Sex diferences in serum and synovial fluid C-reactive protein concentration in healthy dogs

Differences between serum C-reactive protein (SCRP) and synovial fluid C-reactive protein (SFCRP) concentrations in healthy animals may be influenced by the sex of the individual and associated with various factors. The objective of this study was to evaluate the disparities in SCRP and SFCRP concentrations between females and males, as well as within each sex. Sixty healthy dogs (N = 60), comprising both sexes, were enrolled in the study. Peripheral blood and knee synovial fluid samples were collected for SCRP and SFCRP analysis, respectively. Serum C-reactive protein (SCRP) and SFCRP concentrations were measured, with mean of 9.61 ± 4.96 mg/L for SCRP and 1.28 ± 3.05 mg/L for SFCRP. Notably, SFCRP concentrations were consistently lower than SCRP concentrations in both sexes. Statistically significant differences were observed between sexes for both SCRP (P = 0.021) and SFCRP (P = 0.007). Further analysis within females revealed statistically significant differences between SCRP and SFCRP concentrations (P = 0.002), whereas in males, such differences were not significant (P = 0.175). Additionally, weak correlations were found between SCRP and SFCRP concentrations for both sexes (females r = 0.07; males r = 0.29). Joint capsule thickness was assessed using ultrasonography, revealing thicker joint capsules in males. A robust positive association was noted between joint capsule thickness and the SFCRP concentration in both sexes. These findings offer valuable insights into the dynamics of CRP in the context of joint health in male and female patients, elucidating the underlying pathological mechanisms of joint disease and inflammation. Overall, this underscores the importance of considering sex-specific factors in the assessment and management of joint health, as well as in the design and interpretation of studies involving SFCRP concentrations.

0830 Hormonal Contraceptive Use and Sleep: A Systematic Review and Meta-Analysis

Introduction

The effects of hormonal contraceptives on sleep has been matter of debate in current literature. While some articles observed a sleep promoting effect and reduced sleep disordered breathing, others have failed to detect any result or even detected a worse sleep pattern in women using hormonal contraception. As the literature has been growing on this field, a systematic review is necessary to gather and compare all the studies in a comprehensive way.

Methods

A bibliographic search was conducted in Pubmed, Scopus and Web of Science. Studies were selected first based on titles and abstracts, followed by full text analysis and data extraction. Only original studies evaluating women using hormonal contraception were considered eligible. Both objective and subjective sleep-related outcomes were extracted for analyzes. Individual effect size for each articles was calculated using regular or standardized mean differences and meta-analyses were conducted using a DerSimonian and Laird random effects model.

Results

After the bibliographic search, 1787 non-duplicated articles were included in our initial data screening. Articles sample was reduced to 114 records after abstract screening and to ten studies after full text analyses. The following sleep outcomes were eligible for meta-analysis: Pittsburgh Sleep Quality Index (PSQI - 3 studies), total time in bed (4), subjective total sleep time (4), objective total sleep time (3), sleep latency (6), sleep efficiency (6). None of them resulted in statistically significant effects of contraceptive use and the effect size ± 95% interval of confidence overlapped the zero value.

Conclusion

Hormonal contraceptives is not associated to any alteration in sleep patterns in women. This conclusion should be restricted to a general framework, since our sample does not allowed stratified analyses. Future studies should consider the effect of specific hormonal composition (ex.: combined vs. progestogen-only contraceptives) and administration route (contraceptive pills vs. levonorgestrel intrauterine device).

Support

AFIP, CAPES, CNPq

Tree Nuts Anaphylaxis in Preschool Age Children

Summary

Introduction. The incidence of food-induced anaphylaxis (FIA) is increasing in young children. Although the commonest culprits are cow's milk and egg, FIA to tree nuts (TNs) have been increasing. Objective. Characterization of children referred to our allergy department due to TNs-induced anaphylaxis (TNs-FIA) during preschool age. Materials and methods. We have retrospectively included 25 children with clinical history of preschool TNs-FIA, proven by allergological work-up. TNs sensitization was assessed by skin prick tests and/or specific IgE. Results. The mean age of the first anaphylactic episode was 3.1±1.2 years. The majority (92%) had an allergic disease (52% asthma). The implicated TNs were cashew (11 children), walnut (8), pine nut (5), hazelnut (2) and almond (1). The reaction occurred after the first known ingestion in 68%. In 92%, symptoms appeared within 30 minutes after exposure. The most frequent clinical symptoms were mucocutaneous (96%), respiratory (80%) and gastrointestinal (52%). Twenty-one children were admitted to the emergency department, although only 48% were treated with epinephrine. An underneath IgE-mediated mechanism was proven in all cases. Immunologic cross-reactivity with other TNs was identified in 84%, and with peanut in 36%. Overall, in our center, TNs-FIA represents 18% of all causes of FIA. Conclusions. In preschool age children with TNs-FIA, cashew and walnut were the commonest implicated nuts. Most reactions occurred briefly after exposure to minimal amounts of TNs, demonstrating the high potency of these allergens. About one-third also had peanut sensitization. Potentially life-threatening TNs allergy can occur early in childhood and adequate management should be undertaken.

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.

Quantitative analysis of immunoglobulin E reactivity profiles in patients allergic or sensitized to natural rubber latex (Hevea brasiliensis)

BACKGROUND

Characterized native and recombinant Hevea brasiliensis (rHev b) natural rubber latex (NRL) allergens are available to assess patient allergen sensitization profiles.

