Browsing by Author "Geraldes, L"
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- Anafilaxia perioperatória em Coimbra: Experiência da consulta de alergia a fármacosPublication . Faria, E; Sousa, N; Geraldes, L; Santos, A; Chieira, CBackground: The incidence of peri-operative anaphylactic reactions ranges from 1:10,000 to 1:20,000. It is crucial to identify the risk factors, the trigger agent and to fi nd adequate alternatives. Aims: To characterise patients with peri-operative anaphylactic reactions. Methods: We performed a retrospective study of patients with suspected adverse peri-operative reactions to anaesthetic drugs, observed in a Drug Allergy Outpatients Clinic from 1994 to 2005. Anaphylaxis was diagnosed based on the clinical history and skin tests to latex, neuromuscular blocking agents (NMBA), hypnotics, opioids and antibiotics. Specifi c IgE to latex was performed in patients with positive skin-prick-tests. Results: We evaluated the clinical charts of 45 patients with adverse peri-operative reactions, 39 of whom were female. Anaphylaxis was diagnosed in 16 patients (35.6%), 15 females, mean age 36.3 years. The remaining patients had non-anaphylactic (28.8%) or not well-characterised reactions (35.6%). In terms of severity, 50% presented grade III and 50% grade IV anaphylaxis. Skin-prick-tests were positive to latex in three patients and negative to all anaesthetic drugs. Intradermal skin tests were positive in 10 out of 16 patients with anaphylactic reactions: 10 to NMBA [atracurium (n = 8), vecuronium (n = 4), suxamethonium (n = 4) and pancuronium (n = 2)], one to fentanyl, one to thiopental and one to cefuroxime. In three cases, the culprit agent was not identifi ed. In four patients, at least one alternative NMBA, with no skin test reactivity, was found. Of these four patients, two underwent further surgical procedures without adverse reactions. Five patients had previously had two or more anaesthetic procedures and four had presented adverse reactions in prior surgeries. Conclusions: In our study the most common causes of anaphylaxis were NMBAs (62.5%) and latex (18.7%), in line with that described in the literature. In 81% of patients with anaphylactic reactions, skin tests were positive to at least one anaesthetic drug or to latex. A high incidence of severe anaphylaxis was found, probably because cases with less severe clinical signs were not referred to our clinic. The results emphasise the need for systematic evaluation of anaphylactic reactions during anaesthesia. This can be achieved by the creation of a specialised Allergo-Anaesthesia Clinic, as has been the case in our Department.
- Anaphylaxis to mefenamic acid in a patient with new onset of systemic lupus erythematosusPublication . Couto, M; Duarte, C; Geraldes, L; Inês, L; Malcata, AB
- Expression patterns of HLA-DR+ or HLA-DR- on CD4+/CD25++/CD127low regulatory T cells in patients with allergyPublication . Geraldes, L; Morgado, J; Almeida, A; Todo-Bom, A; Santos, P; Chieira, C; Pais, MLBACKGROUND: Allergic rhinoconjunctivitis induced by pollen is a highly prevalent chronic inflammatory disease in Europe. Parietariajudaica is a frequent trigger in the Mediterranean area. The function of regulatory T cells (Treg cells) in allergy has recently been investigated, but further data are necessary to better understand their role and to find new strategies to treat allergic diseases such as allergic rhinoconjunctivitis. OBJECTIVE: To characterize gene expression of HLA-DR+ or HLA-DR- on peripheral CD4+/CD25++/CD127low Treg cells in patients with allergy. METHODS: Peripheral Treg cells (CD4+/CD25++/CD127low) were quantified using flow cytometry and sorted according to HLA-DR expression during the pollen season in patients with allergic rhinoconjunctivitis caused by P. judaica. The results were compared with those of nonatopic controls. Expression of associated cytokines and their receptors was measured using quantitative reverse transcription-polymerase chain reaction after extraction of mRNA in sorted populations. RESULTS: During the pollen season, no significant differences were observed between allergic patients with rhinoconjunctivitis and healthy controls in terms of the absolute number or the percentage of Treg cells in peripheral blood. All patients had a higher number/percentage of HLA-DR- Treg cells than HLA-DR+ Treg cells. In both groups we found high levels of FOXP3 mRNA expression. Despite being lower in number, HLA-DR+ Treg cells presented higher expression of CD28, PRF1, GZMB, and FASL than HLA-DR-Treg cells. CONCLUSIONS: The most relevant results obtained suggest that HLA-DR+ Treg cells tend to present higher gene expression of molecules associated with contact-dependent cell activation and cytotoxicity.
