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- Síndrome alfa-gal: Dois casos clínicosPublication . Fernandes, Mara; Sousa, Filipa; Câmara, RitaIntrodução: Os casos descritos de alergia a carnes vermelhas têm vindo a aumentar e estão relacionados com a sensibilização à galactose -α -1,3 -galactose (alfa -gal). Casos clínicos: Os autores descrevem dois casos de alergia a carnes vermelhas por sensibilização a alfa -gal. Caso A: Sexo masculino, 47 anos, antecedentes de atopia, com vários episódios de urticária generalizada e angioedema do lábio entre 30 minutos a 6 horas após ingestão de carnes verme lhas. Os testes cutâneos foram positivos para carnes vermelhas e as IgE específicas positivas para carne de porco, vaca e alfa -gal. Caso B: Sexo masculino, 42 anos, sem antecedentes de atopia, com urticária generalizada e sensação de edema da orofaringe 6 horas após ingestão de carne de porco (> 10 episódios). Os testes cutâneos foram positivos para carne de porco e as IgE específicas positivas para carne de porco, vaca e alfa -gal. Após evicção de carnes verme lhas nenhum doente voltou a apresentar sintomas.
- Acute Pancreatitis in the Context of Abdominal Attack of Hereditary AngioedemaPublication . Lourenço, T; Fernandes, M; Lopes, A; Pereira Barbosa, M
- 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.
- What Physical Education Teachers Know About Asthma: Impact of a Training CoursePublication . Couto, M; Marques, J; Silva, D; Paiva, M; Jacinto, T; Câmara, R
- Subcutaneous immunotherapy with aeroallergens - evaluation of adherence in real lifePublication . Lourenço, Tatiana; Fernandes, Mara; Lopes, Anabela; Pedro, ElisaIntroduction. Adherence in allergen immunotherapy is crucial for its efficacy. At least 3 years of treatment are recommended for achieving a long-term modifying effect. Objectives. To assess patient’s adherence and to identify determinant factors for allergen subcutaneous immunotherapy (SCIT) suspension in patients with respiratory allergy. Methods. Retrospective analysis of the medical record of patients submitted to SCIT between January 2013 and December 2016 in our Department. Results. 323 patients were included: 52% female; mean age 30 ± 13 years; average treatment time 19 ± 13 months. 52 patients (16%) stopped SCIT: 54% female; mean age 30 ± 9 years; average treatment time 12 ± 6 months; 67% dropped the treatment during the 1st year, 27% in the 2nd and 6% during the 3rd year of treatment. Adherence rate determined was 77%. The most frequent reasons for withdrawal were due to economic reasons (47.9%), followed by patients’ perception of no clinical improvement (23%) and change to sublingual immunotherapy (11.6%). Conclusion. Adherence rate in our study was 77%. Economic reasons were the main cause of abandonment in the first year, while the perception of non-improvement was the main reason for abandonment in subsequent years. Adequate information on SCIT prescribing and rigorous monitoring of patients during the treatment can improve adherence.
- 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.
- Subcutaneous immunotherapy with aeroallergens-evaluation of adherence in real lifePublication . Lourenço, T; Fernandes, M; Coutinho, C; Lopes, A; Spinola Santos, A; Neto, M; Pereira Barbosa, MIntroduction. Adherence in allergen immunotherapy is crucial for its efficacy. At least 3 years of treatment are recommended for achieving a long-term modifying effect. Objectives. To assess patient’s adherence and to identify determinant factors for allergen subcutaneous immunotherapy (SCIT) suspension in patients with respiratory allergy. Methods. Retrospective analysis of the medical record of patients submitted to SCIT between January 2013 and December 2016 in our Department. Results. 323 patients were included: 52% female; mean age 30 ± 13 years; average treatment time 19 ± 13 months. 52 patients (16%) stopped SCIT: 54% female; mean age 30 ± 9 years; average treatment time 12 ± 6 months; 67% dropped the treatment during the 1st year, 27% in the 2nd and 6% during the 3rd year of treatment. Adherence rate determined was 77%. The most frequent reasons for withdrawal were due to economic reasons (47.9%), followed by patients’ perception of no clinical improvement (23%) and change to sublingual immunotherapy (11.6%). Conclusions. Adherence rate in our study was 77%. Economic reasons were the main cause of abandonment in the first year, while the perception of non-improvement was the main reason for abandonment in subsequent years. Adequate information on SCIT prescribing and rigorous monitoring of patients during the treatment can improve adherence.
- 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.
- 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).
- 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.