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Introduction and objectives Cow's milk allergy (CMA) is common, especially in children. The treatment is based on the exclusion of milk and dairy products and guidance regarding the exclusion diet. This study aimed to compare the anthropometric measurements and food intake of children with CMA with those of healthy controls, and to evaluate the serum concentrations of Vitamin A and 25(OH)D in children with CMA. Methods This is a cross-sectional study with 27 children in the CMA group and 30 in the control group. z-Scores of body mass index and height, skinfolds, food intake and serum concentrations of retinol, beta-carotene, lycopene, 25(OH)D, parathyroid hormone and high sensitivity C-reactive protein were evaluated. Results Mean age was four years (±1.9). The CMA group evidenced a lower height compared to those from the control group (p = 0.0043). The CMA group showed a lower intake of calcium (p = 0.0033) and lipids (p = 0.0123). Low serum concentrations of retinol, beta-carotene, lycopene, 25(OH)D were found in 25.9%, 59.3%, 48.1% and 70.3% of the CMA group, respectively. Conclusions Children with CMA consume smaller amounts of calcium and lipids and have shorter height compared to healthy controls. Insufficient levels of vitamins A and D were frequent in the CMA group, emphasizing the need for nutritional guidance and monitoring.

Objective Allergic sensitization is one of the key components for the development of allergies. Polysensitization seems to be related to the persistence and severity of allergic diseases. Furthermore, allergic sensitization has a predictive role in the development of allergies. The aim of this study was to characterize the pattern of sensitization of atopic patients treated at different pediatric allergy referral centers in Brazil. Methods A nation-wide transversal multicenter study collected data on patients attended in Brazil. Peripheral blood samples were collected to determine the serum levels of allergen-specific IgE. If allergen-specific IgE was higher than 0.1 kUA/L, the following specific components were quantified. Results A total of 470 individuals were enrolled in the study. Mite sensitization was the most frequent kind in all participants. A high frequency of sensitization to furry animals and grasses featured in the respiratory allergies. Regarding components, there was a predominance of sensitization to Der p 1 and Der p 2. It has been verified that having a food allergy, atopic dermatitis, or multimorbidity are risk factors for the development of more severe allergic disease. Conclusion Studies on the pattern of allergic sensitization to a specific population offer tools for the more effectual prevention, diagnosis, and treatment of allergic diseases. Sensitization to dust mites house was the most prevalent in the evaluated sample. High rates of sensitization to furry animals also stand out. Patients with food allergy, atopic dermatitis, or multimorbidity appear to be at greater risk for developing more severe allergic diseases.

The clinical history is of importance in the investigation of allergic diseases but does have limitations. Many allergic conditions will be over-diagnosed if anamnesis alone is used for diagnostic criteria. Serum total immunoglobulin E (TIgE) quantification, as well as panels containing allergens prevalent in the studied population, may serve as screening tests and facilitate the diagnosis of allergic disease or its exclusion. We assessed the positivity of two versions of these tests, Phadiatop Europe® (PhEU) and Phadiatop Infant® (PhInf), as well as total IgE (TigE) values in patients with a medical diagnosis of allergic disease and non-allergic individuals. Methods A cross-sectional study performed in eleven Brazilian pediatric allergy centers with patients divided into groups according to the primary condition and a group of assessed control subjects. They were submitted to TIgE measurement and screening tests (PhEu and PhInf). Results TIgE mean serum levels were significantly higher among allergic patients, especially those with asthma/rhinitis or atopic dermatitis. The positivity of the screening tests, considering the total population, was 63.8% for PhEU and 72.6% for PhInf. These increased when we evaluated only the allergic subjects. The concordance index of the two tests was Kappa = 0.7 and higher among those of greater age. Conclusions In the assessed population, there were significantly higher levels among those with positive screening tests and PhInf showed better performance in the identification of sensitized individuals, regardless of age. This is the first study to evaluate Phadiatop and Phadiatop Infant in the same population.

