asthmatics showed higher sensitization to foods (p=0.008). The presence of eosinophils in the esophageal mucosa was determined in 15.8% of patients, and this correlated with greater sensitization to foods (p=0.011). One case of EE was confirmed. A diet excluding identified sensitizing foods led to clinical improvement with regard to GERD symptoms (p=0,004). Conclusion: The presence of eosinophils in esophageal mucosa associated with greater sensitization to foods and the response to restriction diet in patients with positive tests suggest that refractory GERD can represent an initial stage of EE.

Bakgrund: Eksem förekommer hos 10-20% av barn i hela världen. En tredjedel av barnen med eksem har födoämnesallergi. Hos de flesta växer födoämnesallergin bort innan skolåldern. Förbättrat kliniskt omhändertagande och bättre förståelse av hur klinisk tolerans uppkommer är viktiga mål för forskning inom barnmedicin. Studieupplägg: Denna doktorsavhandling baseras på studier av två grupper av barn. Den första är en stor grupp med misstänkt allergi som undersökts med pricktest vid ett tillfälle. Den andra gruppen består av små barn med eksem och misstänkt födoämnesallergi. Barnen påbörjade studien innan två års ålder och har sedan följts över tid till fyra och ett halvt års ålder. Säkerhet vid pricktest: 5908 barn med en medelålder på 6 år och 5 månader, undersöktes med pricktest (SPT). Sju barn (0,12 %) reagerade med generaliserad allergisk reaktion (GAR), och behövde antiallergisk medicinering. Sju barn reagerade vasovagalt (VVR) med svimning eller ”nära-svimning”. Riskfaktorer för GAR var ålder <1 år (RR 6,28) och aktivt eksem (RR 16,98). Risken för VVR var högst hos tonårsflickor och barn/ungdomar undersökta med många allergen (många prickar) samtidigt, oavsett om de var positiva eller inte. Effekt av lokalbehandling och födoämneselimination hos spädbarn med eksem: 123 barn, 52 flickor och 71 pojkar deltog i studien. Åldern varierade mellan 1-24 månader, med en medelålder på 8,4 månader vid studiens början. Kraven för att få delta var eksem och/eller misstänkt födoämnesallergi. Diagnos av eksem gjordes med stöd av Hanifin och Rajkas kriterier. Eksemgrad bedömdes med instrumentet SCORAD. Barnen bedömdes vid två tillfällen med ca sex veckors mellanrum. 62 % av barnen hade positiv pricktest för födoämnen. SCORAD-värdena i gruppen med positiv pricktest var högre än i gruppen med negativ pricktest, barnen som var födoämnessensibiliserade hade alltså svårare eksem. Efter sex veckors behandling; födoämneselimination+ lokalbehandling hos SPTpositiva barn; endast lokalbehandling hos SPT-negativa barn; var det ingen skillnad i eksemens svårighetsgrad mellan de två grupperna. Både födoämnessensibiliserade och icke födoämnessensibiliserade förbättrades signifikant av behandling. En grupp med negativ pricktest, men med påvisade antikroppar mot födoämnen i blodet (analyserade först i efterhand), som behandlades enbart med lokalbehandling förbättrade sina eksem lika mycket som de barn som också ställts på eliminationskost. Antikroppar i blod och saliv i relation till toleransutveckling: Serumnivåer av total- samt ägg- och mjölkspecifika antikroppar av IgE, IgG1 och IgG4 analyserades. I saliv analyserades totalnivåer av sekretoriskt IgA samt specifikt IgA mot mjölk och ägg. Prover togs vid studiens början, efter sex veckor samt vid 4,5 års ålder. Barn som var sensibiliserade mot mjölk och/eller ägg, men som tålde dessa födoämnen vid 4,5 års ålder hade högre IgG4 nivåer och högre IgG4/IgE-kvot vid studiens början, än de barn som ej uppnått tolerans. De högsta IgG4/IgE-kvoterna sågs hos barnen med negativt pricktest men positivt specifikt IgE i blod. Under den första korta observationsperioden på sex veckor sågs ingen påverkan på barnens antikroppsnivåer. Recept/metodutvecklande och resultat av öppna och dubbel-blinda placebokontrollerade födoämnesprovokationer: Efter recept och metodutveckling för födoämnesprovokationer med mjölk och ägg, utfördes 52 provokationer på 39 barn. Fyra barn, alla provocerade blint, reagerade på provokationen. Generella slutsatser: Risken för generaliserade allergiska reaktioner vid pricktest är liten hos barn och tonåringar, men den finns. Riskfaktorer är låg ålder och aktivt eksem. Vasovagala reaktioner är lika vanliga som generaliserade allergiska reaktioner. Lokalbehandling/smörjning ger signifikant förbättring av eksem. Elimination av födoämnen kanske inte är nödvändigt hos eksembarn med sensibilisering för mjölk och ägg under förutsättning att hudvården sköts