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de Mello LM, Serpa FS, Chiabai J, Fernandes FR, Chong-Neto HJ, Sarinho ESC, Rubini NDPM, Solé D. The specialty of allergy and clinical immunology in Brazil. FRONTIERS IN ALLERGY 2022; 3:933816. [PMID: 35935019 PMCID: PMC9347215 DOI: 10.3389/falgy.2022.933816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/21/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To assess the profile of allergist/immunologist (A/I) physicians in Brazil, the workplace, the access to diagnostic and therapeutic procedures, and the impact of the COVID-19 pandemic on professional practice. Methods This cross-sectional study was conducted as an online survey. All adhering members of the Brazilian Association of Allergy and Immunology (ASBAI) received a Google Forms tool by email. The questionnaire addressed sociodemographic and professional aspects of the Brazilian allergists/immunologists (A/I) daily routine. The information was analyzed by SPSS version 20.0. Results Four hundred and sixty members answered the questionnaire. Women were predominant among the responders (336; 73%), and the median age was 47 years (range, 27–82 years). Most participants worked in the private sector (437, 95%), whereas 256 (47%) worked in the public sector. Among the public sector employees, 210 (82%) reported having access to some diagnostic test for allergic diseases and inborn errors of immunity. Only 91 (35%) A/I physicians in the public system had access to allergen-specific immunotherapy, compared to 416 (95, 9%) of those in the private sector. Regarding biological drugs, 135 (52.7%) and 314 (71.9%) of the A/I physicians working in the public and private sector, respectively, reported access. Two hundred and eighty-three (61.6%) had at least a 50% reduction in the number of consultations, and 245 (56%) provided telemedicine care during the COVID-19 pandemic. Conclusion Brazilian A/I have incorporated the most recent advances in managing immunoallergic diseases into their clinical practice, but they still have little access to various diagnostic methods. Strategies to enable the presence of A/I in public health services should be discussed and implemented. The coronavirus pandemic has accelerated the incorporation of telemedicine as a viable and promising method of medical care and can expand access to the specialty.
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Affiliation(s)
- Luane Marques de Mello
- Department of Social Medicine, Ribeirão Preto Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Brazilian Association of Allergy and Immunology (ASBAI), São Paulo, Brazil
| | - Faradiba Sarquis Serpa
- Brazilian Association of Allergy and Immunology (ASBAI), São Paulo, Brazil
- Department of Internal Medicine, School of Sciences of Santa Casa de Misericórdia de Vitória, Vitória, Brazil
| | - Joseane Chiabai
- Department of Pediatrics, Federal University of Espírito Santo, Vitória, Brazil
- Scientific Brazilian Association of Allergy and Immunology (ASBAI), São Paulo, Brazil
| | - Fátima Rodrigues Fernandes
- Brazilian Association of Allergy and Immunology (ASBAI), São Paulo, Brazil
- Division of Allergy and Immunology Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
- PENSI Research Institute, São Paulo, Brazil
| | - Herberto José Chong-Neto
- Brazilian Association of Allergy and Immunology (ASBAI), São Paulo, Brazil
- Department of Pediatrics, Federal University of Paraná, Curitiba, Brazil
- *Correspondence: Herberto Jose Chong-Neto
| | - Emanuel Sávio Cavalcanti Sarinho
- Brazilian Association of Allergy and Immunology (ASBAI), São Paulo, Brazil
- Department of Pediatrics, Federal University of Pernambuco, Recife, Brazil
| | - Norma de Paula Motta Rubini
- Brazilian Association of Allergy and Immunology (ASBAI), São Paulo, Brazil
- Full School of Medicine and Surgery of the Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dirceu Solé
- Brazilian Association of Allergy and Immunology (ASBAI), São Paulo, Brazil
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
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Barker S, Daniels L, Chang YS, Chikovani T, DunnGalvin A, Gerdts JD, Gerth Van Wijk R, Gibbs T, Villarreal Gonzalez RV, Guzman-Avilan RI, Hanna H, Hossny E, Kolotilina A, Ortega Martell JA, Pacharn P, de Lira Quezada CE, Sibanda E, Stukus D, Tham EH, Venter C, Gonzalez-Diaz SN, Levin ME, Martin B, Warner JO, Munblit D. Allergy education and training for physicians. World Allergy Organ J 2021; 14:100589. [PMID: 34820046 PMCID: PMC8591183 DOI: 10.1016/j.waojou.2021.100589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 12/23/2022] Open
Abstract
