Journal of investigational allergology & clinical immunology, 2012
Guided self-management is an important component of asthma care. Most trials have evaluated paper... more Guided self-management is an important component of asthma care. Most trials have evaluated paper-based strategies. The effectiveness of new communication technologies remains uncertain. To compare the feasibility and clinical outcomes of a standard paper-based asthma self-management strategy with web-based strategies. In a crossover trial, 21 patients using inhaled corticosteroids and long-acting B2-agonists (mean [SD] age 29 [10] years) were randomly assigned to use a sequence of web-based and paper-based diary and action plan. Quality of life, asthma control, lung function, and airway inflammation were assessed using the Asthma Life Quality Questionnaire (ALQ), Asthma Control Questionnaire (ACQ-5), Mini Asthma Quality of Life Questionnaire (Mini AQLQ), and office spirometry. The ratio of forced expiratory volume in the first second of expiration (FEV1) to peak expiratory flow (PEF) rate (PiKo-1) and fraction of exhaled nitric oxide (FE(NO)) were monitored. The main clinical outco...
Journal of investigational allergology & clinical immunology, 2011
Sputum induction is a noninvasive method for the assessment of airway inflammation. To evaluate t... more Sputum induction is a noninvasive method for the assessment of airway inflammation. To evaluate the safety of the procedure and the clinical predictors of successful induction, and to analyze the relationship between sputum cell counts and clinical features in asthmatic and nonasthmatic children. We reviewed sputum inductions performed in our department between 2006 and 2008 in individuals under 18 years; 34 asthmatic and 24 nonasthmatic children were included. Sputum induction was performed with 4.5% saline for 5-minute periods with salbutamol pretreatment. The most viscid portions were selected for processing. Inductions which were tolerated for less than 4 minutes or which produced a sample volume of less than 1 mL or a sample with a squamous cell percentage of over 80% were considered unsuccessful. Sputum induction was successful in 43 (74%) of the 58 children studied.The total median induction time was 15 minutes (interquartile range, 10-15 minutes). Only 7 individuals (12%) ex...
RATIONALE: Compare parental self-report of rural environmental triggers with allergen dust sample... more RATIONALE: Compare parental self-report of rural environmental triggers with allergen dust samples and willingness of parents of children with asthma to make changes after home environmental intervention. METHODS: Twenty families previously enrolled in an asthma study received standardized allergen reservoir dust sample collection from child's bedroom for cat, dog, mold and mouse. Parents were interviewed regarding home exposures and their willingness to make changes regarding exposures, how to reduce contact positive dust allergens detected. Analysis was conducted of concordance between dust samples, parental report and frequency of willingness to makes changes in environment. RESULTS: Positive cat exposure was found in 17 homes reporting no cat, and 23% of no cat homes had moderate cat dust levels. Mouse exposure was found in 12 homes that reported no mouse exposure, with 50% at moderate levels. Dog exposure was found in 13 homes reporting no dog, with 61% at high levels. Self-report of home mold was higher in that 87% reporting no dampness or mold verified by home inspection. Most mothers made changes in the home following intervention (18/20, 90%). Maternal history of asthma was associated with positive report of family changes for exposures (6/12, 50%) positive maternal history of asthma made changes in the home after intervention. Neither specialty care, or father's asthma history asthma were associated with making changes. CONCLUSIONS: Validation of self-reported home exposures with dust samples is recommended. Determining maternal asthma history may increase family willingness to intervene recommended environmental control education.
CD8+ Lymphocytes in the Blister Fluid of Severe Acute Cutaneous Graft-versus-Host Disease: Further Similarities with Toxic Epidermal Necrolysis
Dermatology, 2001
Background: Graft-versus-host disease (GvHD) remains the major toxicity of allogeneic bone marrow... more Background: Graft-versus-host disease (GvHD) remains the major toxicity of allogeneic bone marrow transplantation (BMT). In the acute form of the disease, the differential diagnosis includes viral rash and drug eruptions. Methods: We report two patients with chronic myeloid leukemia submitted to allogeneic BMT who developed a severe form of acute cutaneous GvHD, with clinical and histological pictures mimicking toxic epidermal necrolysis (TEN). Results: We found a predominance of peripheral CD8+ T lymphocytes and, at the same time, studying the cellular profile of the blister fluid, just in the beginning of blister eruption, we also found a high proportion of CD8+ T lymphocytes, mainly CD8+CD57–. Conclusion: These data are in agreement with previous reports of the presence of CD8+ T cells in the blister fluid of patients with TEN, further emphasizing similar immunoinflammatory pathways in both diseases.
