The Vespid Allergy Quality of Life Questionnaire - cultural adaptation and translation to Portuguese

A cross-cultural translation of the Vespid Allergy Quality of Life Questionnaire (VQLQ) to the Portuguese population (VQLQ-P) was performed, assessing its applicability in wasp and in non-beekeeper bee venom allergic patients. Additionally, we evaluated a Visual Analogue Scale (VAS) to estimate hymenoptera allergy interference with daily life. Methods. Cross-cultural translation was performed according to recommendations. The final VQLQ-P version, the Expectation of Outcome questionnaire (EoQ), EQ-5D and VAS were applied to wasp (n = 19) and non-beekeeper bee venom allergic patients (n = 30). Results. VQLQ-P significantly correlated with EoQ, (r = 0.76, p < 0.01), EQ-5D (usual activities and anxiety / depression dimensions) and VAS, with a good internal consistency (Cronbach α = 0.88) in wasp allergic individuals. VQLQ-P and EoQ correlation was also high (r = 0.67, p < 0.01) in bee allergy. Conclusion. The VQLQ-P is a valuable tool to evaluate quality of life impairment in Portuguese hymenoptera venom allergic individuals.

Benzodiazepines Intake at Youth–Experience from Adolescent Consultation at Centro Hospitalar Lisboa Norte

Introduction

The increasing intake of psychotropic medication by children and adolescents is a reality that worries many mental health professionals. Recently, european school survey project on alcohol and other drugs showed that tranquillizers and sedatives were mainly consumed by Portuguese youth, without medical prescription, bringing this topic to medical and health stakeholders’ attention.

Objectives

Characterize benzodiazepine prescription in the youth population followed in a psychiatric consultation at centro hospitalar Lisboa Norte psychiatric department.

Aims

Discuss Portuguese trends in mental health among youths.

Methods

Analysis of 127 adolescents, seen for the first time from January to December of 2015, using Microsoft office excel.

Results

Our sample is comprised by adolescents from 12 to 20 years old, 81 female and 46 male. Only 16% of the adolescents were medicated with benzodiazepines, although low neuroleptic doses were often required, and 30% carried out psychotherapy. Sixty-five per cent of the diagnosis corresponds to anxiety, depressive and impulse control disorders.

Conclusion

Although trends in Portuguese youth mental health seem to be encouraging, as highlighted by local reports, European Union Joint Action on Mental Health and Well-Being recommends community and school active roles in primary and secondary prevention. Our experience shows that benzodiazepines’ use is rarely necessary and symptoms as anxiety, impulsivity and insomnia decreased with other strategies. Coping strategies must be discussed with the adolescents, in formal psychotherapy or in a supportive and containing therapeutic relationship, as well as discussed in family interventions. Community initiatives promotion and increased mental health care services accessibility should be priorities.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Paradigm Shift in the Educational System of Adolescents with Disabilities

Introduction

In the last years, there has been a paradigm shift in the educational system of young people with disabilities. Regular schools associated with specific support plans have become the destination of choice for these adolescents, instead of schools with special education. This integrated teaching seeks to reduce stigma and to promote tolerance but frequently these students become easy targets of psychological and physical violence or discrimination.

Objective

To evaluate the integration of adolescents with disabilities in mainstream education compared to special teaching.

Methods

Analysis of 32 patients with disabilities from the adolescence consultation of the psychiatry service of hospital de Santa Maria, between January 2015 and September 2016.

Results

About 30% of the adolescents with disabilities who attend regular schools with special support complains of poor adjustment associated with some kind of mistreatment by peers.

Conclusion

Violence among students in school is a current problem very difficult to fight. Young people with disabilities often find themselves in a significant minority presenting less efficient defense mechanisms. If unprotected, they may easily develop school phobia or refusal. These situations must be identified and avoided to prevent the associated suffering.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Must we fear antidepressants in adolescents?

