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- Acute Pancreatitis in the Context of Abdominal Attack of Hereditary AngioedemaPublication . Lourenço, T; Fernandes, M; Lopes, A; Pereira Barbosa, M
- Chlorhexidine: a hidden life-threatening allergenPublication . Fernandes, Mara; Lourenço, Tatiana; Lopes, Anabela; Spínola Santos, Amélia; Pereira Santos, Maria Conceição; Pereira Barbosa, ManuelChlorhexidine is a commonly used antiseptic and disinfectant in the health-care setting. Anaphylaxis to chlorhexidine is a rare but potentially life-threatening complication. Epidemiologic data suggest that the cases of chlorhexidine allergy appears to be increasing. In this article we report a life-threatening anaphylactic shock with cardiorespiratory arrest, during urethral catheterization due to chlorhexidine. The authors also performed a literature review of PubMed library of anaphylactic cases reports due to this antiseptic between 2014 and 2018, demonstrating the increase in the number of cases occurring worldwide and the importance of detailed anamnesis and appropriate diagnostic workup of allergic reactions to disinfectants.
- Contribution of molecular diagnosis to bee venom allergic patients with systemic reactions during the build-up phase of bee venom immunotherapyPublication . Lourenço, Tatiana; Fernandes, Mara; Lopes, Anabela; Pedro, Elisa; Barbosa, Manuel Pereira; Santos, M. Conceição PereiraIntroduction: Bee venom (BV) allergy is one of the most common causes of severe anaphylaxis. Venom immunotherapy (VIT) is considered the most effective treatment, but systemic reactions may occur. This study aimed to characterize the sensitization profile by molecular components of patients with BV anaphylaxis under VIT and to evaluate whether systemic reactions during the build-up phase of VIT protocol are related to different sensitization patterns. Methods: A retrospective study of 30 patients under VIT for 1 year. The group of patients who reacted during the build-up phase (group A) was compared with the group with no reactions (group B). Specific IgE (sIgE) and IgG4 (sIgG4) for BV and recombinants (rApi m1, rApi m2, rApi m3, rApi m5, and rApi m10) were evaluated before and 1 year after VIT. Statistical analysis was performed using GraphPad Prism v5.01. Results: Men accounted for 80% of the sample, and mean age was 47 years (14-74 years). Group A consisted of 10 patients, and group B of 20 patients. Before VIT, sIgE to rApi m1 was detected in 86.7% of patients, rApi m2 in 46.7%, rApi m3 in 16.7%, rApi m5 in 43.3%, and rApi m10 in 70%. Positive results to at least 1 BV allergen were detected in 100%; 73% of patients were sensitized to >1 allergen, and 13.3% to all allergens. The profile of the two groups did not differ significantly before VIT, but group B showed a significant decrease in whole BV extract (p=0.045), rApi m 3 (p=0.017), and rApi m 10 (p=0.021) 1 year after VIT. Regarding sIgG4, there was a significant increase in rApi m1, which was not observed in other allergens, such as rApi m3 and rApi m10. Conclusion: The analysis of a panel of BV recombinants can improve diagnostic sensitivity, when compared to rApi m1 alone. There was no association between systemic reactions during the build-up phase of VIT and molecular sensitization profile. Nevertheless, it is important to study a greater number of patients.
- Determination of potential childhood asthma biomarkers using a powerful methodology based on microextraction by packed sorbent combined with ultra-high pressure liquid chromatography. Eicosanoids as case studyPublication . Berenguer, Pedro; Camacho, Irene C.; Câmara, Rita; Oliveira, Susana; Câmara, José S.Leukotrienes and prostaglandins are arachidonic acid bioactive derived eicosanoids and key mediators of bronchial inflammation and response modulation in the airways contributing to the pathophysiology of asthma. An easy-to-use ultra-high pressure liquid chromatography (UHPLC)-based strategy was developed to characterize biomarkers of lipid peroxidation: leukotrienes E (LTE4) and B4 (LTB4) and 11β-prostaglandin F2α (11βPGF2α), present in urine of asthmatic patients (N = 27) and healthy individuals (N = 17). A semi-automatic eVol®-microextraction by packed sorbent (MEPS) was used to isolate the target analytes. Several experimental parameters with influence on the extraction efficiency and on the chromatographic resolution, were evaluated and optimized. The method was fully validated under optimal extraction (R-AX sorbent, 3 conditioning-equilibration cycles with 250 μL of ACN-water at 0.1% FA, 10 extract-discard cycles of 250 μL of sample at a pH of 5.1, elution with 2 times 50 μL of MeOH and concentration of the eluate until half of its volume) and chromatographic conditions (14-min analysis at a flow rate of 300 μL min-1 in an UHPLC-PDA equipped with a BEH C18 column), according to IUPAC guidelines. The findings indicated good recoveries (>95%) in addition to excellent extraction efficiency (>95%) at three concentration levels (low mid and high) with precision (RSDs) less than 11%. The lack-of-fit test, goodness-of-fit test and Mandel's fitting test, revealed good linearity within the concentration range. Good selectivity and sensitivity were achieved with a limits of detection ranging from 0.04 μg L-1 for LTB4 to 1.12 μg L-1 for 11βPGF2α, and limits of quantification from 0.10 μg L-1 for the LTB4 to 2.11 μg L-1 for 11βPGF2α. The successful application of the fully validated method shows that, on average, the asthmatic patients had significantly higher concentrations of 11βPGF2α (112.96 μg L-1vs 62.56 μg L-1 in normal controls), LTE4 (1.27 μg L-1vs 0.89 μg L-1 in normal controls), and LTB4 (1.39 μg L-1vs 0.76 μg L-1 in normal controls). The results suggest the potential of the target eicosanoids on asthma diagnosis, however, a larger and more extensive study will be necessary to confirm the data obtained and to guarantee a greater robustness to the approach.