Objective: To describe the frequency and etiology of rhinitis, oral breathing, types of malocclusion and orofacial disorders in patients treated for dental malocclusion. Methods: Patients with poor dental occlusion (n=89, 8-15 years) undergoing orthodontic treatment at the Postgraduate Orthodontics Center (São Paulo, Brazil) participated in the study. Rhinitis and oral breathing were diagnosed by anamnesis, clinical assessment and allergic etiology of rhinitis through immediate hypersensitivity skin prick test with airborne allergens. The association between types of breathing (oral or nasal), rhinitis and types of dental malocclusion, bruxism and cephalometric alterations (increased Y axis of facial growth) compared to standard cephalometric tracing (Escola de Odontologia da Universidade de São Paulo) were assessed. Results: The frequency of rhinitis in patients with dental malocclusion was 76.4% (68), and, of these, 81.7% were allergic (49/60 positive skin prick test), whereas the frequency of oral breathing was 62.9%. There was a significant association between an increased Y axis of facial growth and oral breathing (p

Considering its role in inflammation and recently described "alternative" roles in epithelial homeostasis and Th1/Th2 balance, we hypothesize that inflammasome genetics could contribute to the development of asthma. Selected functional polymorphisms in inflammasome genes are evaluated in a cohort of asthmatic children and their families. Gain-of-function NLRP1 variants rs11651270, rs12150220 and rs2670660 resulted significantly associated to asthma in trios (TDT) analysis; and rs11651270 and rs2670660 also with asthma severity and total IgE level in asthmatic children. NLRP1 activators in humans are still unknown, however we hypothesized that individuals with gain-of-function SNPs in NLRP1 could be more prone in activating inflammasome in the presence of asthma-related cell stressors (i.e. ER stress or ROS), and this activation contribute to exacerbate inflammatory response and asthma development. Gain-of-function IL1A rs17561 resulted significantly associated with a reduced pulmonary capacity in asthmatic children. IL18 rs5744256 which lead to lower serum level of IL-18 appeared to be associated to a worse response to bronchodilators. Concluding, this work provides evidences about the contribution of inflammasome genetics in the development of paediatric asthma, both considering its inflammatory role in alveolar macrophages (i.e.: NLRP1) or its homeostatic role in lung epithelial cells (i.e.: IL1A, IL18).