noga. Höga IgG4/IgE-kvoter av specifika antikroppar mot födoämnen kan vara associerat med snabbare toleransutveckling, och kan stödja idén med fortsatt allergenexponering hos födoämnessensibiliserade barn. Recept på beredningar som väl maskerar komjölk och ägg, vid öppna och blindade födoämnesprovokationer, är en god hjälp vid provokationer av små barn som ofta är misstänksamma mot nya smaker och konsistenser av mat. / Background: Eczema affects at least 20 % of children worldwide, and 1/3 of them also have food allergy. In most children, the food allergy is temporary. Improved clinical management and better understanding of etiological mechanisms underlying the tolerance development are target issues in paediatric research. Study design: The thesis is based on two study groups. The first is a large group of children with suspected allergy investigated with skin prick test in a cross-sectional study. The second group is a cohort of infants with eczema and/or suspected food allergy before 2 years of age, investigated prospectively with follow-up to 4.5 years of age. Safety of skin prick test (SPT): 5908 children with a mean age of 6.4 years (range: 1 month – 18 years) were investigated with SPT. Seven children, i.e. 0.12%, displayed a generalized allergic reaction (GAR), necessitating pharmacological treatment. Seven children showed a vasovagal reaction (VVR). Risk factors for GAR were age < 1 year (RR 6.28) and eczema (RR 16.98). The risk for VVR was highest among female adolescents, and children investigated with multiple skin pricks. The effect of skin care and food elimination on eczema in infants: 123 children, 52 girls and 71 boys, with a mean age of 8.4 months (range: 1-24 months) were recruited due to eczema and/or suspected food allergy. For diagnosis of eczema, the Hanifin and Rajka criteria were used, and for scoring of eczema severity SCORAD. The infants were investigated twice with an interval of 6 weeks. 62% showed positive SPTs. The SCORAD was higher among the sensitized children before treatment compared to not sensitized children. After treatment, i.e. skin care for all and elimination diet for sensitized children, there was no difference regarding eczema severity. Both SPT-positive and SPT-negative children decreased their SCORAD values significantly after treatment. A SPT-negative subgroup, with circulating specific IgE to milk/egg, was only treated with skin care, but these children improved their eczema to the same extent as those also treated with an elimination diet. Serum and salivary antibodies and achievement of tolerance Analyses were performed regarding: serum levels of total and egg- and milk-specific IgE antibodies, IgG1 and IgG4 antibodies to β-lactoglobulin (BLG) and ovalbumin (OVA); and salivary levels of total IgA, total SIgA and salivary IgA antibodies to OVA and BLG. Samples were drawn at inclusion, after 6 weeks of intervention (skin care, elimination diet), and at 4.5 years of age. Children sensitized to egg and/or milk who had developed tolerance at 4 ½ years of age had higher levels of IgG4 antibodies to OVA and BLG and also higher IgG4/IgE ratios on inclusion in the study, than those who remained non-tolerant. The highest IgG4/IgE ratios were found in children with circulating IgE antibodies to egg and/or milk but negative SPT on inclusion. The six-week treatment period did not significantly affect the levels of serum and salivary antibodies. Recipes and outcomes of open and double-blinded food challenges in children: After development of recipes for open and blinded challenge with cow’s milk and egg, 52 challenges were performed in 39 children. 4 children, challenged blindly, had a positive outcome of the challenge. General conclusions: The risk for generalized allergic reactions at SPT is low among children and teenagers, but allergic reactions do occur, and low age and eczema are risk factors. Vasovagal reactions occur as often as allergic reactions. Skin care gives significant improvement of eczema severity. Elimination diet may not be needed in infants with sensitization to milk and/or egg, provided that the skin care is adequate. High ratios of serum IgG4/IgE antibodies to food allergens may be associated with faster achievement of clinical tolerance, and may support the concept of benefit from continuing allergen exposure in sensitized children. Recipes for masking of cow’s milk and egg in open or blinded food challenges may help to accomplish challenges in young children, often suspicious to unfamiliar tastes or textures.