- FoxP3, GATA-3 and T-bet expression in elderly asthmaPublication . Vale-Pereira, S; Todo-Bom, A; Geraldes, L; Schmidt-Weber, C; Akdis, CA; Mota-Pinto, ABACKGROUND: Asthma is a chronic inflammatory disorder in which Th2, Th1 and suppressive T cells (Tregs) play a role. The transcription factor FoxP3 plays a role in Treg differentiation while T-bet is important for Th1 and GATA-3 for Th2 differentiation from naïve T cells. Recent data show that age-related deregulation of Treg cells is a mechanism of senescence affecting several chronic diseases. It is crucial to understand the behaviour of these cell populations in asthma for elderly patients. OBJECTIVE: To evaluate FoxP3, GATA-3 and T-bet gene expression under basal conditions and after in vitro activation in a group of elderly asthmatic compared with age-matched healthy individuals. METHODS: Thirty-two elderly asthmatics and 17 healthy elderly individuals were selected. Serum total IgE was measured, and peripheral blood mononuclear cells (PBMCs) were isolated and stimulated in vitro with anti-CD3/anti-CD28, followed by mRNA isolation. After reverse transcription, real-time quantitative PCR was performed and relative quantification was determined 2(-ΔΔCt)(2(-ΔΔCt) method). RESULTS: The mean values and standard deviation of FoxP3, GATA-3 and T-bet relative expression for control vs. asthma were 10.2±6.8 vs. 4.8±3.8, 2.4±2.9 vs. 1.7±0.9 and 3.3±2.1 vs. 2.1±1.5, respectively. Healthy individuals showed significantly higher expression of FoxP3 and T-bet; asthmatics had a lower T-bet/GATA-3 ratio, higher serum IgE and a positive significant correlation between total IgE and GATA-3 expression. CONCLUSION AND CLINICAL RELEVANCE: Elderly asthmatic patients have lower FoxP3 mRNA expression in PBMC, which can be associated with the sustained inflammatory process and with the decreased immune tolerance by Treg cells. The T-bet deficiency and the correlation of GATA-3 expression with the increase of IgE are characteristics of long-lasting asthma. Changes related to the immunosenescence process could provide an explanation for the minor differences observed between the groups. It is important to clarify persistent modifications in long-lasting asthma in the elderly and adequate future therapeutic approaches.
- Mugwort-celery-carrot-curry syndrome: a case reportPublication . Carrapatoso, I; Bartolomé, B; Ribeiro, F; Geraldes, L; Chieira
- Padrão clínico e laboratorial de sensibilização a fungosPublication . Santos, A; Carrapatoso, I; Rodrigues, F; Geraldes, L; Loureiro, C; Chieira, CObjectivo: Caracterizar clinicamente um grupo de doentes sensibilizados a fungos; comparar os resultados de diferentes testes diagnósticos; e definir um padrão de reactividade a espécies fúngicas comuns numa população de doentes com alergia respiratória. Métodos: Entre os doentes que consecutivamente realizaram testes cutâneos (TC) com bateria de fungos entre 2001 e 2005 (n=304), seleccionaram -se vinte com maior reactividade cutânea a pelo menos um dos seguintes fungos: Alternaria alternata, Aspergillus fumigatus, Candida albicans, Cladosporium herbarum e Penicillium chrysogenum. Para todos os doentes, analisaram -se os processos clínicos e realizaram -se TC, doseamento de IgE especifica (IgE) e immunoblotting (IB) aos cinco fungos mencionados. A concordância dos exames referidos foi avaliada através do coeficiente kappa (κ) de Cohen. Resultados: No grupo de 20 doentes, com idades compreendidas entre os 20 e os 60 anos, 90% apresentavam rinite (55% persistente (P) moderada -grave, 39% P ligeira e 6% intermitente ligeira), 80% asma (56% P moderada, 19% P ligeira e 25% intermitente), 35% sinusite, 5% polipose nasal e 35% conjuntivite. A maioria estava sensibilizada a mais do que um fungo e a outros aeroalergénios. Comparando os resultados dos exames realizados, observou-se uma concordância entre IgE e IB (κ=0,240; p=0,009), mas não entre TC e IgE (κ=0,09; p=0,303) ou TC e IB (κ=0,036; p=0,719). No estudo de IB, foram identificadas proteínas com diferentes pesos moleculares, alguns correspondendo a alergénios já descritos. Conclusões: Este estudo vem reforçar a discordância entre testes in vivo e in vitro na sensibilização a fungos. Mais estudos e melhores extractos alergénicos são necessários. Por enquanto, deve manter-se um elevado índice de suspeição, bem como uma combinação de exames complementares no diagnóstico de alergia a fungos.