Objetivo:Avaliar a asma na população pediátrica brasileira pelo protocolo do International Study of Asthma and Allergies in Childhood (ISAAC), internacionalmente padronizado e validado.Fontes de dados:O ISAAC, idealizado para maximizar o valor de estudos epidemiológicos em asma e doenças alérgicas, estabeleceu um método padronizado (questionário escrito autoaplicável e/ou vídeo-questionário) capaz de facilitar a colaboração internacional. Concebido para ser realizado em três fases sucessivas e dependentes, o ISAAC reuniu uma casuística até então inimaginável no mundo e no Brasil. Nesta revisão, reuniram-se os dados de centros brasileiros oficiais do ISAAC e de outros que empregaram o seu método.Síntese dos dados:Finalizada a primeira fase, a prevalência de asma entre escolares brasileiros foi documentada como a oitava em magnitude entre todos os centros participantes do estudo. Os poucos centros envolvidos na segunda fase investigaram possíveis fatores etiológicos, especialmente aqueles sugeridos pelos resultados da primeira fase, e geraram muitas especulações. A terceira fase, repetida após sete anos, avaliou a tendência evolutiva da prevalência de asma e das doenças alérgicas nos centros participantes simultaneamente das fases I e III e determinou a prevalência em outros não envolvidos na fase I.Conclusões:No Brasil, o ISAAC demonstrou, de forma definitiva, que a asma é uma doença de alta prevalência e impacto em crianças e adolescentes, devendo ser encarada como problema de Saúde Pública. Encontraram-se importantes variações regionais, ainda não bem esclarecidas, assim como diversos fatores de risco, o que traz a questão: há no Brasil uma ou muitas asmas? Objective:To assess asthma among Brazilian pediatric population applying the International Study of Asthma and Allergies in Childhood (ISAAC), an internationally standardized and validated protocol.Data sources:ISAAC was conceived to maximize the value of epidemiologic studies on asthma and allergic diseases, establishing a standardized method (self-applicable written questionnaire and/or video questionnaire) capable to facilitate the international collaboration. Designed to be carried out in three successive and dependent phases, the ISAAC gathered a casuistic hitherto unimaginable in the world and in Brazil. This review included data gathered from ISAAC official Brazilian centers and others who used this method.Data synthesis:At the end of the first phase, it has been documented that the prevalence of asthma among Brazilian schoolchildren was the eighth among all centers participating all over the world. Few centers participated in the second phase and investigated possible etiological factors, especially those suggested by the first phase, and brought forth many conjectures. The third phase, repeated seven years later, assessed the evolutionary trend of asthma and allergic diseases prevalence in centers that participated simultaneously in phases I and III and in other centers not involved in phase I.Conclusions:In Brazil, the ISAAC study showed that asthma is a disease of high prevalence and impact in children and adolescents and should be seen as a Public Health problem. Important regional variations, not well understood yet, and several risk factors were found, which makes us wonder: is there only one or many asthmas in Brazil? Objetivo:Evaluar el asma en la población pediátrica brasileña por el protocolo del International Study of Asthma and Allergies in Childhood (ISAAC), internacionalmente estandarizado y validado.Fuentes de datos : El ISAAC, idealizado para maximizar el valor de estudios epidemiológicos en asma y enfermedades alérgicas, estableció un método estandarizado (cuestionario escrito autoaplicable y/o video-cuestionario) capaz de facilitar la colaboración internacional. Concebido para realizarse en tres etapas sucesivas y dependientes, el ISAAC reunió una casuística hasta entonces inimaginable en el mundo y en Brasil. En esta visión, se reunieron los datos de centros brasileños oficiales del ISAAC y de otros que emplean su método.Síntesis de los datos:Finalizada la primera etapa, la prevalencia de asma entre escolares brasileños fue documentada como la octava en magnitud entre todos los centros participantes del estudio. Los pocos centros involucrados en la segunda etapa investigaron posibles factores etiológicos, especialmente aquellos sugeridos por los resultados de la primera etapa, y generaron muchas especulaciones. La tercera etapa, repetida tras siete años, evaluó la tendencia evolutiva de la prevalencia de asma y de las enfermedades alérgicas en los centros participantes simultáneamente en las etapas I y III y determinó la prevalencia en otros no involucrados en la etapa I.Conclusiones:En Brasil, el ISAAC demostró, de modo definitivo, que el asma es una enfermedad de alta prevalencia e impacto en niños y adolescentes, debiendo ser encarada como problema de Salud Pública. Se encontraron importantes variaciones regionales, todavía no bien aclaradas, así como diversos factores de riesgo, lo que nos hace cuestionar: ¿hay en Brasil una o muchas asmas? Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de Pediatria UNIFESP, EPM, Depto. de Pediatria SciELO

RESUMO Objetivo: Analisar a relação entre hábitos e atitudes de mães com os tipos de leite oferecidos para seus filhos nos dois primeiros anos de vida. Métodos: Estudo retrospectivo incluindo 773 entrevistas de mães de 11 cidades brasileiras com filhos com até 2 anos de idade. Foram analisadas as seguintes informações: tipo de aleitamento que planejava enquanto estava na gestação e o efetivamente realizado após o nascimento; tipo(s) de leite(s) utilizado(s) no dia da entrevista e anteriormente; idade de introdução do leite de vaca integral; e origem das recomendações para usar determinado tipo de leite. Resultados: O leite materno era oferecido para 81,7% dos lactentes no primeiro semestre de vida, 52,2% no segundo semestre (p

Universidade Federal de Sao Paulo, Dept Pediat, Div Allergy Clin Immunol & Rheumatol, Sao Paulo, Brazil