- Distribution of polymorphisms IL4 -590 C/T and IL4 RP2 in the human populations of Madeira, Azores, Portugal, CapePublication . Berenguer, Alberto; Câmara, Rita A; Brehm, António D; Oliveira, Susana; Fernandes, Ana TAbstract: The IL4 gene is located on chromosome 5q23.3-31.2. Polymorphisms within this cytokine gene, like the derivative allele T of IL4-590, have been reported as being associated to elevated IgE serum levels and asthma. In the present work, the allelic and genotypic frequency of the IL4-590 and IL4 RP2 polymorphisms was carried out in 599 individuals from Madeira, Azores, Portugal mainland, Cape Verde and Guinea-Bissau and in a sample of 101 asthmatics from Madeira population. In all populations the polymorphisms were in LD and presented a significant dissimilar allelic and genotypic distribution (p<0.05) except between mainland Portugal and Madeira when compared to Azores. Significant differences regarding both loci were found between Madeira population and the group of asthmatics. Genotype 183183TT frequency is higher for African populations while 253253CC prevails in Caucasian populations. The existence of a Hardy-Weinberg Disequilibrium in Guinea-Bissau population not observed in neutral markers leads to the hypothesis of natural selection occurring in these loci probably associated to a rapid population growth an hypothesis strengthened by neutral STRs D5S818 and CSF1PO gene diversity.
- Eritema fixo induzido por naproxenoPublication . Silva, Joana; Correia, Magna
- Fluconazole - a case report on fixed drug eruptionPublication . Correia, Magna; Freitas, João; Vieira, Rita; Perneta, Filipe; Brazão, LuzAdverse reactions to drugs, Fixed Erythema (FE), correspond to 16-21% of all skin eruptions. This disease results in the development of one or more erythematous annular or oval, plaques as a result of systemic exposure to a drug. On reexposure relapse occurs in the same place, although new lesions may arise simultaneously in other areas. Any drug can cause FE. The physiopathology involves an allergic reaction (vasculitis).
- Genetic polymorphisms and asthma: findings from a case–control study in the Madeira islandPublication . Berenguer, Anabela Gonçalves; Oliveira, Susana; Fernandes, Ana Teresa; Rodrigues, Mariana; Ornelas, Pedro; Ornelas, Pedro; Romeira, Diogo; Serrão, Tânia; Rosa, AlexandraBackground Asthma is a complex disease influenced by multiple genetic and environmental factors. While Madeira has the highest prevalence of asthma in Portugal (14.6%), the effect of both genetic and environmental factors in this population has never been assessed. We categorized 98 asthma patients according to the Global Initiative for Asthma (GINA) guidelines, established their sensitization profile, and measured their forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) indexes. Selected single nucleotide polymorphisms (SNPs) were analysed as potential markers for asthma susceptibility and severity in the interleukin 4 (IL4), interleukin 13 (IL13), beta-2-adrenergic receptor (ADRB2), a disintegrin and metalloprotease 33 (ADAM33), gasdermin-like (GSDML) and the signal transducer and activator of transcription 6 (STAT6) genes comparatively to a population reference set.
- Os Jovens Imunoalergologistas Portugueses e a RPIAPublication . Alves-Correia, Magna
- Paracoccidioidomycosis: Endobronchial Involvement in a Rare Disease in EuropePublication . Sousa, Cláudia; Alves, José; Cordeiro, MichelleWe report the case of a 64 years old man, a former farmer inVenezuela, with heavy alcoholic and tobacco smoking habits withno immunosuppressive status.As he presented hemoptoic sputum, a computed tomographicstudy was performed, showing multiple calcifications, fibro-cicatricial lesions scattered in both lungs, along with emphysema and bronchiectasis. Bronchofibroscopy documented an exuberantinflammatory process, with nacreous plaques, hemorrhagic areasand ulceration of the lower third of tracheal mucosa and bothbronchial trees. Histology of bronchial biopsies revealed a necrotiz-ing granulomatous inflammatory process with polymorphonuclearcells and macrophages. Histochemical study revealed the presenceof fungus in Grocott and PAS coloration stains (Fig. 1). No mycobac-teria or neoplastic cells were detected.A second bronchofibroscopy was executed to collect samples tomycological evaluation in a National Center, were PCR for detectionof fungal DNA identified the fungus Paracoccidioides brasiliensis.Paracoccidioidomycosis is endemic in South America, mainlyBrazil (80%), Argentina, Colombia and Venezuela1,2. Although pul-monary involvement is frequent, endobronchial lesions solelyrarely have been described2and in this case were initially misinter-preted as suggestive of neoplasm, what was excluded in histologicalstudies. This patient presented clinical, imagiological and endo-scopic improvement after treatment with itraconazole 200 mg foreighteen months.