OBJECTIVE

Quantification of individual IgE responses to the spectrum of documented NRL allergens and evaluation of cross-reactive carbohydrate determinants (CCDs) for more definitive diagnosis.

METHODS

Sera of 104 healthcare workers (HCW; 51 German, 21 Portuguese, 32 American), 31 spina bifida patients (SB; 11 German, 20 Portuguese) and 10 Portuguese with multiple surgeries (MS) were analysed for allergen-specific IgE antibody (sIgE) to NRL, single Hev b allergens and CCDs with ImmunoCAP technology.

RESULTS

In all patient groups rHev b 5-sIgE concentrations were the most pronounced. Hev b 2, 5, 6.01 and 13 were identified as the major allergens in HCW and combined with Hev b 1 and Hev b 3 in SB. In MS Hev b 1 displayed an intermediate relevance. Different sIgE antibody levels to native Hevea brasiliensis (nHev b) 2 and rHev b 6.01 allowed discrimination of SB with clinical relevant latex allergy vs. those with latex sensitization. Sensitization profiles of German, Portuguese and American patients were equivalent. rHev b 5, 6.01 and nHev b 13 combined detected 100% of the latex-allergic HCW and 80.1% of the SB. Only 8.3% of the sera showed sIgE response to CCDs.

CONCLUSIONS

Hev b 1, 2, 5, 6.01 and 13 were identified as the major Hev b allergens and they should be present in standardized latex extracts and in vitro allergosorbents. CCDs are only of minor relevance in patients with clinical relevant latex allergy. Component-resolved diagnostic analyses for latex allergy set the stage for an allergen-directed immunotherapy strategy.

Barnacle allergy: allergen characterization and cross-reactivity with mites

BACKGROUND

Barnacles are a type of seafood with worldwide distribution and abundant along the shores of temperate seas. They are particularly appreciated and regularly consumed in Portugal as well as in Spain, France and South America, but barnacle allergy is a rare condition of which there is only one reference in the indexed literature. The molecular allergens and possible cross-reactivity phenomena implicated (namely with mites) have not been established.

OBJECTIVE

To demonstrate the IgE-mediated allergy to barnacle and to identify the proteins implicated as well as possible cross-reactivity phenomena with mites.

METHODS

We report the clinical and laboratory data of five patients with documented IgE-mediated allergy to barnacle. The diagnosis was based on a suggestive clinical history combined with positive skin prick tests (SPT) to barnacle--prick to prick method. Two barnacle extracts were prepared (raw and cooked barnacle) and sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS-PAGE) and IgE-immunoblotting were performed. An immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done in order to evaluate cross-reactivity.

RESULTS

All patients had mite-related asthma and the allergic rhinoconjunctivitis; they all experienced mucocutaneous symptoms. All of them had positive SPT to barnacle, and the immunoblotting showed several allergenic fractions with a wide molecular weight range (19 - 94 kDa). The D. pteronyssinus extract inhibited several IgE-binding protein fractions in the barnacle extract.

CONCLUSIONS

We describe five patients with IgE-mediated barnacle allergy. We also describe a group of IgE-binding+proteins between 30 and 75 kDa as the allergenic fractions of this type of Crustacea. Cross-reactivity with D. pteronyssinus was demonstrated in two cases.

Risk factors for latex sensitization in children with spina bifida

BACKGROUND

Children with spina bifida represent the major risk group for latex sensitization.

PURPOSE

To determine the prevalence of latex sensitization in these children and to identify risk factors.

MATERIAL AND METHODS

We studied 57 patients with spina bifida. The mean age was 5.6 years and the male/female ratio was 0.8/1. In all patients a questionnaire, skin prick test (SPT) with latex (UCB-Stallergènes, Lofarma and ALK-Abelló), common aeroallergens and fruits (UCB-Stallergènes) and serum determination of total IgE (AlaSTAT) were performed.

RESULTS

The prevalence of latex sensitization was 30 %; only two sensitized children (12 %) had symptoms after exposure. Risk factors for latex sensitization were age >/= 5 years (p = 0.008; OR = 6.0; 95 % CI = 1.7-22.1), having at least four previous surgical interventions (p < 0.0001; OR = 18.5; 95 % CI = 3.6-94.8), having undergone surgery in the first 3 months of life (p = 0.008; OR = 5.4; 95 % CI = 0.7-29.2) and total serum IgE >/= 44 IU/ml (p = 0.03; OR = 3.8; 95 %CI = 1.1-13.1). Multiple logistic regression analysis showed that only a history of four or more surgical interventions (p < 0.0001; OR = 26.3; 95 %CI = 2.9-234.2) and total serum IgE >/= 44 IU/ml (p = 0.02; OR = 8.6; 95 % CI = 1.4-53.4) were independently associated with latex sensitization. Sex, family and personal allergic history, hydrocephalus with ventriculoperitoneal shunt, cystourethrograms, intermittent bladder catheterization and atopy were not related to latex sensitization.

CONCLUSIONS

In children with spina bifida, significant and independent risk factors identified for latex sensitization were multiple interventions and higher levels of total serum IgE. A prospective study will clarify the clinical evolution of assymptomatic children sensitized to latex.