Individuals with chronic lung disease are more susceptible to present reduction in exercise tolerance and muscles strength not only due to pulmonary limitations but also due systemic repercussions of the pulmonary disease. The aim of this study is to assess the physical capacity, peripheral muscle function, physical activity in daily life, and the inflammatory markers in children and adolescents with asthma after pulmonary rehabilitation program. This is a study protocol of randomized controlled trial in asthmatic patients between 6 to 18 years old. The assessments will be conducted in three different days and will be performed at the beginning and at the end of the protocol. First visit: quality of life questionnaire, asthma control questionnaire, pre- and post-bronchodilator spirometry (400 μcg salbutamol), inflammatory assessment (blood collection), and cardiopulmonary exercise test on a cycle ergometer to determine aerobic capacity. Second visit: assessment of strength and endurance of the quadriceps femoris and biceps brachii muscles with concomitant electromyography to assess peripheral muscle strength. Third visit: incremental shuttle walk test (ISWT) and accelerometer to evaluate functional capacity and physical activity in daily life during 7 days. Then, the volunteers will be randomized to receive pulmonary rehabilitation program (intervention group) or chest physiotherapy + stretching exercises (control group). Both groups will have a supervised session, twice a week, each session will have 60 minutes duration, with minimum interval of 24 hours, for a period of 8 weeks. Intervention group: aerobic training (35 minutes) intensity between 60 to 80 % of the maximum workload of cardiopulmonary exercise testing or of ISWT; strength muscle training will be applied to the quadriceps femoris, biceps brachii and deltoid muscles (intensity: 40 to 70 % of maximal repetition, 3 x 8 repetition); finally the oral high-frequency oscillation device (Flutter®) will be used for 5 minutes. The control group: oral high-frequency oscillation device (Flutter®) for 10 minutes followed by the stretching of upper and lower limbs for 40 minutes. It is expected to observe the improvement in aerobic capacity, physical activity in daily life, muscle strength and quality of life of patients in the intervention group, and reduction in inflammatory markers. Clinical Trial Number: NCT02383069 . Data of registration: 03/03/2015

OBJETIVO: Determinar a frequencia de sensibilizacao a alergenos inalantes e alimentares em criancas atendidas em servicos brasileiros de alergia. PACIENTES E METODOS: IgE serica total e especifica (RAST) a alergenos inalantes e alimentares (UniCAP® - Pharmacia) foram determinados em 457 criancas acompanhadas em servicos de alergia pediatrica e em um grupo de controles (n = 62). Resultados classe igual ou maior que 1 foram considerados positivos (R+). RESULTADOS: A frequencia de R+ foi significantemente maior entre os atopicos (361/457, 79%) quando comparados aos controles (16/62, 25,8%). Nao houve diferencas quanto ao sexo. A prevalencia de R+ entre os atopicos foi significantemente maior para todos os alergenos avaliados. Os niveis sericos de IgE total foram significantemente mais elevados entre os atopicos com R+ quando comparados aos com R-. Comparando-se atopicos e controles, a frequencia de R+ para os principais alergenos inalantes foi como segue: D. pteronyssinus = 66,7 versus 14,5% (p < 0,05), D. farinae = 64,5 versus 17,8% (p < 0,05), B. tropicalis = 55,2 versus 19,4% (p < 0,05), barata = 32,8 versus 9,7% (p < 0,05) e gato = 12 versus 8,1%. Com os alimentos, observou-se: peixe = 29,5 versus 11,3% (p < 0,05), ovo = 24,4 versus 4,8% (p < 0,05), leite de vaca = 23,1 versus 3,2% (p < 0,05), trigo = 20 versus 8,1% (p < 0,05), amendoim = 14 versus 4,8% (p < 0,05), soja = 11,8 versus 4,8% (p < 0,05) e milho = 10,6 versus 4,8% (p < 0,05). Segundo a idade, os R+ aos alimentares predominaram entre as criancas mais jovens, e o inverso ocorreu com os inalantes. CONCLUSOES: Nesta populacao, predominou a sensibilizacao aos aeroalergenos, sobretudo aos acaros domiciliares, e os alimentos foram importantes em criancas mais jovens.

