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Objectives: Ethnic background interferes on the prevalence of asthma among schoolchildren (4 to 9 years old, SC) born and living in São Paulo, Brazil., Methods: International Study of Asthma and Allergy in Childhood (ISAAC)'s written standard and complementary questionnaires were applied to SC (similar socioeconomic status) living in the city of São Paulo: no-Japanese Brazilian (NJB, N = 306) and Japanese Brazilian (third generation, born in Brazil, from Japanese families with no miscegenation, JB, N = 258)., Results: The prevalence of current asthma was significantly higher among NJB in comparison to JB (22.2% vs 14.7%, respectively). To have rhinitis and to exercise less than once/week were risk factors for both groups of children., Conclusion: Although both groups were apparently exposed to the same environment, other cultural differences do not allow us to conclude about the ethnic component having greater influence than the environment in the development of asthma in these individuals.

Background: Current guidelines on chronic spontaneous urticaria (CSU) suggest a treatment based on a 3-step approach that aims at total symptom control, starting with H1-antihistamines. However, a significant number of patients present an antihistamine-resistant urticaria that must be treated with an alternative third-line therapy such as omalizumab., Methods: Patients with a history of CSU who did not respond to treatment with high doses of modern antihistamines were treated with 150 or 300 mg of omalizumab every 4 weeks. The response to treatment was recorded as complete (CR), partial (PR) or no response. A dose adjustment was proposed according to response., Results: We treated 47 CSU patients with omalizumab (40 females), of whom 39.5% had evidence of autoimmunity. The average number of treatments was 11.4 (range 2-87). All patients had been refractory to high-dose modern antihistamines. A CR was seen in 84.6% of patients who started with 300 mg and in 60% of those who started with 150 mg. Only 1 patient had no response to both the 150- and 300-mg doses. In 6 of the PR patients with 150 mg, a higher dose of 300 mg was proposed and 4 had a CR. Four patients discontinued the treatment. No severe adverse events were reported in the patients who finished the study., Discussion: Although good results were seen in both groups, CR rates were higher in those under a high-dose initial treatment. Our data strongly suggest that the therapy should be individualized., (© 2016 S. Karger AG, Basel.)

The subspecialty of pediatric allergy and immunology in Brazil is in its early years and progressing steadily. This review highlights the research developed in the past years aiming to show the characteristics of allergic and immunologic diseases in this vast country. Epidemiologic studies demonstrated the high prevalence of asthma in infants, children, and adolescents. Mortality rates and average annual variation of asthma hospitalization have reduced in all pediatric age groups. Indoor aeroallergen exposure is excessively high and contributes to the high rates of allergy sensitization. Prevalence of food allergy has increased to epidemic levels. Foods (35%), insect stings (30%), and drugs (23%) are the main etiological agents of anaphylaxis in children and adolescents. Molecular diagnosis of primary immunodeficiencies (PID) showed a high incidence of fungal infections including paracoccidioidomycosis in X-linked hyper-IgM syndrome, and the occurrence of BCG adverse reactions or other mycobacterial infections in patients with chronic granulomatous disease. Education in pediatric allergy and immunology is deficient for medical students, but residency programs are effective in training internists and pediatricians for the practice of allergy. The field of PID requires further training. Last, this review is a tribute to Prof. Dr. Charles Naspitz, one of the pioneers of our specialty in Brazil., (© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Background: In Brazil, studies evaluating the prevalence of asthma and allergic diseases among children living in rural area compared to urban area are rare. Some authors identified as risk factors for higher prevalence of current wheezing to have a family history of asthma, to have contact with pets, and being student in an urban school. The International Study of Asthma and Allergies in Childhood (ISAAC) phase 3 has shown higher prevalence of wheezing, nasal symptoms and cutaneous rash in the last 12 months in centers from Northern (N) and Northeastern (NE) regions of Brazil., Objective: To evaluate if adolescents with similar genetic background, living in a rural area are protected against the development of symptoms of asthma, rhinitis, and atopic eczema when compared to those living in an urban area in the same region of the country., Subjects and Method: Adolescents (13-14 year-old) living in Caruaru (Pernambuco) and in Santa Maria (Rio Grande do Sul) were enrolled in this study (2002-2003). The adolescents filled in the ISAAC written questionnaire (WQ), previously translated and validated to the Brazilian culture (30-32). Data obtained were transcribed manually into a database (Epi-Info) supplied by ISAAC's coordinators and were statistically analyzed by the SSPS-12 software., Results: The prevalence of asthma related symptoms were higher among those adolescents living in the urban centers in comparison to the rural ones. These differences were significant for wheezy ever, wheezy in the last 12 months, asthma ever, and wheezy with exercise in Caruaru and for wheezy ever and asthma ever, in Santa Maria. Comparing urban areas, the prevalence of asthma related symptoms in Caruaru was higher than in Santa Maria, except for wheezy ever and wheezy with exercise. The opposite was observed comparing rural areas: the prevalence of asthma (except for nocturnal cough) was higher in Santa Maria despite lesser severity of symptoms in this city.