The increasing prevalence of allergic diseases has placed a significant burden on global healthcare and society as whole. This has necessitated a rapid development of "allergy" as a specialist area. However, as allergy is so common and, for most, relatively easy to diagnose and control, all clinicians need to have basic knowledge and competence to manage mild disease and recognize when referral is required. The allergology specialty has not yet been recognized in many countries and even where allergy is fully recognized as a specialty, the approach to training in allergy differs significantly. In the light of recent developments in allergy diagnosis and management, there is an urgent need to harmonize core competences for physicians, as well as the standardization of core principles for medical education and post-graduate training in allergy. All physicians and allied health professionals must appreciate the multidisciplinary team (MDT) approach to allergy, which is key to achieving the highest standards in holistic care. Due to worldwide variation in resources and personnel, some MDT roles will need to be absorbed by the treating physician or other healthcare professionals. We draw particular attention to the role of psychological input for all allergy patients, dietetic input in the case of food allergy and patient education to support all patients in the supported self-management of their condition on a daily basis. A strong appreciation of these multidisciplinary aspects will help physicians provide quality patient-centered care. We consider that harmonization of allergy components within undergraduate curricula is crucial to ensure all physicians develop the appropriate allergy-related knowledge and skills, particularly in light of inconsistencies seen in the primary care management of allergy. This review from the World Allergy Organization (WAO) Education and Training Committee also outlines allergy-related competences required of physicians working with allergic patients and provides recommendations to promote harmonization of allergy training and practice worldwide.
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Affiliation(s)
- Sally Barker
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lydia Daniels
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Tinatin Chikovani
- Department of Immunology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland.,Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | | | - Roy Gerth Van Wijk
- Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Trevor Gibbs
- Association for Medical Education in Europe (AMEE), Dundee, Scotland, UK.,Independant Consultant in Primary Care and Medical Education
| | - Rosalaura V Villarreal Gonzalez
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr. Jose Eleuterio Gonzalez", Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Rosa I Guzman-Avilan
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr. Jose Eleuterio Gonzalez", Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | | | - Elham Hossny
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Anastasia Kolotilina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | | | - Punchama Pacharn
- Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Cindy E de Lira Quezada
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr. Jose Eleuterio Gonzalez", Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Elopy Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, Twin Palms Medical Centre, Harare, Zimbabwe.,Department of Pathology, Medical School, National University of Science and Technology, Bulawayo, Zimbabwe
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore.,Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carina Venter
- Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Colorado, USA
| | - Sandra N Gonzalez-Diaz
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr. Jose Eleuterio Gonzalez", Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Michael E Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Bryan Martin
- Division of Allergy and Immunology, Department of Otolaryngology, The Ohio State University, Columbus, OH, USA
| | - John O Warner
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.,Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom.,Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
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3
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Gonzalez-Diaz SN, Martin B, de Lira-Quezada CE, Villarreal-Gonzalez RV, Guzman-Avilan RI, Macías-Weinmann A, Ortega-Martell JA, Macouzet-Sanchez C, Sánchez-Borges M, Rosario Filho NA, Yañez A, Guzman-Melendez MA, Cardona R, Monge-Ortega OP, Cherrez-Ojeda I, Herrera-Castro D, Valentin-Rostan M, Sisul-Alvariza JC, Ansotegui IJ, Elizondo-Villarreal B. Current situation of allergy education in Mexico and other parts of Latin America. World Allergy Organ J 2021; 14:100543. [PMID: 34093955 PMCID: PMC8142083 DOI: 10.1016/j.waojou.2021.100543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/17/2021] [Accepted: 04/14/2021] [Indexed: 11/21/2022] Open