Background Elite swimmers are at increased risk of asthma, which has been related to chronic effe... more Background Elite swimmers are at increased risk of asthma, which has been related to chronic effects of pool chlorine environment. However acute effects of swimming on rhinitis remain unknown. Objective We aimed to assess the nasal response to exercise in competitive swimmers compared with competitive runners. Methods Measurements of nasal symptoms, peak nasal inspiratory flow, lung function, dyspnea, and of airway inflammation were obtained before and after a training session of 19 international-level swimmers and 13 professional runners. Exercise-induced rhinitis was defined as a fall in peak nasal inspiratory flow above 20% from baseline and atopy by positivity to skin-prick testing. Changes within groups were compared using paired t test and differences compared by analysis of covariance. Results Prevalence of exercise-induced rhinitis was similar between swimmers and runners, respectively 21% and 23%. Contrary to runners, swimmers experienced a decrease in nasal inspiratory flo...
Allergy & Clinical Immunology International - Journal of the World Allergy Organization, 2006
Background: This paper reviews the recent literature on rhinitis in athletes and the relationship... more Background: This paper reviews the recent literature on rhinitis in athletes and the relationship of nasal and exercise physiology with environmental factors with a negative impact on sport performance, including the relationship between allergic rhinitis and ...
features at presentation (6). Some recent studies also underlined a higher risk of death in patie... more features at presentation (6). Some recent studies also underlined a higher risk of death in patients whose asthma is resistant to corticosteroids (4). Other studies are needed to better understand, the disparities in asthma-related mortality. They should take into account associated causes of death to estimate the global burden of asthma. We would like to thank the French speaking Society of Pneumology (SPLF) for having supported this work and the Center for Epidemiology on Medical Causes of Death (Ce´piDc) for having provided mortality data and comments. None declared.
A alveolite alérgica extrínseca (AAE) é uma doença intersticial pulmonar de mediação imunológica,... more A alveolite alérgica extrínseca (AAE) é uma doença intersticial pulmonar de mediação imunológica, resultando da inalação repetida de vários agentes ambientais. Tem sido descrita heterogeneidade da apresentação clínica e do perfil do líquido de lavagem broncoalveolar (LLBA), ABSTRACT Extrinsic Allergic Alveolitis (EAA) is an immunologically mediated interstitial lung disease that may result from repeated inhalation of many different environmental agents. Heterogeneity of the clinical presentation and bronchoalveolar lavage profiles has been described, possibly related * Vencedor ex-aequo Suberose e doença dos criadores de aves: estudo comparativo do perfil radiológico, funcional e do lavado broncoalveolar Suberosis and bird fancier's disease: comparative study of radiological, functional and bronchoalveolar characteristics profile CORE Metadata, citation and similar papers at core.ac.uk
Background
Endurance swimming exercises coupled to disinfection by-products exposure has been ass... more Background Endurance swimming exercises coupled to disinfection by-products exposure has been associated with increased airways dysfunction and neurogenic inflammation in elite swimmers. However, the impact of swimming pool exposure at a recreational level on autonomic activity has never been explored. Therefore, this study aimed to investigate how swimming pool attendance is influencing lung and autonomic function in school-aged children. Methods A total of 858 children enrolled a cross sectional survey. Spirometry and airway reversibility to beta-2 agonist, skin-prick-tests and exhaled nitric oxide measurements were performed. Pupillometry was used to evaluate autonomic nervous function. Children were classified as current swimmers (CS), past swimmers (PS) and non-swimmers (NS), according to the amount of swimming practice. Results Current swimmers group had significantly lower maximum and average pupil constriction velocities when compared to both PS and NS groups (3.8 and 5.1 vs 3.9 and 5.3 vs 4.0 and 5.4 mm/s, p = 0.03 and p = 0.01, respectively). Moreover, affinity to the beta-2 agonist and levels of exhaled nitric oxide were significantly higher in CS when compared to NS (70 vs 60 mL and 12 vs 10 ppb, p<0.01 and p = 0.03, respectively). A non-significant trend for a higher risk of asthma, atopic eczema and allergic rhinitis was found with more years of swimming practice, particularly in atopic individuals (β = 1.12, 1.40 and 1.31, respectively). After case analysis, it was possible to observe that results were not influenced by the inclusion of individuals with asthma. Conclusions Concluding, swimming pool attendance appears to be associated with autonomic changes and increased baseline airway smooth muscle constriction even in children without asthma.