Introduction

Epidemiological studies have established that teenager's prevalence rates of major depression are significant (10%). The media has given a good deal of attention to the potential risks of antidepressants and their connection to increased suicidality (especially in children and adolescents). These concerns have had a significant impact on both the prescribing of antidepressants and the parental fears about their use. It is interesting to note that in large groups’ studies of adolescents treated with selective serotonin reuptake inhibitors there have been no evidence of increased suicidal risk.

Objective

Understand if there is a significant association between antidepressant treatment and suicidality in a 3-months follow-up study of the adolescent's consultation of Centro Hospitalar Lisboa Norte.

Methods

Analysis of 81 adolescents with an initial diagnosis of major depression treated with an antidepressant for at least 3 months.

Results

After the follow-up period there has been an improvement in sadness in 92.6% of the adolescents, a remission of death thoughts in 98.8% and an absence of suicides attempts. In 61.7%, it was necessary to introduce also an antipsychotic in a low dose and in 12.3% another antidepressant with a hypnotic effect.

Conclusion

It is clear that untreated major depression carries significant suffering and disability. Although treatment with antidepressants may take several weeks before clinical improvement appear and depression may worsen in the first days, its therapeutic effect should not be underestimated even if becomes necessary to add another medication in the first days. In evaluating these kinds of concerns, we must always differentiate between media hype and scientific data.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Conjunctival allergen provocation test : guidelines for daily practice

Conjunctival allergen provocation test (CAPT) reproduces the events occurring by instilling an allergen on the ocular surface. This paper is the compilation of a task force focussed on practical aspects of this technique based on the analysis of 131 papers. Main mechanisms involved are reviewed. Indications are diagnosing the allergen(s)-triggering symptoms in IgE-mediated ocular allergy in seasonal, acute or perennial forms of allergic conjunctivitis, especially when the relevance of the allergen is not obvious or in polysensitized patients. Contraindications are limited to ongoing systemic severe pathology, asthma and eye diseases. CAPT should be delayed if receiving systemic steroids or antihistamines. Local treatment should be interrupted according to the half-life of each drug. Prerequisites are as follows: obtaining informed consent; evidencing of an allergen by skin prick tests and/or serum-specific IgE dosages; being able to deal with an unlikely event such as acute asthma exacerbation, urticaria or anaphylaxis, or an exacerbation of allergic conjunctivitis. Allergen extracts should be diluted locally prior to administration. Positive criteria are based on itching or quoted according to a composite score. An alternative scoring is based on itching. CAPT remains underused in daily practice, although it is a safe and simple procedure which can provide valuable clinical information.

Trends of asthma hospitalization and hospital mortality in mainland Portugal

AIM

To evaluate nationwide asthma hospitalizations and hospital mortality from the year 2000 to 2010.

METHODS

Data from the Health Services Central Administration of the Portuguese Ministry of Health on hospital admissions and hospital mortality in the National Health Service in mainland Portugal, from January 1st 2000 to December 31st 2010, were analysed. Cases with bronchial asthma as a main diagnosis were selected.

RESULTS

We found a mean frequency of asthma hospitalizations of 2.5 / 1000 hospital admissions, 28.1 / 100,000 inhabitants (66.6/100,000 in < 19 years old). The global frequency of hospital admissions decreased 18.6% from 2000 to 2010 (r = -0.85, p = 0.002), and 47.0% in those aged 0 to 2 years old (r = -0.77, p = 0.008). There were 261 hospital deaths attributed to asthma (68.5% > 65 years old), accounting for an in-hospital mortality of 8.0 / 1000 asthma hospitalizations and 2.4 / 1,000,000 inhabitants, with no change throughout the years.

CONCLUSION

Asthma hospitalization rates have decreased, especially in younger children. Mortality remained unchanged, particularly in the elderly; this might be explained by deficient control in this age group.

One-year survey of paediatric anaphylaxis in an allergy department

AIM

To determine the frequency of anaphylaxis in an allergy outpatient department, allowing a better understanding regarding aetiology, clinical manifestations and management, in children and adolescents.

METHODS

From among 3646 patients up to 18 years old observed during one-year period, we included those with history of anaphylaxis reported by allergists.