Abstract
Allergic diseases are one of the most frequent chronic diseases in the world. It has been established that there is a worldwide epidemic of allergic diseases; therefore, the treatment of allergies should be acknowledged as a worldwide priority and the specialty of allergy should be considered an important field in medicine. Due to the fact that allergic diseases involve many organs, and Allergy and Clinical Immunology is one of the specialties in which physicians may be trained to treat patients of all ages, the subject in medical schools is not always taught as an individual specialty but often as part of another subject such as internal medicine or pediatrics. Certified allergists are an important contribution to health systems, providing the necessary care for patients who have allergic diseases. Undergraduate programs in many universities do not include allergy as a subject, contributing to a lack of knowledge regarding the correct management of allergic diseases. World Health Organization (WHO) recommends 1 allergist per 50,000 people; however, there is an uneven distribution of allergy and clinical immunology specialists. Most practitioners are localized mainly in larger cities and state capitals, while in other regions, specialists are still greatly needed. Support and training systems are required for allergy and clinical immunology specialists to promote continuing education and keep their clinical competence up to date, which will lead to better care for their patients. Increased exposure to the concepts of allergy and clinical immunology diagnosis and treatment in undergraduate education may also potentially lead to an increase in interest in the field of allergy and clinical immunology among physicians in training. This review will approach allergy education in Mexico and other parts of Latin America.
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Affiliation(s)
- Sandra Nora Gonzalez-Diaz
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. José Eleuterio González”, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, NL, CP 64460, Mexico
| | - Bryan Martin
- Allergy and Immunology, The Ohio State University, Columbus, OH, USA
| | - Cindy Elizabeth de Lira-Quezada
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. José Eleuterio González”, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, NL, CP 64460, Mexico
| | - Rosalaura Virginia Villarreal-Gonzalez
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. José Eleuterio González”, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, NL, CP 64460, Mexico
| | - Rosa Ivett Guzman-Avilan
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. José Eleuterio González”, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, NL, CP 64460, Mexico
| | - Alejandra Macías-Weinmann
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. José Eleuterio González”, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, NL, CP 64460, Mexico
| | | | - Carlos Macouzet-Sanchez
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. José Eleuterio González”, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, NL, CP 64460, Mexico
| | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Clinica El Avila, Caracas, Venezuela
| | | | - Anahí Yañez
- Investigaciones en Alergia y Enfermedades Respiratorias - InAER, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia Erandio, Bilbao, Spain
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4
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Aranda CS, Cocco RR, Pierotti FF, Mallozi MC, Franco JM, Porto A, Goudouris E, Moraes L, Rosário N, Wandalsen NF, Pastorino A, Sarinho E, Sano F, Chavarria ML, Borres MP, Solé D. Increased sensitization to several allergens over a 12-year period in Brazilian children. Pediatr Allergy Immunol 2018; 29:321-324. [PMID: 29314278 DOI: 10.1111/pai.12860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Marcia Carvalho Mallozi
- Federal University of São Paulo, Sao Paulo, Brazil.,Faculdade de Medicina do ABC, Santo Andre, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Magnus P Borres
- Thermo Fisher Scientific, Uppsala, Brazil.,Department of Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Dirceu Solé
- Federal University of São Paulo, Sao Paulo, Brazil
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5