Background: Beta-lactam allergy is overdiagnosed. Diagnosis of penicillin allergy has been associ... more Background: Beta-lactam allergy is overdiagnosed. Diagnosis of penicillin allergy has been associated with a greater use of hospital resources and an increased risk of antibiotic-resistant infections, although this issue remains poorly studied in children. We aimed to compare patient characteristics and use of hospital resources in hospitalized children with and without a record of penicillin allergy. Methods: We identified all hospitalizations in children labelled as being allergic to penicillin in a database containing all hospitalizations in Portuguese public hospitals between 2000 and 2014, and compared these with a similar number of age-, sex-, and main diagnosis-matched hospitalizations without a penicillin allergy label. Comparisons were made for length of hospital stay, comorbidities (Charlson Comorbidity Index), in-hospital mortality, and hospitalization costs. Results: We identified 1,718 hospitalizations corresponding to children labelled as penicillin-allergic. Compared with patients without such a label, these children had longer hospital stays (mean 5 vs. 4 days, p = 0.03) and a higher comorbidity index (mean 0.11 vs. 0.09, p < 0.001). Hospitalization costs were also higher (EUR 2,071 vs. 1,798), but the difference was not significant (p = 0.12). Conclusions: Hospitalizations of children labelled as allergic to penicillin are associated with longer hospital stays, more comorbidities, and a tendency towards higher hospitalization costs. An accurate diagnosis of penicillin allergy based on clinical history and confirmatory tests is therefore essential in all paediatric patients.
Background: Penicillin allergy is commonly reported, but only a minority of claimants has a confi... more Background: Penicillin allergy is commonly reported, but only a minority of claimants has a confirmed diagnosis. Nevertheless, patients labeled as having penicillin allergy are treated with second-line antibiotics, which are more expensive and less effective, possibly increasing the risk of drug-resistant infections. Objective: To compare hospitalizations with and without registration of penicillin allergy concerning their morbidity and hospital resource use. Methods: We analyzed a national administrative database containing a registration of all Portuguese hospitalizations from 2000 to 2014. All episodes occurring in adults with a penicillin allergy registration were compared with an equal number of hospitalizations without such registration and matched for inpatients' age, sex, and main diagnosis. We compared those episodes concerning their length of stay, hospital price charges, comorbidities, and frequency of drug-resistant infections. Differences between medical and surgical hospitalizations were explored. Results: Hospitalizations with registration of penicillin allergy (n = 102,872) had a longer average length of stay than the remainder episodes (8 vs 7 days; P < .001) and higher hospital charges (3,809.0 vs 3,490.0 USD; P < .001). Inpatients with penicillin allergy registration also had a higher mean Charlson Comorbidity Index (0.91 vs 0.76; P < .001) and a significantly higher frequency of infections by several agents, including methicillinresistant Staphylococcus aureus, Enterococcus species, and Escherichia coli. Among surgical episodes, septicemia was 1.2-fold more frequent among penicillin allergy cases. Conclusion: Hospitalizations with registration of penicillin allergy are associated with increased economic costs and frequency of infections by drug-resistant agents, reinforcing the need to establish a correct diagnosis of penicillin allergy. the respective abstract was published (Sousa-Pinto B, Fernandes A, Araújo L, et al. Clinical and economic burden of hospitalizations with registry of penicillin allergy. J Allergy Clin Immunol. 2017;139[suppl]:AB59).
Heart rate variability Muscle sympathetic nerve activity Noradrenaline spillover rate Baroreflex ... more Heart rate variability Muscle sympathetic nerve activity Noradrenaline spillover rate Baroreflex sensitivity s u m m a r y Background: Obesity has been linked to autonomic dysfunction, which is thought to be one of the main contributors for hypertension, cardiac remodelling and death. Exercise and diet-based weight loss are the mainstay therapy for obesity, but there is a paucity of data regarding the effect of weight changes in autonomic nervous system (ANS) activity. Objective: To describe the impact of weight changes in autonomic nervous system. Methods: A systematic literature search of four biomedical databases was performed evaluating effects of weight changes, thorough diet and/or exercise-based interventions, in the following ANS outcomes: heart rate variability, namely low frequency (LF)/high frequency (HF) ratio (LF/HF ratio), normalized units of LF (LFnu) and HF (HFnu), muscle sympathetic nerve activity (MSNA), noradrenaline spillover rate (NA-SR), standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), baroreflex sensitivity and pupillometry. Quality appraisal was performed using the GRADE methodology and, where fitting, studies with comparable outcomes were pooled for metaanalysis. Results: Twenty-seven studies -7 controlled clinical trials and 20 observational studies -were included. Weight gain was reported in 4 studies and weight loss in all the other studies. Interventions inducing weight changes included: hypocaloric or hypercaloric diets, exercise (strength, endurance or aerobic training) and hypocaloric diet coupled with exercise programs. Most studies which resulted in weight loss reported decreases in LF/HF ratio, LFnu, MSNA burst frequency and incidence, NA-SR, and an increase of baroreflex sensitivity, HF, HFnu and RMSSD, pointing to a parasympathetic nervous system activation. Meta-analysis regarding weight loss interventions showed a significant pooled effect size (95% CI) with a decreased of MSNA burst frequency À5.09 (À8.42, À1.75), MSNA incidence À6.66 (À12.40, À0.62), however this was not significant for SDNN 14.32 (À4.31, 32.96). Weight gain was associated with an increase in LF/HF, LFnu, MSNA burst frequency and incidence. The weight loss effects were potentiated by the association of hypocaloric diet with exercise. Nevertheless, weight changes effects in these outcomes were based in low or very low quality of evidence.