RESULTS

Sixty-four children had history of anaphylaxis (prevalence of 1.8%), with mean age 8.1±5.5 years, 61% being male. Median age of the first anaphylactic episode was 3 years (1 month-17 years). The majority of patients had food-induced anaphylaxis (84%): milk 22, egg 7, peanut 6, tree nuts 6, fresh fruits 6, crustaceans 4, fish 4 and wheat 2. Food-associated exercise-induced anaphylaxis was reported in 2 adolescents. Drug-induced anaphylaxis occurred in 8%: 4 non-steroidal anti-inflammatory drugs and 1 amoxicillin. Three children had cold-induced anaphylaxis, one adolescent had anaphylaxis to latex and one child had anaphylaxis to insect sting. The majority (73%) had no previous diagnosis of the etiologic factor. Symptoms reported were mainly mucocutaneous (94%) and respiratory (84%), followed by gastrointestinal (42%) and cardiovascular (25%). Fifty-one patients were admitted to the emergency department, although only 33% were treated with epinephrine. Recurrence of anaphylaxis occurred in 26 patients (3 or more episodes in 14).

CONCLUSIONS

In our paediatric population, the main triggering agent of anaphylaxis was IgE-mediated food allergy. Epinephrine is underused, as reported by others. Often, children have several episodes before being assessed by an allergist. We stress the importance of systematic notification and improvement of educational programmes in order to achieve a better preventive and therapeutic management of this life-threatening entity.

A dose-response curve for biodosimetry from a 6 MV electron linear accelerator

Biological dosimetry (biodosimetry) is based on the investigation of radiation-induced biological effects (biomarkers), mainly dicentric chromosomes, in order to correlate them with radiation dose. To interpret the dicentric score in terms of absorbed dose, a calibration curve is needed. Each curve should be constructed with respect to basic physical parameters, such as the type of ionizing radiation characterized by low or high linear energy transfer (LET) and dose rate. This study was designed to obtain dose calibration curves by scoring of dicentric chromosomes in peripheral blood lymphocytes irradiated in vitro with a 6 MV electron linear accelerator (Mevatron M, Siemens, USA). Two software programs, CABAS (Chromosomal Aberration Calculation Software) and Dose Estimate, were used to generate the curve. The two software programs are discussed; the results obtained were compared with each other and with other published low LET radiation curves. Both software programs resulted in identical linear and quadratic terms for the curve presented here, which was in good agreement with published curves for similar radiation quality and dose rates.

Salivirus and aichivirus A infections in children with gastroenteritis in Brazil

Stool samples were obtained from healthy children and children with diarrhoea in Rio de Janeiro, Brazil, and analysed for aichivirus A and salivirus by reverse transcription PCR. Aichivirus A was detected in 5 (0.8%) and salivirus in 10 (1.7%) of the samples obtained from children with diarrhoea. None of the healthy children tested positive for these viruses. The results demonstrate that these viruses continuously circulate in the country, although at a low frequency.

Characterisation of systemic reactions to subcutaneous immunotherapy with airborne allergens and classification according to WAO 2010

BACKGROUND

Systemic reactions (SR) to subcutaneous immunotherapy (SCIT) are rare but potentially severe. The use of different definitions and classifications hampered comparability between studies.

AIMS

To determine the frequency of SR to SCIT with airborne allergens, and to characterise and classify them according to the WAO 2010 recommendations.

METHODS

Cross-sectional, retrospective study. Data on patients, immunotherapy and SR to SCIT were collected from the SCIT record forms. During the study period, 22,332 SCIT injections were administered (3732 patients).

RESULTS

A total of 26 SR (0.1% of administrations) were recorded in 16 (0.6%) patients (median age 22 years, nine males, all with rhinitis and nine with asthma). Twenty-one (81%) SR occurred during the induction phase; eight (31%) in the first hour after administration. According to the WAO 2010 classification, 12 (46%) were grade 1 and 14 (54%) were grade 2. Most grade 2 reactions occurred in asthmatics, presented as mild asthma symptoms and resolved without need for medical observation. Only two individuals without asthma presented grade 2 reactions, both with concurrent cutaneous and low respiratory symptoms; both required medical observation and treatment despite late onset; 82% (n=12) of grade 2 reactions were late. No grade 3-5 reactions were registered and only one patient needed adrenaline treatment. No risk factors for SR to SCIT were identified in this study.