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Guest JF, Yang AC, Oba J, Rodrigues M, Caetano R, Polster L. Relative cost-effectiveness of using an extensively hydrolyzed casein formula in managing infants with cow's milk allergy in Brazil. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:629-639. [PMID: 27799804 PMCID: PMC5076537 DOI: 10.2147/ceor.s113448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective To estimate the cost-effectiveness of three alternative dietetic strategies for cow’s milk allergy in Brazil: 1) using an extensively hydrolyzed casein formula (eHCF; Nutramigen) as a first-line formula, but switching to an amino acid formula (AAF) if infants remain symptomatic; 2) using an AAF as a first-line formula and then switching to an eHCF after 4 weeks once infants are symptom-free, but switching back to an AAF if infants become symptomatic; and 3) using an AAF as a first-line formula and keeping all infants on that formula. The analysis was conducted from the perspective of the Brazilian public health care system, Sistema Único de Saude. Methods Decision modeling was used to estimate the probability of immunoglobulin E (IgE)-mediated and non-IgE-mediated allergic infants developing tolerance to cow’s milk by 12 months from starting a formula. The models also estimated the Sistema Único de Saude cost (at 2013/2014 prices) of managing infants over 12 months after starting a formula, as well as the relative cost-effectiveness of each of the dietetic strategies. Results The probability of developing tolerance to cow’s milk by 12 months from starting a formula was higher among infants with either IgE-mediated or non-IgE-mediated allergy who were initially fed with an eHCF, compared with those who were initially fed with an AAF. The total health care cost of initially feeding an eHCF to cow’s milk allergic infants was less than that of initially feeding both IgE-mediated and non-IgE-mediated infants with an AAF. Conclusion Within the study’s limitations, using an eHCF instead of an AAF for the first-line management of newly-diagnosed infants with cow’s milk allergy affords a cost-effective use of publicly funded resources, since it improves the outcome for less cost.
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Affiliation(s)
- Julian F Guest
- Catalyst Health Economics Consultants, Northwood, Middlesex, UK; Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Ariana C Yang
- Universidade de São Paulo, São Paulo & Universidade Estadual de Campinas, São Paulo, Brazil
| | - Jane Oba
- Hospital Israelita Albert Einstein, São Paulo, Brazil & Hospital Municipal Menino Jesus, São Paulo, Brazil
| | - Maraci Rodrigues
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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6
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Melo J, Moreno A, Ferriani V, Araujo AC, Vianna E, Borges M, Roxo P, Gonçalves M, Mello L, Parreira R, Silva J, Stefanelli P, Panazolo L, Cetlin A, Queiroz L, Araujo R, Dias M, Aragon D, Domingos N, Arruda LK. University and public health system partnership: A real-life intervention to improve asthma management. J Asthma 2016; 54:411-418. [PMID: 27715349 DOI: 10.1080/02770903.2016.1218012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Asthma is under-diagnosed in many parts of the world. We aimed to assess the outcome of a capacitating program on asthma for non-specialist physicians and other healthcare professionals working in the public system in Ribeirão Preto, Brazil. METHODS A group of 16 asthma specialists developed a one-year capacitating program in 11 healthcare clinics in the Northern District of the city, which included lectures on asthma, training on inhalation device use and spirometry, and development of an asthma management protocol. Researchers visited one health unit 2-4 times monthly, working with doctors on patients' care, discussing cases, and delivering lectures. Asthma education was also directed to the general population, focusing on recognition of signs and symptoms and long-term treatment, including production of educational videos available on YouTube. Outcome measures were the records of doctors' prescriptions of individual asthma medications pre- and post-intervention. RESULTS Prior to the program, 3205 units of inhaled albuterol and 2876 units of inhaled beclomethasone were delivered by the Northern District pharmacy. After the one-year program, there was increase to 4850 units (51.3%) for inhaled albuterol and 3526 units (22.6%) for inhaled beclomethasone. The albuterol increase followed the recommendation given to the non-specialist doctors by the asthma experts, that every patient with asthma should have inhaled albuterol as a rescue medication, by protocol. No increase was observed in other districts where no capacitating program was conducted. CONCLUSION A systematic capacitating program was successful in changing asthma prescription profiles among non-specialist doctors, with increased delivery of inhaled albuterol and beclomethasone.
