Browsing by Author "Loureiro, C"
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- Anaphylaxis in an emergency department: a retrospective 10-year study in a tertiary hospitalPublication . Alen Coutinho, I.; Ferreira, D; Regateiro, FS; Pita, J; Ferreira, M; Martins, JF; Fonseca, IA; Loureiro, C; Todo-Bom, ABackground. Anaphylaxis is a potentially fatal medical emergency. The frequency of hospital admissions for anaphylaxis seems to be increasing in the recent decades. Objective. Characterize the patients admitted for anaphylaxis to the adult emergency department (ED) of a tertiary care hospital over a 10-year period, discriminating aetiologies, clinical features and therapy administered. Methods. Retrospective, descriptive and inferential study, evaluating age, sex, Manchester triage system, suspected allergen, site of allergen exposure, comorbidities, cofactors, clinical findings and symptoms, treatment and management. Patients admitted between January 2007 and December 2016 were included. Results. Forty-three patients were enrolled: 23 males, mean age 54.3 ± 16.2 years, n = 22 had history of allergic disease. Two patients were triaged as non-urgent. The most frequently suspected causes of anaphylaxis were: drugs (33%, n = 14), Hymenoptera venoms (23%, n = 10), foods (21%, n = 9) and iodinated contrast products (12%, n = 5). Adrenaline was used in 88% of the episodes (n = 38), 55% of which (n = 21) intramuscularly. Mortality was registered in one case. At discharge, adrenaline auto-injector was prescribed in 7% (n = 3) of the patients, and Allergy and Clinical Immunology consultation (ACIC) was requested in 65% of the episodes (n = 28). Statistically significant associations (p minor 0.05) were established: a, anaphylaxis to drugs associated with a low intramuscular adrenaline use and with frequent oxygen therapy; b, anaphylaxis to food associated with intramuscular adrenaline administration; c, anaphylaxis to Hymenoptera venom associated with male sex; and d, anaphylaxis to iodinated contrasts associated with referral to ACIC and with shock. All obese patients developed shock. Conclusions. Anaphylaxis is a life-threatening condition that requires early recognition. Although most patients received adrenaline, administration was not always performed by the recommended route and only a few patients were prescribed adrenaline auto-injector.
- Asthma and rhinitis have different genetic profiles for IL13, IL17A and GSTP1 polymorphismsPublication . Resende, EP; Todo-Bom, A; Loureiro, C; Mota-Pinto, A; Oliveiros, B; Mesquita, L; Silva, HCBACKGROUND: Asthma and rhinitis have a complex etiology, depending on multiple genetic and environmental risk factors. An increasing number of susceptibility genes are currently being identified, but the majority of reported associations have not been consistently replicated across populations of different genetic backgrounds. PURPOSE: To evaluate whether polymorphisms of IL4R (rs1805015), IL13 (rs20541), IL17A (rs2275913) and GSTP1 (rs1695) genes are associated with rhinitis and/or asthma in adults of Portuguese ancestry. METHODS: 192 unrelated healthy individuals and 232 patients, 83 with rhinitis and 149 with asthma, were studied. All polymorphisms were detected by real time polymerase chain reaction (PCR) using TaqMan assays. RESULTS: Comparing to controls, significant association with asthma was observed for GSTP1 rs1695 AA genotype (odds ratio (OR) - 1.96; 95% CI - 1.18 to 3.25; p=0.010). The association sustains for allergic asthma (OR - 2.17; 95% CI - 1.23 to 3.80; p=0.007). IL13 rs20541 GG genotype was associated with less susceptibility to asthma (OR - 0.55, 95% CI - 0.33 to 0.94, p=0.028). Among patients, IL17A rs2275913 AA genotype was less associated with asthma than with rhinitis (OR - 0.20; 95% CI of 0.07 to 0.56; p=0.002). A similar association was found for IL13 rs20541 GG genotype (OR - 0.48; 95% CI of 0.25 to 0.93; p=0.031). There were no significant differences in the distribution of allelic and genotypic frequencies between patients and controls for the IL4R polymorphism' analyzed. CONCLUSION: These results support the existence of a significant association between GSTP1 rs1695 and IL13 rs20541 SNPs, with susceptibility to asthma, in the population studied. Different genotype profiles of IL17A and IL13 genes seem to influence the clinical pattern of disease expression mainly confined to the upper airways, as rhinitis, or including the lower airways, as asthma.