- Padrões clínicos e laboratoriais na hipersensibilidade ao camarão e reactividade cruzada com Dermatophagoides pteronyssinusPublication . Carrapatoso, I; Rodrigues, F; Geraldes, L; Faria, E; Todo-Bom, A; Loureiro, C; Chieira, CObjectivos: Investigar padrões clínicos em doentes com hipersensibilidade a camarão e a ocorrência de reactividade cruzada a Dermatophagoides pteronyssinus (Dp). Caracterizar as principais proteínas envolvidas na reactividade a camarão, em estudos de immunoblotting. Métodos: Avaliaram-se 20 doentes com clínica de hipersensibilidade imediata, após ingestão de camarão. Aplicou-se um questionário estandardizado, foram efectuados testes cutâneos por prick a alimentos e aeroalergénios e procedeu-se à determinação de IgE específica a camarão e Dp por UniCap e immunoblotting. A existência de eventual reactividade cruzada imunológica entre camarão e Dp foi investigada por estudos de inibição de immunoblotting. Resultados: A média de idades dos doentes era de 33±16 anos, sendo 13 do sexo masculino. As manifestações clínicas após ingestão de camarão foram urticária e/ou angioedema generalizados em 8 doentes, síndrome de alergia oral em 9 e anafilaxia em 3. Para além do camarão, foi detectada em todos os doentes sensibilização a outros crustáceos com sintomas semelhantes. Outros alimentos reportados em que se confirmou sensibilização foram moluscos -12 doentes e ovo -1. Em todos os doentes foi detectada sensibilização a Dp e sensibilização associada a barata em 12, a pólenes em 13, a cão em 5 e a gato em 5. Doseamentos de IgE específica a Dp e camarão superiores ou iguais a 3,5 KU/l foram encontrados, respectivamente, em 15 e 12 doentes. Considerando os estudos de immunoblotting a camarão, observou-se uma maior intensidade de ligação a bandas com peso molecular (PM) de 35 -40 KDa em 14 doentes, 17 KDa em 2, 22 KDa em um e 43-50 KDa nos restantes 3. Os estudos de inibição de immunoblotting evidenciaram reactividade cruzada em 15 doentes, recíproca camarão - Dp em 10 e não recíproca em 5, não sendo possível demonstrar a sua existência em 5. Conclusões: O PM encontrado para as bandas de maior intensidade nos estudos de immunoblotting a camarão sugere o envolvimento de tropomiosinas na maioria dos doentes, reforçando o papel destes panalergénios como alergénios major na hipersensibilidade a camarão em doentes sensibilizados a ácaros. Sensibilização simultânea a camarão e Dp pode ocorrer na ausência de reactividade cruzada e diferentes padrões de sensibilização deverão ser considerados.