Purpose of review Food-dependent exercise-induced anaphylaxis (FDEIA) is a form of anaphylaxis th... more Purpose of review Food-dependent exercise-induced anaphylaxis (FDEIA) is a form of anaphylaxis that occurs associated with exercise, in which symptoms develop by the combination of food ingestion and physical activity. We aimed to review and discuss the main clinical recommendations for management of FDEIA, focusing on individual factors. Recent findings New diagnostic strategies have been developed to optimize the accuracy of provocation challenges, taking in consideration augmenting factors, such as alcohol or non-steroidal anti-inflammatory drugs. However, FDEIA is still insufficiently diagnosed and a high index of clinical suspicion is usually required. Management is complex and based on preventing the reaction and education of the patient, followed by treatment of the acute episode. Several pharmacological strategies for prophylactic treatment have been proposed; however, they are based mainly in low quality of evidence. Summary For management of FDEIA, the culprit food allergen should be avoided at least 4 h before exercise and the individual needs to be educated on how to practice exercise in safe conditions, particularly recognizing the importance of stopping exercise or physical activity at the earliest manifestation of symptoms. This prevention strategy should be developed accordingly to the specific characteristics of the individual and food allergen involved. Due to the difficulty in avoiding and preventing a reaction, pharmacological prophylactic treatment options, namely antihistamines, montelukast, oral cromolyn sodium, misoprostol, and omalizumab, have been proposed. However, they do not replace current recommendations. The risk and quality-of-life impact of FDEIA warrants more accurate diagnostic tools and management strategies. The improvement on the knowledge of the mechanisms mediating FDEIA will help to find new prevention and treatment targets.
Background: Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and erythema multiforme... more Background: Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and erythema multiforme (EM) are immunologically‑mediated dermatological disorders commonly triggered by drug exposure and/or other external agents. We aimed to characterise SJS/TEN‑ and EM‑drug‑related hospitalisations in a nationwide administrative data‑ base, focusing on demographic and clinical characteristics, and in the most frequently implicated drug classes. Methods: We analysed all drug‑related hospitalisations with associated diagnosis of SJS/TEN or EM in Portuguese hospitals between 2009 and 2014. We compared gender, age, comorbidities, length of stay, and in‑hospital mortality and estimated the number of episodes per million packages sold of drug classes. Predictors of in‑hospital mortality were investigated in both conditions by logistic regression. Results: There were 132 SJS/TEN‑related and 122 EM‑related hospitalisations. Incidence and in‑hospital mortality of SJS/TEN episodes (24.2%) were consistent with previous studies. HIV co‑infection was more common among SJS/ TEN hospitalisations (9 vs. 2% with EM; P = 0.009). Liver disease, advanced age, and a TEN diagnosis, were significantly associated with higher risk of mortality in patients with SJS/TEN. The highest numbers of SJS/TEN and EM episodes per million drug packages sold were observed for antivirals (8.7 and 1.5, respectively), antineoplastic/immunosuppres‑ sive drugs (5.6 and 3.9, respectively) and hypouricaemic drugs (5.0 and 2.4, respectively). Conclusions: SJS/TEN in‑hospital mortality is high, and its risk factors include advanced age, liver disease, and TEN diagnosis. The drug classes most frequently associated with these conditions include antivirals, hypouricaemic drugs and antineoplastic/immunosuppressive drugs. Administrative databases seem useful in the study of SJS/TEN drug‑ related hospitalisations, yielding results consistent with previous studies and on a nationwide basis.