Thesis (Ph.D.) -- University of Western Sydney, Hawkesbury, 2001. / A thesis presented in fulfilment of the requirement for the degree of Doctor of Philosophy, College of Science, Technology and Environment, University of Western Sydney, Richmond, April 2001. Bibliography : leaves 138-148.

A Aspergilose Broncopulmonar alérgica (ABPA) é uma doença complexa,desencadeada por uma reação de hipersensibilidade ao Aspergillus fumigatus, que apresenta vários estágios, sendo que no estágio mais grave, os pacientes apresentam bronquiectasias. O diagnóstico da doença é difícil e o maior problema é a falta de antígenos padronizados necessários para a determinação de anticorpos específicos. O objetivo do presente estudo é avaliar se os testes cutâneos com os análogos de Asp f 1 podem auxiliar no diagnóstico e no estadiamento da ABPA. Três grupos de pacientes classificados por testes sorológicos foram obtidos a saber 20 ABPA (16BQ+; 4BQ-), 25 possíveis -ABPA (14BQ+;11BQ-) e 24 asmáticos sem ABPA (11BQ+;13BQ-). Fizeram parte do estudo 10 pessoas sem asma . Todos foram submetidos a testes intradérmicos com três antígenos a-sarcina, mitogilina e estrictocina.Houve uma intensa reação a todos os antígenos e as reações produzidas foram semelhantes para os três antígenos. As reações de leitura tardia positivas à mitogilina foram biopsiadas. As biopsias de 2 (12,5%) dos pacientes BQ+ do grupo ABPA e 5 do grupo ABPA possível com BQ+ (35,6%) mostraram vasculite por depósito de imunocomplexos. 11 pacientes do terceiro grupo não apresentaram vasculite. O quarto grupo não apresentou reação tardia. Todos os pacientes com reação positiva apresentaram BQ+. alfa-sarcina, a mitogilina e a restrictocina diferenciaram pacientes com ABPA por testes intradérmicos e podem ser aplicados no diagnóstico da doença. A maior incidência de bronquiectasias foi encontrada no primeiro grupo (80%) e no segundo (56%). No terceiro grupo nenhum caso foi encontrado em 23 pacientes com asma e teste ID positivo ao aspergillus fumigatus todos os pacientes com vasculite tinham bronquiectasia. Há possibilidade de que as lesões produzidas nos pulmões sejam produzidas por vasculite. / Allergic Bronchopulmonary Aspergillosis (ABPA) is a complex disease, triggered by a hypersensitivity reaction to Aspergillus fumigatus. The disease diagnosis is difficult, and a major problem is the lack of standardized allergens for the determination of specific antibodies. The aim of the present study is to evaluate if intradermal (ID) tests with analogs of Asp f 1 can aid in the diagnosis and stage assessment of abpa. Three groups of patients classified by serological tests were obtained. 20 ABPA (16BQ+; 4BQ-), 25 possible-ABPA (14BQ+; 11BQ-), 24 asthmatic-ABPAfree (11BQ+; 13BQ-) and 10 asthma-free people were submitted to id tests with three antigens: mitogillin, a-sarcin and restrictocin. There was intense reaction to all three antigens and the response was similar. The positive reactions to mitogillin were biopsied. The skin biopsies of two (12,5%) bq+ patients of the first group and 5 BQ+ (35,6%) patients of the second one showed vasculitis by immune complexes (IC) deposition. 11 patients of the third group had negative biopsies. The fourth group didn\'t have late-reaction. All patients with positive reaction were BQ+. By ID test, alfa-sarcin, mitogillin and restrictocin could differentiate patients with abpa and can be applicable in disease diagnosis. The higher incidence of bronchiectasis was found in the first (80%) and second (56%) groups. In the third group, IC wasn\'t found in 23 asthma patients and id test was positive to A. fumigatus. All patients with vasculitis by IC had bronchiectasis. Therefore, the results indicate that this kind of pulmonary lesion is caused by vasculitis.