- Padrões de sensibilização na hipersensibilidade a leguminosas. Estudo numa população da região Centro.Publication . Geraldes, L; Carrapatoso, I; Santos, A; Rodrigues, F; Todo-Bom, A; Faria, E; Chieira, CBackground: Foods from the legume family are used in the Mediterranean diet as a source of protein. In some cases, their ingestion triggers potentially life -threatening reactions. A high degree of immunological cross-reactivity has been described, but its clinical relevance is controversial. Aim: To carry out a clinical and laboratory characterisation of patients sensitised to leguminosae who had symptoms after the ingestion of at least one food from the leguminosae botanical family. Methods: We selected 13 consecutive patients from a food allergy outpatient clinic with allergy symptoms after the ingestion of leguminosae during the year of 2006. Case history data, skin prick tests (SPT) with commercial extracts of white bean, green bean, pea, chickpea, soya bean and peanut, and prick-to-prick (PP) tests to these legumes, both raw and boiled, and also to lupini bean and black -eyed bean were performed. Serum specific IgE and immunoblotting assays were also carried out. Results: Most patients had had symptoms with more than one legume (mean 3 legumes) with bean the most reported. The first culprit leguminosae reported was chickpea in 4 patients, bean in 4 patients and lupini bean in 3. Sensitisation to other legumes without clinical symptoms also occurred (mean 2 legumes). Anaphylaxis was described in 3 patients, to bean, soya and lupini bean, respectively. Asthma was connected to chickpea (2 patients) and to bean (1). One or more of the following symptoms: urticaria, angiooedema and oral allergy syndrome were reported by other patients. Symptomatic patients always had positive PP tests to leguminosae and most SPT were also positive. Conclusions: Lifethreatening reactions to leguminosae were found. PP tests used alone to raw and boiled legumes seem to be the most reliable diagnostic tests as in the case of other vegetable foods. However, immunoblotting assays are still important in the identification of new allergens.
- Suspected heparin hypersensitivity reaction: case reportPublication . Sousa, N; Loureiro, G; Geraldes, L; Santos, A; Faria, E; Chieira, C
- Valor diagnóstico das provas de provocação com cápsulas de aditivos alimentares ou de níquelPublication . Carrapatoso, I; Pereira, C; Faria, E; Geraldes, L; Loureiro, C; Chieira, CObjectivo: O uso crescente de aditivos na indústria alimentar e farmacêutica tem dificultado o diagnóstico das reacções adversas a estes produtos. O grande desafio é, actualmente, determinar em cada doente a substância a testar. Constituiu objectivo deste trabalho a avaliação do valor diagnóstico das provas de provocação, utilizando cápsulas de aditivos alimentares ou de níquel, em doentes com suspeita, respectivamente, de intolerância alimentar ou de hipersensibilidade ao níquel. Métodos: Incluíram-se num estudo prospectivo doentes observados consecutivamente, numa consulta de alergia alimentar, num período de dois anos, com suspeita de intolerância alimentar ou de dermatite sistémica ao níquel. Após exclusão de um mecanismo de hipersensibilidade mediado por IgE e revisão dos diários de dieta, os doentes foram submetidos, durante seis semanas, a dieta restritiva em aditivos alimentares ou alimentos com alto teor em níquel. Durante o período de estudo procedeu-se ao registo das reacções adversas e medicamentos consumidos. Nos doentes com lesões de eczema efectuaram-se testes epicutâneos. Os doentes que beneficiaram da dieta restritiva foram submetidos, em regime de internamento, a provas de provocação oral (PPO), controladas por placebo, utilizando cápsulas de aditivos alimentares ou de níquel. Os aditivos foram seleccionados de acordo com a história clínica. Resultados: Dos 27 doentes submetidos a dieta restritiva, 19 (17 do sexo feminino) apresentaram melhoria clínica, pelo que foram submetidos a PPO. A ocorrência de urticária e/ou angioedema após ingestão de aditivos alimentares foi referida por 15 doentes (seis referiam sintomas também com medicamentos). Em três doentes observaram-se lesões de eczema generalizadas que foram, gradualmente, desaparecendo com a dieta restritiva em níquel. Em cinco doentes registaram-se testes epicutâneos positivos (em quatro ao sulfato de níquel e dicromato de potássio e numa doente a mistura de fragrâncias, timerosal e resina de butilfenol formaldeído). Das 25 PPO efectuadas, 14 foram positivas (metabissulfito de sódio-5, benzoato de sódio-3, sulfato de níquel-3, lactose-1, soja-1, amido de trigo-1). Numa mesma doente obtivemos 2 PPO positivas: ao benzoato de sódio e à lactose. Com a evicção específica dos aditivos ou de alimentos com alto teor em níquel, observou-se uma evolução favorável. Conclusões: As PPO permitiram o diagnóstico de dermatite de contacto sistémica, induzida pela ingestão de níquel em três doentes e de intolerância alimentar em dez, possibilitando o seguimento de dietas menos restritivas.