The evidence of exercise-induced bronchoconstriction (EIB) without asthma (EIBw A) occurring in a... more The evidence of exercise-induced bronchoconstriction (EIB) without asthma (EIBw A) occurring in athletes led to speculate about different endotypes inducing respiratory symptoms within athletes. Classical postulated mechanisms for bronchial obstruction in this population include the osmotic and the thermal hypotheses. More recently, the presence of epithelial injury and inflammation in the airways of athletes was demonstrated. In addition, neuronal activation has been suggested as a potential modulator of bronchoconstriction. Investigation of these emerging mechanisms is of major importance as EIB is a significant problem for both recreational and competitive athletes and is the most common chronic condition among Olympic athletes, with obvious implications for their competing performance, health and quality of life. Hereby, we summarize the latest achievements in this area and identify the current gaps of knowledge so that future research heads toward better defining the etiologic factors and mechanisms involved in development of EIB in elite athletes as well as essential aspects to ultimately propose preventive and therapeutic measures.
Ocular allergy (OA) includes a group of common and less frequent hypersensitivity disorders frequ... more Ocular allergy (OA) includes a group of common and less frequent hypersensitivity disorders frequently misdiagnosed and not properly managed. The diagnosis of OA is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when identification of the specific allergen is required. To date, no specific test is available for the diagnosis of the whole spectrum of the different forms of OA. The lack of recommendations on diagnosis of OA is considered a medical need not only for allergists but also for ophthalmologists. This position paper aims to provide a comprehensive overview of the currently available tools for diagnosing OA to promote a common nomenclature and procedures to be used by different specialists. Questionnaires, sign and symptom grading scales, tests, and potential biomarkers for OA are reviewed. We also identified several unmet needs in the diagnostic tools to generate interest, increase understanding, and inspire further investigations. Tools, recommendations, and algorithms for the diagnosis of OA are proposed for use by both allergists and ophthalmologists. Several unmet needs in the diagnostic tools should be further improved by specific clinical research in OA.
We hypothesize that oxidative stress induced by trichloramine exposure during swimming could be r... more We hypothesize that oxidative stress induced by trichloramine exposure during swimming could be related to etiopathogenesis of asthma among elite swimmers. Aim: To investigate the effect of a swimming training session on oxidative stress markers of asthmatic compared to non-asthmatic elite swimmers using exhaled breath (EB) metabolomics. Methods: Elite swimmers annually screened in our department (n=27) were invited and those who agreed to participate (n=20, of which 9 with asthma) had EB collected (Tedlar ® bags) before and after a swimming training session. SPME fiber (DVB/CAR/PDMS) was used to extract EB metabolites followed by a multidimen-sional gas chromatography analysis (GC×GC-ToFMS). Dataset comprises eight me-tabolites end products of lipid peroxidation: five aliphatic alkanes (nonane, 2,2,4,6,6-pentamethylheptane, decane, dodecane, and tetradecane) and three alde-hydes (nonanal, decanal, and dodecanal). To assess exercise impact on lipid peroxida-tion markers, data were analyzed using principle component analysis (PCA), which was run on the original data set and on the data set constructed using differences in the metabolite total areas before and after exercise session.
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Papers by L. Delgado
Endurance swimming exercises coupled to disinfection by-products exposure has been associated with increased airways dysfunction and neurogenic inflammation in elite swimmers. However, the impact of swimming pool exposure at a recreational level on autonomic
activity has never been explored. Therefore, this study aimed to investigate how swimming pool attendance is influencing lung and autonomic function in school-aged children.
Methods
A total of 858 children enrolled a cross sectional survey. Spirometry and airway reversibility to beta-2 agonist, skin-prick-tests and exhaled nitric oxide measurements were performed. Pupillometry was used to evaluate autonomic nervous function. Children were classified as
current swimmers (CS), past swimmers (PS) and non-swimmers (NS), according to the amount of swimming practice.
Results
Current swimmers group had significantly lower maximum and average pupil constriction velocities when compared to both PS and NS groups (3.8 and 5.1 vs 3.9 and 5.3 vs 4.0 and 5.4 mm/s, p = 0.03 and p = 0.01, respectively). Moreover, affinity to the beta-2 agonist and
levels of exhaled nitric oxide were significantly higher in CS when compared to NS (70 vs 60 mL and 12 vs 10 ppb, p<0.01 and p = 0.03, respectively). A non-significant trend for a higher risk of asthma, atopic eczema and allergic rhinitis was found with more years of swimming
practice, particularly in atopic individuals (β = 1.12, 1.40 and 1.31, respectively). After case analysis, it was possible to observe that results were not influenced by the inclusion of individuals with asthma.
Conclusions
Concluding, swimming pool attendance appears to be associated with autonomic changes and increased baseline airway smooth muscle constriction even in children without asthma.