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Background: Anaphylaxis is increasing at pediatric age; however, its characterization is hampered by underdiagnosis and underreporting. The aim of this study was to identify the causes of anaphylaxis in children and adolescents in Portugal, thus contributing to a better knowledge of its etiology, clinical manifestations, and management. Methods: During a 10‐year period, a nationwide notification system for anaphylaxis was implemented, with voluntary reporting by allergists. Data on 533 patients under 18 years of age with anaphylaxis were included. Results: Mean age was 8.5 ± 4.9 years, 61% were male; 45% had asthma. Mean age at the first anaphylaxis episode was 5.3 ± 4.7 years (ranging from 1 month to 17 years of age), 63% at pre‐school age. Most reactions occurred at home (57%). Food‐induced anaphylaxis was the leading cause (77%). The main culprit foods were cow's milk (32%), tree nuts (16%), shellfish (13%), egg (12%), fresh fruits (11%), fish (8%), and peanut (8%). Other causes included drugs (11%), insect sting (5%), cold‐induced anaphylaxis (4%), exercise‐induced anaphylaxis (2%), latex (1%), and idiopathic anaphylaxis (1%). Most patients (83%) were admitted to the emergency department; only 46% received adrenaline treatment. Recurrence of anaphylaxis occurred in 41% of the patients (3 or more episodes in 21%). An adrenaline autoinjector was used in 9% of the patients. Conclusions: In the Portuguese pediatric population, food is the leading cause of anaphylaxis. Undertreatment with adrenaline and high recurrence of anaphylaxis highlight the need to improve both the diagnosis and the therapeutic management of this life‐threatening entity. [ABSTRACT FROM AUTHOR]

Background: Peach is a common food allergen source throughout Europe. The aim of this study was to characterize peach allergy in a Portuguese patient population. Methods: Thirty peach-allergic patients confirmed by double-blind placebo-controlled food challenges and 29 controls were included. All subjects completed a standardized questionnaire regarding symptoms and epidemiologic characteristics, skin prick tests with inhalant allergens and foods as well as specific IgE antibodies to peach, recombinant peach allergens rPru p 1, rPru p 3, rPru p 4 and cross-reactive carbohydrate determinants. Results: Thirty-seven percent of patients reported only oral allergy syndrome, while 37% reported generalized urticaria and/or angioedema, 17% localized contact urticaria and 10% anaphylaxis with peach. Sensitization to other Rosaceae fruits and tree nuts was present in 90 and 77% of the patients, respectively. Respiratory allergy history was associated with less severe symptoms (oral allergy syndrome or contact urticaria; p < 0.01) and positive skin prick test to peach peel or plum with more severe symptoms (urticaria and/or angioedema or anaphylaxis; p < 0.05). Ninety-seven percent were sensitized to Pru p 3, 13% to Pru p 4, 3% to Pru p 1 and 10% to cross-reactive carbohydrate determinants. Pru p 3 specific IgE was associated with Artemisia vulgaris sensitization and tree nut allergy (p < 0.05) but not with clinical severity. Conclusions: Half the patients reported systemic reactions to peach. Peach allergy appeared predominantly mediated by Pru p 3 but some patients were sensitized to Pru p 4. Applying a 0.10 kUA/l cutoff level, the diagnostic value of combining the 3 recombinant allergens was noteworthy, with 100% sensitivity and 90% specificity. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Seven seawater polychlorinated biphenyls (PCBs) were measured in water (DAP), suspended particulate matter (SPM), and blue mussels (Mytilus edulis) collected from four beaches in northwest Portugal. PCBs were extracted using solid-phase-extraction, ultrasound-extraction and QuEChERS before GC-MS analysis. The two-year annual average concentrations of PCBs in DAP, SPM and the four-year analysis in mussels were ∼ 4.4 ng/L, ∼15.9 μg/kg, and ∼ 56.0 μg/kg. The results suggest higher concentrations of PCBs in summer for SPM and in spring for mussels, mainly those collected close to the Ave River estuary. The origins of PCBs remain uncertain. Risk assessment shows that PCBs in water are unlikely to harm local biota due to their low thyroid hormone toxicity equivalents (TEQ-TH; ∼1.4E-04 ng/L and ∼ 4.1E-04 μg/kg) and on WHO toxicity equivalents (TEQ-WHO; ∼2.1E-05 ng/L and ∼ 4.9E-05 μg/kg). However, the lifetime carcinogenic risk (LCR) for humans consuming local bivalves is concerning, as it exceeds 1.0E-06., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included ( n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact ( n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 ( n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 ( n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms ( p < 0.001). Class 3 ( n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month ( p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

Background: Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) is the first questionnaire that assesses simultaneously allergic rhinitis and asthma control in children. It was recently developed, but redundancy of questions and its psychometric properties were not assessed. This study aimed to (i) establish the final version of the CARATKids questionnaire and (ii) evaluate its reliability, responsiveness, cross-sectional validity, and longitudinal validity., Methods: A prospective observational study was conducted in 11 Portuguese centers. During two visits separated by 6 wk, CARATKids, visual analog scale scales and childhood asthma control test were completed, and participant's asthma and rhinitis were evaluated by his/her physician without knowing the questionnaires' results. Data-driven item reduction was conducted, and internal consistency, responsiveness analysis, and associations with external measures of disease status were assessed., Results: Of the 113 children included, 101 completed both visits. After item reduction, the final version of the questionnaire has 13 items, eight to be answered by the child and five by the caregiver. Its Cronbach's alpha was 0.80, the Guyatt's responsiveness index was -1.51, and a significant (p < 0.001) within-patient change of CARATKids score in clinical unstable patients was observed. Regarding cross-sectional validity, correlation coefficients of CARATKids with the external measures of control were between 0.45 and -0.69 and met the a priori predictions. In the longitudinal validity assessment, the correlation coefficients between the score changes of CARATKids and those of external measures of control ranged from 0.34 to 0.46., Conclusion: CARATKids showed adequate psychometric properties and is ready to be used in clinical practice., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Anaphylaxis is a potentially lethal condition. Prevention of mortality depends on the correct diagnosis and on early epinephrine injection by the patients affected., Objective: Evaluate practical knowledge of diagnostic and therapeutic aspects of anaphylaxis in general practitioners., Material and Methods: 100 GPs were inquired through the use of an anonymous and voluntary questionnaire with 5 multiple-choice questions (just one correct answer): 3 about diagnostic aspects and two about therapeutic aspects of anaphylaxis. There was also one other question where it was asked the commercial name of the only device for epinephrine auto-injection available in Portugal. Eight minutes were given to fulfil the questionnaire. 92 complete questionnaires were eligible for evaluation., Results: In the three diagnostic questions we observed a percent of correct answers ranging from 36 to 46%. In the two questions regarding anaphylaxis therapy only 18 to 22% of the GPs gave the correct answers. Only 14% of the GPs were able to indicate the correct commercial name of the epinephrine auto-administration kit., Conclusions: The results of this study stress the need to promote, within the GP community, continuous medical education programmes regarding adequate diagnosis and treatment of anaphylaxis. Wrong concepts related to anaphylaxis treatment are frequently observed and this is a serious problem since GPs are the front-line doctors in the management of out-patient anaphylactic reactions and therefore it is absolutely mandatory that they can be able not only to accurately diagnose and treat an acute anaphylactic episode but also to make a correct retrospective diagnosis and to advise on the use of epinephrine auto-injectors.