CONCLUSIONS

SCIT is a safe treatment when administered by trained staff. The WAO 2010 classification might be useful for retrospectively classifying the severity of reactions, although its usefulness in treatment decision needs further research.

Tetranychus urticae allergy in a population without occupational exposure

BACKGROUND

Tetranychus urticae is a phytophagus mite found in the leaves of numerous plants. High sensitization rates have been demonstrated, however, provocation tests have only been performed in an occupational setting.

OBJECTIVE

To assess accuracy of skin prick tests and clinical relevance of T. urticae sensitization by means of conjunctival provocation tests (CPT) in a population without occupational exposure and to evaluate possible environmental risk factors for T. urticae allergy.

METHODS

Patients ≥ 18 years old sensitized to T. urticae (n = 12) and a non-sensitized control group (n = 12) were invited to perform CPT with T. urticae and fulfill a questionnaire including demographic data, questions on environmental exposure to T. urticae and allergy symptoms/diagnosis. A single-blinded placebo-controlled CPT with T. urticae (Leti®) was performed with increasing concentrations (0.002, 0.02, 0.2 and 2 mg/mL) and considered positive if conjunctival hyperemia, palpebral edema or lacrimation were observed in the tested eye.

RESULTS

Of T. urticae sensitized patients (mean wheal 4.4 ± 1.5 mm), 9 had a positive CPT, including 3 monosensitized. A good diagnostic accuracy was found for skin prick tests: AUC = 0.952, sensitivity = 100%, specificity = 80%, positive likelihood ratio = 5 and negative likelihood ratio = 0 for a 3 mm wheal. No differences were found between allergic and non-allergic subjects regarding atopy, allergic disease or farming activities.

CONCLUSIONS

A high prevalence of allergy to Tetranychus urticae was found in the north of Portugal. Future studies with a larger number of patients are needed to evaluate its relation to clinical symptoms and the impact of environmental factors.

Frequency of micronuclei and of other nuclear abnormalities in erythrocytes of the grey mullet from the Mondego, Douro and Ave estuaries--Portugal

Fish are bioindicators of water pollution, and an increased rate of their erythrocyte nuclear morphological abnormalities (ENMAs)-and particularly of erythrocyte micronuclei (EMN)-is used as a genotoxicity biomarker. Despite the potential value of ENMAs and MN, there is scarce information about fish captured in Iberian estuaries. This is the case of the Portuguese estuaries of the Mondego, Douro and Ave, suffering from different levels of environmental stress and where chemical surveys have been disclosing significant amounts of certain pollutants. So, the aim of this study was to evaluate genotoxicants impacts and infer about the exposure at those ecosystems, using the grey mullet (Mugil cephalus) as bioindicator and considering the type and frequency of nuclear abnormalities of erythrocytes as proxies of genotoxicity. Sampling of mullets was done throughout the year in the important Mondego, Douro and Ave River estuaries (centre and north-western Portugal). The fish (total n = 242) were caught in campaigns made in spring-summer and autumn-winter, using nets or fishing rods. The sampled mullets were comparable between locations in terms of the basic biometric parameters. Blood smears were stained with Diff-Quik to assess the frequencies of six types of ENMAs and MN (given per 1,000 erythrocytes). Some basic water physicochemical parameters were recorded to search for fluctuations matching the ENMAs. Overall, the most frequent nucleus abnormality was the polymorphic type, sequentially followed by the blebbed/lobed/notched, segmented, kidney shaped, vacuolated, MN and binucleated. The total average frequency of the ENMAs ranged from 73 ‰ in the Mondego to 108 ‰ in the Ave. The polymorphic type was typically ≥50 % of the total ENMAs, averaging about 51 ‰, when considering all three estuaries. The most serious lesion-the MN-in fish from Mondego and Douro had a similar frequency (≈0.38 ‰), which was significantly lower than that in the Ave (0.75 ‰). No significant seasonal differences existed as to the MN rates and seasonal differences existed almost only in the Douro, with the higher values in AW. In general, the pattern of ENMAs frequencies was unrelated with the water physicochemical parameters. Considering the data for both the total ENMAs and for each specific abnormality, and bearing in mind that values of MN in fish erythrocytes >0.3 ‰ usually reflect pollution by genotoxicants, it is suggested that mullets were likely being chronically exposed to such compounds, even in the allegedly less polluted ecosystem (Mondego). Moreover, data supported the following pollution exposure gradient: Mondego < Douro < Ave. The scenario and inferences nicely agree with the published data from chemical monitoring.