OBJECTIVE: The authors present a review about the diagnosis of pulmonary diseases, with special emphasis on laboratorial procedures. METHODS: The most important articles about laboratorial procedures were selected through Medline search. RESULTS: To diagnose pulmonary diseases we need to evaluate clinical history, laboratorial tests, several radiografic techniques, bronchoscopy, thoracentesis and lung biopsy among others. We present the main laboratorial tests which include the clinical tests and pulmonary function evaluation to diagnose these diseases. CONCLUSION: The laboratorial tests are part of pulmonary tests diagnosis. The obtained results should be associated with clinical history and the other diagnostic methods.

Introduction. The presence of eczema and gastrointestinal manifestations are often observed in cow’s milk allergy (CMA) and also in some primary immunodeficiency diseases (PID). Objective. To describe 7 patients referred to a tertiary allergy/immunology Center with a proposed diagnosis of CMA, who were ultimately diagnosed with PID. Methods. This was a retrospective study based on clinical and laboratory data from medical records. Results. Seven patients (6 males) aged between 3 mo and 6 y were referred to our clinic with a proposed diagnosis of CMA. They presented with eczema and/or gastrointestinal symptoms. Five were receiving replacement formula. All patients presented with other clinical features, including severe/recurrent infections unrelated to CMA, and two of them had a positive family history of PID. Laboratory tests showed immune system dysfunctions in all patients. Hyper-IgE and Wiskott-Aldrich syndromes, CD40L deficiency, severe combined immunodeficiency, X-linked agammaglobulinemia, transient hypogammaglobulinemia of infancy, and chronic granulomatous disease were diagnosed in these children. In conclusion, allergic diseases and immunodeficiency are a result of a different spectrum of abnormalities in the immune system and may be misdiagnosed. Educational programs on PID among clinical physicians and pediatricians can reduce the occurrence of this misdiagnosis.

Results LSJ, a 13-years old Brazilian girl has complained of urticaria and asthma about 40 minutes after ingesting salty boiled beetroot on a meal. She had a previous history of wheezing until she was five years old. Seric-specific IgE to beetroot and other foods were negative, as well as to latex, bee, wasp and ant. She was sensitized only to house dust mite. Boiled and raw beetroot prick to prick were also negative (histamine resulted 4mm) but a food challenge with boiled beetroot resulted positive after 30 minutes with generalized hives, throat tightness and bronchospasm. Symptoms were controlled with intramuscular epinephrine, inhaled beta-2-agonists and intravenous corticosteroids. She was advised for a diet free of beetroot and she has had no symptoms for the last 8 months.