Objectives: To evaluate the relationship between exposure to gaseous air pollutants (ozone [O3], carbon monoxide [CO], nitrogen dioxide [NO2], and sulfur dioxide [SO2]) socioeconomic status and the prevalence of symptoms of asthma, rhinitis and atopic eczema in adolescents., Subjects and Methods: A sample of 16 209 adolescents from São Paulo West (SPW), São Paulo South (SPS), Santo André (SA), Curitiba (CR), and Porto Alegre (PoA) were enrolled. Data on air pollutants and socioeconomic status were compared to prevalence of symptoms with the Spearman correlation coefficient., Results: Socioeconomic status was quite similar in all cities. The levels of O3 in SPW, SPS, and SA, and of CO in SA were higher than the acceptable ones. In relation to O3 and CO exposures, adolescents from SPW and SA had a significant risk of current wheezing, whereas living in SPW was associated with a high risk of rhinoconjunctivitis, eczema, and flexural eczema and living in CR to rhinitis. Exposure to NO2 was associated with a high risk of current wheezing in SPW and SA, and of severe asthma in SPW and PoA. Exposure to SO2 was associated with a high risk of current wheezing in SPW and SA, severe asthma in SPW and PoA, and nighttime cough, eczema, flexural eczema and severe eczema in SPW. Living in SPW, CR, or PoA was associated with a high risk of rhinitis, rhinoconjunctivitis, and severe rhinitis., Conclusions: Although we did not detect a characteristic pattern for all symptoms evaluated or a specific air pollutant, our data suggest a relationship between higher exposure to photochemical pollutants and high prevalence or risk of symptoms of asthma, rhinitis, and atopic eczema.

Background: International comparisons of the prevalence of atopic eczema and related symptoms are scarce. The standardized protocol of the International Study of Asthma and Allergies in Childhood (ISAAC) facilitates investigation of prevalence all over the world., Objective: To apply the ISAAC written questionnaire to evaluate the prevalence of atopic eczema and related symptoms among 6-7 year-old children and 13-14 year-old adolescents living in 20 Brazilian cities., Methods: The ISAAC written questionnaire was filled in by 23,422 children aged 6-7 years and 58,144 adolescents aged 13-14 years living in 2 population centers in the north, 8 in the northeast, 1 in the midwest, 5 in the southeast, and 5 in the south., Results: The prevalence of flexural eczema (itchy rash ever in characteristic places in the last 12 months) ranged from 5.3% to 13.0% for children and was lower among the adolescents (range, 3.4%-7.9%). Among children, the highest rates were observed in population centers in the northeast, mainly along the coast. Among adolescents the highest rates were observed in the north and northeast, mainly in Natal, Aracaju, and Vitória da Conquista. The northeastern countryside had higher prevalence rates of severe eczema (kept awake at night by this itchy rash in the last 12 months) in comparison to northeastern coastal centers. There was a significant correlation between the prevalence of flexural eczema and severe eczema for both age groups, separately (6-7 year-olds, prho= 0.756, P<.004; 13-14 year-olds, rho=0.874, P<.0001) or grouped (6-7 plus 13-14 years-olds, rho=0.696, P<.0001)., Conclusion: The prevalence of eczema and related symptoms is variable in Brazil, where the highest prevalence is found in the north and northeast; on the other hand, a higher prevalence of severe eczema was observed in Brazilian centers in the south.