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Affiliation(s)
- Janaina Melo
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Adriana Moreno
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Virginia Ferriani
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Ana Carla Araujo
- c Department of Medicine , University of Ribeirão Preto UNAERP , Ribeirão Preto , Brazil
| | - Elcio Vianna
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Marcos Borges
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Pérsio Roxo
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Marcos Gonçalves
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Luane Mello
- d Department of Social Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Rosa Parreira
- e Department of Pediatrics , Barão de Mauá University Center , Ribeirão Preto , Brazil
| | - Jorgete Silva
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Patricia Stefanelli
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Larissa Panazolo
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Andrea Cetlin
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Luana Queiroz
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Rosângela Araujo
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Marina Dias
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Davi Aragon
- b Department of Pediatrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
| | - Nélio Domingos
- f Health Secretariat of Municipal Government of the City of Ribeirão Preto , Ribeirão Preto , Brazil
| | - L Karla Arruda
- a Department of Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil
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Caraballo L, Zakzuk J, Lee BW, Acevedo N, Soh JY, Sánchez-Borges M, Hossny E, García E, Rosario N, Ansotegui I, Puerta L, Sánchez J, Cardona V. Particularities of allergy in the Tropics. World Allergy Organ J 2016; 9:20. [PMID: 27386040 PMCID: PMC4924335 DOI: 10.1186/s40413-016-0110-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/25/2016] [Indexed: 12/27/2022] Open
Abstract
Allergic diseases are distributed worldwide and their risk factors and triggers vary according to geographical and socioeconomic conditions. Allergies are frequent in the Tropics but aspects of their prevalence, natural history, risk factors, sensitizers and triggers are not well defined and some are expected to be different from those in temperate zone countries. The aim of this review is to investigate if allergic diseases in the Tropics have particularities that deserve special attention for research and clinical practice. Such information will help to form a better understanding of the pathogenesis, diagnosis and management of allergic diseases in the Tropics. As expected, we found particularities in the Tropics that merit further study because they strongly affect the natural history of common allergic diseases; most of them related to climate conditions that favor permanent exposure to mite allergens, helminth infections and stinging insects. In addition, we detected several unmet needs in important areas which should be investigated and solved by collaborative efforts led by the emergent research groups on allergy from tropical countries.
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Affiliation(s)
- Luis Caraballo
- />Institute for Immunological Research, University of Cartagena, Cra. 5 # 7-77, Cartagena, Colombia
| | - Josefina Zakzuk
- />Institute for Immunological Research, University of Cartagena, Cra. 5 # 7-77, Cartagena, Colombia
| | - Bee Wah Lee
- />Khoo Teck Puat- National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- />Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nathalie Acevedo
- />Department of Medicine Solna, Karolinska Institutet, Translational Immunology Unit, Stockholm, Sweden
| | - Jian Yi Soh
- />Khoo Teck Puat- National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- />Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mario Sánchez-Borges
- />Allergy and Clinical Immunology Department, Centro Médico- Docente La Trinidad and Clínica El Avila, Caracas, Venezuela
| | - Elham Hossny
- />Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, Egypt
| | - Elizabeth García
- />Allergy Section, Fundación Santa Fe de Bogotá, Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Nelson Rosario
- />Federal University of Parana, Rua General Carneiro, Curitiba, Brazil
| | - Ignacio Ansotegui
- />Department of Allergy and Immunology, Hospital Quirón Bizkaia, Bilbao, Spain
| | - Leonardo Puerta
- />Institute for Immunological Research, University of Cartagena, Cra. 5 # 7-77, Cartagena, Colombia
| | - Jorge Sánchez
- />Department of Pediatrics, Graduate Program on Allergology, University of Antioquia, Medellín, Colombia
| | - Victoria Cardona
- />Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron, Barcelona, Spain
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8