OBJETIVO: Avaliar o papel dos probióticos, prebióticos e simbióticos no equilíbrio do sistema imunológico do lactente, bem como seu efeito preventivo no desenvolvimento de doenças alérgicas na criança. FONTE DE DADOS: A partir do levantamento de todos os ensaios clínicos duplo-cegos e randômicos em seres humanos, publicados nos últimos cinco anos na base de dados Medline e que contivessem unitermos relacionados a prebióticos (oligossacarídeos), probióticos e simbióticos versus hipersensibilidade, analisou-se seu papel quanto à utilização em doenças alérgicas. SÍNTESE DE DADOS: Foram incluídos nesta revisão três trabalhos com prebióticos, os quais utilizaram a mistura GOS:FOS (9:1) em fórmulas infantis em lactentes nos primeiros meses de vida; 24 trabalhos com probióticos, sendo os micro-organismos utilizados na suplementação L. rhamnosus GG, B. lactis, L. casei, L. paracasei, L. reuteri, L. acidophilus, B. longum, B. breve e P. freudenreichii sp., e dois estudos com simbióticos. CONCLUSÕES: Apesar das evidências de benefícios da suplementação precoce de probióticos com algumas cepas específicas, prebióticos e simbióticos na prevenção da dermatite atópica, em crianças de alto risco para alergias, e do uso de probióticos no tratamento das dermatites atópicas moderadas e graves mediadas por IgE, há necessidade de ampliar os estudos quanto ao tempo de observação dos indivíduos suplementados, quanto à segurança e aos efeitos em longo prazo OBJECTIVE: To review current evidence about the effects of probiotics, prebiotics and symbiotics on the immune development as well as on the prevention of allergic diseases in children. DATA SOURCES: Randomized, double-blind clinical trials in humans published in the last five years, in the Medline database, containing the following keywords: prebiotics (oligosaccharides), probiotics, symbiotics and hypersensitivity. DATA SYNTHESIS: For this review three papers with prebiotics were included, all of them using a mixture of GOS:FOS (9:1) in infant formula for the first months of life; 24 papers with probiotics, where L. rhamnosus GG, B. lactis, L. casei, L. paracasei, L. reuteri, L. acidophilus, B. longum, B. breve and P. freudenreichii sp. were the tested bacterial strains; and two papers about symbiotics. CONCLUSIONS: Although there are some evidence of benefits of early supplementation with some specific probiotic strains, prebiotics and symbiotics for the prevention of atopic eczema in children with high risk of allergy development, and probiotic use for the treatment of IgE-mediated moderate and severe atopic dermatitis, further research is needed in order to extended the evaluation of supplemented individuals, safety aspects and long term effects

PURPOSE: The purpose of this study was to analyze the cutaneous sensitivity to a variety of allergens in patients with vernal keratoconjunctivitis (VKC) and to demonstrate the relation between skin response and clinical aspects of the disease. METHODS: Twenty patients with vernal keratoconjunctivitis were randomly chosen from the External Disease and Cornea Sector. They were clinically evaluated, and a score ranging from 0 to 20 was applied based on signs and symptoms on ophthalmic examination. All subjects underwent a skin prick test against standardized allergens, such as house dust mites D. pteronyssinus, D. farinae, and Blomia tropicalis, as well as allergens from cat, dog, fungi and feather. RESULTS: Seventy-five per cent of patients were positive for at least one of the allergens tested. House dust mites were responsible for the majority of the cases (75%). There was a poor correlation between the clinical score and sensitivity to allergens (r= - 0.119 for fungi; r= - 0.174 for dog; r= - 0.243 for house dust mites; r= - 0.090 for feather). A significant correlation was found only for cat allergen extract (r = - 0.510; p=0.024). CONCLUSIONS: Our study demonstrated poor correlation between cutaneous hypersensitivity tests and clinical findings in patients with vernal keratoconjuntivitis. We concluded that skin response to inhalant allergens is not a useful test to identify clinical severity and chronicity of inflammatory process in this disease. OBJETIVO: Avaliar o papel da sensibilização cutânea a diferentes aeroalérgenos em pacientes com ceratoconjuntivite vernal e a correlação entre esta e os aspectos clínicos da doença. MÉTODOS: Vinte pacientes do setor de doenças externas e córnea foram aleatoriamente convidados para participar deste estudo. Os pacientes foram avaliados e a eles foi atribuído um escore clínico variando de 0 a 20 de acordo com sinais e sintomas presentes no exame oftalmológico. Todos os pacientes foram submetidos a testes cutâneos de hipersensibilidade imediata contra aeroalérgenos padronizados como os ácaros domiciliares D. pteronyssinus, D. farinae e Blomia tropicalis, assim como também a alérgenos de epitélio de gato, epitélio de cão, mistura de fungos e mistura de penas. RESULTADOS: Setenta e cinco por cento dos pacientes tiveram teste de hipersensibilidade imediata positivo contra pelo menos um dos antígenos testados. Os ácaros domiciliares foram responsáveis pela maioria destes casos (75%). Houve uma pobre correlação entre o escore clínico e a hipersensibilidade cutânea aos alérgenos (r= -0,119 para fungos; r= -0,174 para epitélio de cão; r= -0,243 para ácaros domiciliares; r= -0,090 para mistura de penas). Houve correlação significativa apenas contra epitélio de gatos (r= -0,510; p=0,024). CONCLUSÃO: O estudo demonstrou uma pobre correlação entre os testes cutâneos de hipersensibilidade imediata e os achados clínicos nos pacientes com ceratoconjuntivite vernal. Os testes cutâneos de hipersensibilidade imediata contra aeroalérgenos não foi parâmetro eficaz na identificação dos casos de maior gravidade e cronicidade de ceratoconjuntivite vernal.