By using the standard written questionnaire (WQ), designed for the International Study of Asthma and Allergies in Childhood (ISAAC) we determined the prevalence of rhinitis and its related-symptoms, in Brazilian children and adolescents, living in different cities of the country. The WQ was answered by the parents of 11,403 children aged 6-7 years from five Brazilian cities: Porto Alegre (South, N = 2,846), São Paulo (Southeast, N = 3,005) Uberlândia (Southeast, N = 2,991), Itabira (Southeast, N = 1,151) and Recife (Northeast, N = 1,410). The WQ was also applied to 20,587 adolescents (13-14 years old) living in: Porto Alegre (South, N = 3,195), Curitiba (South, N = 3,004), São Paulo (Southeast, N = 3,008), Uberlândia (Southeast, N = 2,998), Itabira (Southeast, N = 2,134), Salvador (Northeast, N = 3,162) and Recife (Northeast, N = 3,086). The mean response rates were 75% and 95%, for the 6-7 year-old children and for the adolescents, respectively. The data was transcribed to a database (Epi-Info) and analyzed regarding the answers to questions of rhinitis module. The mean prevalence of rhinitis (affirmative response to question 2) was 26.6% and 34.2% in the groups of 6-7 and 13-14 year-old, respectively. Applying the criteria that evaluate the association between nasal and ocular symptoms (affirmative response to question 3) the mean prevalence of allergic rhinitis were 12.8% for the 6-7 year-old children and 18.0% for the adolescents. In conclusion, the prevalence of rhinitis and its related symptoms among children and adolescents living in different Brazilian cities was as high as the prevalence observed in other areas of the world.

OBJECTIVE: To review concepts, long-term treatment schemes and peculiarities of the approach to adolescents with respiratory allergy, asthma and/or allergic rhinitis. METHODS: The data were obtained by systematic revision of studies published in the BIREME database between 1990 and 2001. RESULTS: Most teenagers with asthma and/or rhinitis prefer to view their disease as episodic and do not accept the need for regular medication. These factors combined with the fear of being different from their peer group are responsible for poor treatment adherence. CONCLUSIONS: It is extremely important that adolescent patients affected by asthma and/or allergic rhinitis be well-informed about their condition and receive proper medication; however, the following should also be considered: 1) open communication between the clinician and adolescent patients 2) inquiry into the fears and anxieties of the patient 3) shared responsibility for the treatment.

Objective: The purpose of this study was to obtain data on the clinical evolution and risk factors related to asthma in children followed as outpatients in our Division of Allergy., Methods: The asthmatic group consisted of 165 children (107 boys, 58 girls), between the ages of 3 and 14 years. All children were atopic and had a positive skin prick test to D. pteronyssinus. The control group consisted of 40 healthy children (20 boys, 20 girls), within the same age range, without personal history of asthma or other atopic disease and with negative skin prick test to D. pteronyssinus. The mothers were interviewed to obtain data on: a) clinical evolution, b) family history of asthma or any other atopic disease, c) description of the house environment., Results: 1) in approximately half of the cases symptoms started on the first year of life. Mothers were not informed of the condition at the time; 2) upper respiratory tract infections and bronchiolitis were responsible for triggering the first wheezing episode in most cases and remain the main precipitating factors in the first year of the disease whilst allergens, irritants, sinusitis, physical exertion and emotional factors were the main precipitating factors between the ages of 5 and 13; 3) changes in climatic conditions precipitated acute attacks throughout the evolution of the disease and; 4) asthma was not the only allergic manifestation, allergic rhinitis being the most frequent associated condition; 5) family history of atopy (Relative Risk (RR) = 2.40; 95% confidence interval (CI95%) = 1.60-3.50); maternal history of asthma (RR = 2.23; CI95% = 1.10-4.63) and the presence of smokers in the house (RR = 2.30; CI95% = 1.20-4.31) were the main risk factors for the manifestation of asthma., Conclusions: a) there were no differences between boys and girls regarding the evolutionary aspects, b) asthma was underdiagnosed, c) family history of atopy, maternal history of asthma, and the presence of smokers in the house were risk factors for the manifestation of asthma.