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de Sousa RB, Medeiros D, Sarinho E, Rizzo JÂ, Silva AR, Bianca ACD. Risk factors for recurrent wheezing in infants: a case-control study. Rev Saude Publica 2016; 50:15. [PMID: 27143615 PMCID: PMC4904490 DOI: 10.1590/s1518-8787.2016050005100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 05/30/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the association between recurrent wheezing and atopy, the Asthma Predictive Index, exposure to risk factors, and total serum IgE levels as potential factors to predict recurrent wheezing. METHODS A case-control study with infants aged 6-24 months treated at a specialized outpatient clinic from November 2011 to March 2013. Evaluations included sensitivity to inhalant and food antigens, positive Asthma Predictive Index, and other risk factors for recurrent wheezing (smoking during pregnancy, presence of indoor smoke, viral infections, and total serum IgE levels). RESULTS We evaluated 113 children: 65 infants with recurrent wheezing (63.0% male) with a mean age of 14.8 (SD = 5.2) months and 48 healthy infants (44.0% male) with a mean age of 15.2 (SD = 5.1) months. In the multiple analysis model, antigen sensitivity (OR = 12.45; 95%CI 1.28–19.11), positive Asthma Predictive Index (OR = 5.57; 95%CI 2.23–7.96), and exposure to environmental smoke (OR = 2.63; 95%CI 1.09–6.30) remained as risk factors for wheezing. Eosinophilia ≥ 4.0% e total IgE ≥ 100 UI/mL were more prevalent in the wheezing group, but failed to remain in the model. Smoking during pregnancy was identified in a small number of mothers, and secondhand smoke at home was higher in the control group. CONCLUSIONS Presence of atopy, positive Asthma Predictive Index and exposure to environmental smoke are associated to recurrent wheezing. Identifying these factors enables the adoption of preventive measures, especially for children susceptible to persistent wheezing and future asthma onset.
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Affiliation(s)
| | - Décio Medeiros
- Departamento Materno Infantil, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - Emanuel Sarinho
- Departamento Materno Infantil, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - José Ângelo Rizzo
- Departamento de Medicina Clínica, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - Almerinda Rêgo Silva
- Departamento Materno Infantil, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - Ana Carolina Dela Bianca
- Departamento Materno Infantil, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brasil
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Di Francesco RC, Alvarez J. Allergic rhinitis affects the duration of rapid eye movement sleep in children with sleep-disordered breathing without sleep apnea. Int Forum Allergy Rhinol 2016; 6:465-71. [DOI: 10.1002/alr.21689] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 09/26/2015] [Accepted: 10/22/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Renata C. Di Francesco
- Department of Otolaryngology; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
| | - Jessica Alvarez
- Department of Otolaryngology; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
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Abstract
PURPOSE OF REVIEW This review is to explore the childhood nutrition and health in relation to socioeconomic changes in transitional countries, and to describe the good experiences and policies in these countries to combat childhood nutritional challenges. RECENT FINDINGS Double burden of malnutrition - the coexistence of under-nutrition and over-nutrition in the same population - is a prominent public health concern in transitional countries. With rapid industrialization, these countries are facing a growing epidemic of overweight/obesity in children and adolescents. The increasing prevalence of childhood overweight/obesity is a likely consequence of behavioral changes, and accompanied with an increasing incidence of noncommunicable chronic diseases. Although remarkable improvement of childhood nutrition was achieved, the stunting growth and micronutrient deficiency remain to be child health issues in transitional countries. SUMMARY The social transition caused a broad range of nutrition-associated problems. Previous successful experiences indicated that if appropriate action is undertaken, the child nutritional problems accompanied with economic transition could be controlled to some extent. However, greater efforts are needed to improve the status of childhood nutrition in transitional countries.
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Affiliation(s)
- Wei Cai
- aXin Hua Hospital, Shanghai Jiao Tong University, School of Medicine bShanghai Institute for Pediatric Research cShanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
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