Imunoalergologia
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- Envolvimento pulmonar subclínico em sarcoidose cutâneaPublication . Robalo-Cordeiro, C; Gonçalo, Margarida; Lima, MA; Mesquita, L; Teixeira, L; Santos-Rosa, M; Azevedo-Bernarda, R; Poiares-Baptista, A; Robalo-Codeiro, AJ
- Specific immunotherapy for occupational latex allergyPublication . Pereira, C; Rico, P; Lourenço, M; Lombardero, M; Pinto-Mendes, J; Chieira, C
- Imunodeficiência primária por défice de ZAP-70Publication . Barata, LT; Henriques, R; Hivroz, C; Jouanguy, E; Paiva, A; Freitas, AM; Coimbra, HB; Fischer, A; Carmona da Mota, HThe authors present the case of a child with recurrent infections since the age of 4 months, including bilateral pneumonia by Pneumocystis carinii and protracted varicella. Serum immunoglobulin values (when 10 months old), and B cell values were normal. There was persistent lymphocytic leucocytosis, near absence of CD8+ cells, and an increased CD4/CD8 ratio. The percentage of activated T cells and the expression of HLA class I were normal. Proliferation, activation and IL-2 synthesis studies in T cells showed a TCR/CD3-associated signal transduction deficit. ZAP-70 cDNA sequencing showed a mutation, and no ZAP-70 protein was detected in T cells. ZAP-70 deficiency is associated with a rare immune deficiency with absence of CD8+ T cells as well as a functional deficiency in T cells. Seven months after bone marrow transplantation the child is clinically well and immunologically recovered
- Granulomatose de Wegener: forma limitadaPublication . Gil, I; Porto, J; Fernandes, B; Gonçalo, Margarida; Carvalho, L; Vieira, JD; Moura, JA
- Caracterização dos doentes com síndrome de alergia múltipla a fármacosPublication . Faria, E; Carrapatoso, I; Loureiro, C; Todo-Bom, A; Chieira, C
- Grupos de alimentos com maior reactividade cruzada: artigo de revisãoPublication . Carrapatoso, I
- Alergia alimentar a rosáceas e frutos secos: a propósito de um caso clínicoPublication . Carrapatoso, I; Tavares, B; Pereira, C; Rodrigues, F; Barbosa, A; Chieira, C
- Tratamento de imunodeficiências primárias por deficiência predominante de anticorposPublication . Faria, E; Silva, S; Español, TAs imunodeficiências primárias (IDP) por défice predominante de anticorpos são as IDP mais frequentes. Apresentam fenótipos muito diversos, com espectro de manifestações clinicas muito variável que pode atrasar o diagnóstico. O seguimento destes doentes implica na maioria dos casos, a instituição a longo prazo de terapêutica substitutiva com gamaglobulina intravenosa ou subcutânea. A dose terapêutica com gamablobulina deve ser ajustada a cada doente com o objectivo de manter os níveis de IgG superiores a 500mg/dl. Apresenta-se um protocolo, elaborado a partir da experiência partilhada no estágio efectuado no Hospital de Vall d´Hebron. Inclui-se as doses, forma de administração de GGIV, reacções adversas e medidas de avaliação clínica e laboratorial da sua eficácia e eventual iatrogenia. São referidas as principais complicações associadas a este tipo de IDP: infecciosa, envolvendo diversos sistemas e outras menos frequentes como doenças autoimunes, neoplásicas e linfoproliferativas. O diagnóstico precoce e instituição terapêutica adequada são factores determinantes na evolução clínica, qualidade de vida e prognóstico destes doentes.
- Kinetics and dynamic evaluation of specific immunotherapyPublication . Pereira, C; Botelho, F; Tavares, B; Lourenço, C; Baeta, C; Palma-Carlos, AG; Pedroso de Lima, J; Chieira, CSpecific immunotherapy (SIT) is frequently used in the treatment of allergic diseases. However, the mechanisms by which SIT achieves clinical improvement remained unclear. We decided to study the in vivo kinetics of this therapy, using a nuclear medicine approach (leukocytes labelled with 99mTc-HMPAO) in patients on maintenance doses of specific immunotherapy with confirmed clinical efficacy. MATERIAL AND METHODS: We studied 13 allergic patients grouped according to different treatment schedules: subcutaneous aqueous allergenic extract (3 latex and 2 hymenoptera venom), subcutaneous depot extract (2 house dust mite and 2 pollens), subcutaneous modified allergens (2 pollens), sublingual extract (2 house dust mites). The control group included two allergic patients submitted to subcutaneous injections of bacterial extract (1 patient--positive control), and aqueous solution (1 patient). At the same time that the therapeutic allergen was administered subcutaneously, the autologous labelled white cells were injected intravenously in a peripheral vein in the contralateral arm. A thoracic dynamic acquisition of 60 mins, 64x64 matrix, 2 frame/min, in anterior view was performed. Static acquisition for 256x256 matrix, during 5 mins each at 60, 90, 120, 180, 240, 300 and 360 mins after the administration of the radiolabelled leukocytes, in thoracic (anterior and posterior), and abdominal view were performed. During the examination, the local erythema was monitored. A similar procedure was undertaken for Sublingual administration of immunotherapy. RESULTS: The inflammatory activity at the site of SIT injection (aqueous depot extract) started in the first hour and the increase was time related. For modified allergen extract and sublingual SIT the activity was present since the beginning of the administration. The ascendant lymphatic drainage, which was directed to the homolateral axillary region, to the lymphoid tissue of the upper mediastinum and to the anterior region of the neck began earlier. Thoracic focalisations were present for all the patients, whereas bowel focalisations were only observed for the subcutaneous route of administration. Sublingual SIT did not induce axillary or intestinal inflammatory focalisations, even though the patients had swallowed the allergenic extract. The uptake coefficient in individualized areas corrected to the uptake coefficient background was also studied. CONCLUSIONS: For the subcutaneous route of administration, except for glutaraldehyde-modified allergen, the local inflammatory activity at the allergenic injection site was significantly higher in depth and was time dependent, maintaining activity even after complete disappearance of the erythema and/or wheal. These results express a prompt inflammatory involvement of the immune system with this allergenic therapy, which was unexpected until now. We also observed differences concerning allergic diseases, the type of allergenic extracts and routes of administration.