Costs of treatment affect compliance to specific subcutaneous immunotherapy

BACKGROUND

Specific subcutaneous immunotherapy (SCIT) is cost-effective; however its economical burden can lead to non-adherence. We aimed to identify the reported reasons, patient's personal or socio-demographic characteristics and SCIT-related factors associated with non-adherence to SCIT.

METHODS

This is a cross-sectional, observational study held in a Portuguese University Hospital. All records from patients starting SCIT in the last 4 years were reviewed in July 2011. Those without registry of SCIT administration in the previous 3 months were included (n = 181). A telephonic survey was performed and 56 were confirmed as non-adherent; reasons for discontinuation were assessed. Univariate and multiple logistic regression models were developed using characteristics previously described as being associated with non-adhesion.

RESULTS

Economical burden of SCIT was the most important factor leading to treatment discontinuation (40%). In the univariate analysis, presence of family history of allergic disease treated with immunotherapy was associated with decreased OR of non-adherence to SCIT (OR [95%CI] = 0.31 [0.11- 0.88]). In the multiple logistic regression model, none of the factors was significantly associated with non-adherence.

CONCLUSION

Adherence is influenced by economic factors. More attention should be given to the impact of economic changes in allergic patient's treatment.

Prevalence and classification of rhinitis in preschool children in Portugal: a nationwide study

BACKGROUND

Information on rhinitis epidemiology in preschool children is scarce.

OBJECTIVES

To estimate, in children with 3-5 years of age, current rhinitis prevalence, to describe rhinitis symptoms and associated sociodemographic characteristics, and to report allergic rhinitis and its impact on asthma (ARIA) classification.

METHODS

Cross-sectional, nationwide, population-based study including children aged 3-5 years. A multistep selection strategy was used to obtain a representative sample. Data were collected at kindergartens and parish centers by face-to-face interview to caregivers, using an adapted ISAAC questionnaire. 'Current rhinitis' (CR) was defined as the presence of ≥1 rhinitis symptom (repeated sneezing and/or itchy nose, blocked nose for >1 h, or runny nose without having a cold/flu) in the last year. Rhinitis lasting ≥4 days/week and ≥4 consecutive weeks was classified as persistent. Moderate-severe disease interfered 'a moderate amount' or 'a lot' in daily activities.

RESULTS

Five thousand and eighteen children were included. CR prevalence was 43.4% [95% CI (42.0-44.8%); n = 2179] and that of physician-diagnosed rhinitis was 11.7% [95% CI (10.8-12.6%); n = 588]. Of children with CR, 67% reported blocked nose, 48% rhinorrhea, and 46% sneezing/itchy nose. Considering ARIA classification, 30% of the population had mild intermittent, 3% mild persistent, 7% moderate-severe intermittent, and 3% moderate-severe persistent rhinitis. Children with CR had more current wheezing, physician-diagnosed asthma, self-reported food allergy, and family history of allergic disease. These characteristics were also associated with persistent and moderate-severe rhinitis.

CONCLUSIONS

This is the first nationwide population-based study reporting rhinitis prevalence and ARIA classification in preschool children. In this age-group, rhinitis is frequent and underdiagnosed. About 25% children with rhinitis presented moderate-severe disease.