OBJETIVO: Estabelecer intervalos de concentrações referenciais de cortisol salivar em crianças saudáveis, nos períodos matutino e vespertino, verificando os fatores de interferência nessa dosagem e a possibilidade de presença de ritmo circadiano. MÉTODOS: Pesquisa observacional controlada, incluindo aleatoriamente 91 crianças com idade de 45 dias a 36 meses, residentes em comunidade de Santo André (SP). Critérios de inclusão: nutridas, saudáveis, sem febre ou uso de corticóide, subdivididas em faixas etárias (cinco subgrupos) com intervalo de 6 meses. Houve coleta de saliva domiciliar nos períodos manhã e tarde para dosagem de cortisol, sob radioimunoensaio com anticortisol 3-oxima-albumina bovina. RESULTADOS: Os cinco subgrupos apresentaram dosagens matutinas superiores às vespertinas (p < 0,001), com diferença superior a 30% a partir de 1 ano de idade. Valor médio em nmol/L foi de 557,86 (manhã) e 346,36 (tarde). Observou-se correlação linear negativa na dosagem matutina para horas de repouso e freqüência de dieta (p < 0,05); na vespertina, para medidas antropométricas (p < 0,05). CONCLUSÕES Foram estabelecidos valores de referência de normalidade de cortisol salivar em crianças saudáveis, e aos 45 dias foi possível observar ritmo circadiano, que atingiu maturidade aos 12 meses de vida. Privações de sono e dieta elevaram valores de cortisol matutino. OBJECTIVE: To establish reference concentration intervals for salivary cortisol in healthy children, in the morning and in the afternoon, investigating factors that interfere with the concentration measured and the possibility that circadian rhythms are present. METHODS: A controlled observational study was carried out with 91 children aged 45 days to 36 months, selected at random and living in Santo André, state of São Paulo, Brazil. Inclusion criteria were: healthy, well-nourished, free from fever and corticoid use, subdivided by age group (five subsets) at 6-month intervals. Saliva was collected during home visits in the morning and afternoon. Cortisol was radioimmunoassayed with cortisol 3-oxime-bovine albumin antiserum. RESULTS: The five subsets exhibited higher cortisol concentration during the morning than in the afternoon (p < 0.001), and this difference passed 30% from 1 year of age onwards. Mean concentrations, in nmol/L, were 557.86 (morning) and 346.36 (afternoon). A negative linear correlation was observed between morning concentrations and hours' sleep and frequency of meals (p < 0.05), and in the afternoon with anthropometric measurements (p < 0.05). CONCLUSIONS: Reference values for normal salivary cortisol in healthy children were established. At 45 days it was possible to observe circadian rhythms, which reached maturity at 12 months of life. Sleep and food deprivation increased morning cortisol levels.

Objective: To establish reference concentration intervals for salivary cortisol in healthy children, in the morning and in the afternoon, investigating factors that interfere with the concentration measured and the possibility that circadian rhythms are present. Methods: A controlled observational study was carried out with 91 children aged 45 days to 36 months, selected at random and living in Santo Andre, state of Sao Paulo, Brazil. Inclusion criteria were: healthy, well-nourished, free from fever and corticoid use, subdivided by age group (five subsets) at 6-month intervals. Saliva was collected during home visits in the morning and afternoon. Cortisol was radioimmunoassayed with cortisol 3-oxime-bovine albumin antiserum. Results: The five subsets exhibited higher cortisol concentration during the morning than in the afternoon (p