- Caracterização dos doentes com síndrome de alergia múltipla a fármacosPublication . Faria, E; Carrapatoso, I; Loureiro, C; Todo-Bom, A; Chieira, C
- Chronic rhinosinusitis with nasal polyps in allergic patientsPublication . Sousa, N; Santos, A; Loureiro, G; Tavares, B; Loureiro, C; Faria, E; Chieira, C
- Dermatite endógena induzida pela ingestão de níquel: a propósito de dois casos clínicosPublication . Carrapatoso, I; Loureiro, G; Loureiro, C; Faria, E; Todo-Bom, A; Chieira, CA sensibilização ao níquel representa uma das principais causas de dermatite de contacto alérgica. Um número significativo de doentes apresenta lesões cutâneas, em locais que não estão em contacto directo com este metal. Nos últimos anos a influência do conteúdo em níquel da dieta na evolução da dermatite ao níquel tem merecido particular atenção. Descrevem-se os casos de duas doentes com dermatite de contacto ao níquel em que, apesar da evicção total do contacto com este metal, persistiam lesões de dermatite eczematosa, predominando nas zonas de maior sudação. Com a exclusão da dieta de alimentos com alto teor em níquel observou-se uma redução progressiva da intensidade do eczema, conducente ao desaparecimento total das lesões. As doentes foram, então, submetidas a prova de provocação oral com sulfato de níquel. Na primeira doente estudada observou-se aparecimento de eritema, prurido e reacção eczematosa, generalizados, doze horas após a ingestão de 20 mg de sulfato de níquel. Concomitantemente verificou-se a ocorrência de eritema pruriginoso e pequenas vesículas, no local de aplicação do patch teste ao níquel. No segundo caso a reactivação da dermatite ocorreu seis horas após a ingestão de 10 mg de sulfato de níquel. A manutenção de dieta restritiva em alimentos com alto teor em níquel permitiu o desaparecimento total da dermatite e estabilização clínica que se mantém desde há 6 meses. O diagnóstico de dermatite endógena induzida pela ingestão de níquel foi demonstrado através da realização de prova de provocação oral. A excreção de níquel através do suor parece ser relevante. A redução da ingestão diária de níquel, permitindo a menor concentração deste elemento no suor poderá explicar a melhoria da dermatite, particularmente, nas zonas cutâneas de maior sudação.
- Increased prevalence of allergic sensitisation in rheumatoid arthritis patients treated with anti-TNFalphaPublication . Machado, P; Santos, A; Pereira, C; Loureiro, C; Silva, J; Chieira, C; Malcata, ABINTRODUCTION: Tumour necrosis factor alpha (TNFalpha) has emerged as a therapeutic target in chronic inflammatory disorders characterised by a Th1 type immune response, such as rheumatoid arthritis (RA). The presence of allergic disease in these patients could be influenced both by the presence of RA and anti-TNFalpha therapy. Our aim was to evaluate the prevalence of sensitisation to airborne allergens and allergic disease in RA patients, with and without anti-TNFalpha treatment. METHODS: RA patients with (N=20) and without (N=20) anti-TNFalpha therapy (groups T and R) were enrolled. Healthy controls (N=60, group C) were randomly selected from the general population. All participants answered a standardised questionnaire to assess the prevalence of allergic disease and had skin prick tests (SPT) with a standard panel of airborne allergen extracts. RESULTS: Significant differences were found in the prevalence of positive SPT between groups T and R (70% vs 35%, p=0.027) and groups T and C (70% vs 36.7%, p=0.009), but not between groups R and C. The prevalence of allergic disease was similar in the three groups. Groups T and R had similar gender and age distribution, disease duration, disease activity score (DAS28), erythrocyte sedimentation rate and serum C-reactive protein. CONCLUSIONS: Increased prevalence of sensitisation to airborne allergens in RA patients treated with anti-TNFalpha was found. The clinical impact of the positive SPT following anti-TNFalpha initiation has now to be assessed.
- Interrelationship between skin sensitization, rhinitis, and asthma in patients with allergic rhinitis: a study of Spain and PortugalPublication . Valero, A; Pereira, C; Loureiro, C; Martínez-Cócera, C; Murio, C; Rico, P; Palomino, R; Dávila, IOBJECTIVE: Allergic rhinitis can determine the presence and type of asthma. The main aim of this study was to evaluate the link between allergic rhinitis, asthma, and skin test sensitization in patients with allergic rhinitis. METHODS: Patients with allergic rhinitis, aged 10 to 50 years, were consecutively enrolled at different allergy centers in Spain and Portugal. All the patients underwent skin prick tests with a panel of 20 biologically standardized aeroallergens. Allergic rhinitis was classified according to etiology and the Allergic Rhinitis and its Impact on Asthma guidelines and asthma was classified according to the Global Initiative for Asthma guidelines. RESULTS: A total of 3225 patients, with a mean age of 27 years, were evaluated. House dust mites and grass and olive tree pollens were the most common aeroallergens. The mean (SD) number of positive skin tests per patient was 6.5 (4), the mean wheal size was 42.3 (28) mm2, and the mean atopy index was 6.5 (2). Forty-nine percent of the patients had concomitant asthma. Asthma severity was associated with a longer time since onset (P < .04) and allergic rhinitis severity (P < .001). Patients with concomitant asthma had a significantly higher number of aeroallergens and sensitization intensity than those without asthma (P < .001). CONCLUSIONS: In this broad population sample, the presence and type of asthma was influenced by skin sensitization and both time since onset and severity of allergic rhinitis.
- MÓDULO 7 - Desenvolvimento e NeurologiaPublication . Bento, C; Rodrigues, F; Oliveira, G; Lopes, MF; Brito, MJ; Diogo, L; Loureiro, C; Santos, I; Cordinhã, C; Canha, J; Mirante, A; Baptista, N; Jorge, A; Estanqueiro, P; Gomes, C
- 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 de hipersensibilidade a frutos: estudos in vivo e in vitroPublication . Carrapatoso, I; Faria, E; Rodrigues, F; Todo-Bom, A; Loureiro, C; Chieira, C