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Background: Food allergy has considerably increased in recent years and this situation has been aggravated mainly by the consumption of more processed and complex foods, since minor or potentially allergenic foods are not required to be labeled. Manihot esculenta (cassava) is a widely consumed food in South America, Africa, and Asia and can be used in the production of flour and starch, as well as several other products. This root can cause allergic reactions with symptoms ranging from mild to severe. Methods: Thus, the aim of this study was the characterization of the immunogenic cassava proteins responsible for sensitizing patients allergic to it. Using a 2D-SDS-PAGE based proteomic approach, six proteins were identified, including Fructose Bisphosphate Aldolase (FBA). Recombinant FBA was produced in Expi293 cells and evaluated by immunoblotting with the serum of 10 individual study subjects. Results: Our results showed six cassava IgE-reactive proteins. From those, recombinant fructose bisphosphate aldolase (FBA) showed a positivity of 80% among tested sera, proving to be a highly sensitizing protein. Conclusion: The recombinant FBA molecule obtained in this study can be important for in vivo diagnostic assays, by producing more accurate results, and for desensitization protocols, in which the use of the isolated molecule produces more precise results by avoiding secondary sensitization. Trial registration: All patients signed a consent form approved by the internal ethics committee CAPPesq, Comissão de Ética para Análise de Projetos de Pesquisa do HC FMUSP (CAAE: 10420619.6.0000.0068).

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Abstract Introduction The guidelines on allergic rhinitis aim to update knowledge about the disease and care for affected patients. The initiative called "Allergic Rhinitis and its Impact on Asthma", initially published in 2001 and updated in 2008 and 2010, has been very successful in disseminating information and evidence, as well as providing a classification of severity and proposing a systemized treatment protocol. In order to include the participation of other medical professionals in the treatment of allergic rhinitis, it is important to develop algorithms that accurately indicate what should and can be done regionally. Objective To update the III Brazilian Consensus on Rhinitis - 2012, with the creation of an algorithm for allergic rhinitis management. Methods We invited 24 experts nominated by the Brazilian Association of Allergy and Immunology, Brazilian Association of Otorhinolaryngology and Head and Neck Surgery and Brazilian Society of Pediatrics to update the 2012 document. Results The update of the last Brazilian Consensus on Rhinitis incorporated and adapted the relevant information published in all "Allergic Rhinitis and its Impact on Asthma" Initiative documents to the Brazilian scenario, bringing new concepts such as local allergic rhinitis, new drugs and treatment evaluation methods. Conclusion A flowchart for allergic rhinitis treatment has been proposed.

Resumo Introdução As diretrizes sobre rinite alergica visam atualizar os conhecimentos sobre a doença e os cuidados para com esses pacientes. A iniciativa designada "Rinite Alergica e seu Impacto na Asma", cujo relatorio inicial foi publicado em 2001 e atualizada em 2008 e 2010, tem sido muito bem sucedida na disseminaçao de informaçoes e evidencias, bem como na formulaçao da classificaçao de gravidade e proposta de sistematizaçao do tratamento. Entretanto, visando a participaçao de outros profissionais medicos no atendimento da rinite alergica, e importante o desenvolvimento de algoritmos que indiquem com precisao o que deve e pode ser feito regionalmente. Objetivo Atualizar o III Consenso Brasileiro sobre Rinites-2012, com elaboraçao de algoritmo para conduta da rinite alergica. Método Foram convidados 24 especialistas indicados pelas Associaçao Brasileira de Alergia e Imunologia, Associaçao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial e Sociedade Brasileira de Pediatria para atualizaçao do documento de 2012. Resultados A atualizaçao do ultimo Consenso Brasileiro sobre Rinites, incorporou e adaptou para a realidade brasileira as informaçoes relevantes publicadas em todos os documentos da Iniciativa "Rinite Alergica e seu Impacto na Asma", trazendo novos conceitos como a rinite alergica local, novos medicamentos e metodos de avaliaçao de tratamento. Conclusão Proposto um fluxograma de tratamento para a rinite alergica.

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BACKGROUND: Hereditary angioedema (HAE) with normal C1 inhibitor (C1-INH) is a rare condition with clinical features similar to those of HAE with C1-INH deficiency. Mutations in the F12 gene have been identified in subsets of patients with HAE with normal C1-INH, mostly within families of European descent. OBJECTIVES: Our aim was to describe clinical characteristics observed in Brazilians from 42 families with HAE and F12 gene mutations (FXII-HAE), and to compare these findings with those from other populations. METHODS: We evaluated a group of 195 individuals, which included 102 patients clinically diagnosed with FXII-HAE and their 93 asymptomatic relatives. RESULTS: Genetic analysis revealed that of the 195 subjects, 134 individuals (77.6% females) carried a pathogenic mutation in F12. The T328K substitution was found in 132 individuals, and the c.971_1018+24del72 deletion was found in 2 patients. The mean age at onset of symptoms in patients with FXII-HAE was 21.1 years. The most common symptoms were subcutaneous edema (85.8% of patients), abdominal pain attacks (69.7%), and upper airway edema (32.3%). Of male individuals carrying F12 mutations, 53.3% (16 of 30) were symptomatic. Compared with reports from Europe, fewer female patients (68.6%) reported an influence of estrogen on symptoms. CONCLUSIONS: Our study included a large number of patients with FXII-HAE, and, as the first such study conducted in a South American population, it highlighted significant differences between this and other study populations. The high number of symptomatic males and patients with estrogen-independent FXII-HAE found here suggests that male sex and the absence of a hormonal influence should not discourage clinicians from searching for F12 mutations in cases of HAE with normal C1-INH.

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INTRODUCTION: The guidelines on allergic rhinitis aim to update knowledge about the disease and care for affected patients. The initiative called "Allergic Rhinitis and its Impact on Asthma", initially published in 2001 and updated in 2008 and 2010, has been very successful in disseminating information and evidence, as well as providing a classification of severity and proposing a systemized treatment protocol. In order to include the participation of other medical professionals in the treatment of allergic rhinitis, it is important to develop algorithms that accurately indicate what should and can be done regionally. OBJECTIVE: To update the III Brazilian Consensus on Rhinitis - 2012, with the creation of an algorithm for allergic rhinitis management. METHODS: We invited 24 experts nominated by the Brazilian Association of Allergy and Immunology, Brazilian Association of Otorhinolaryngology and Head and Neck Surgery and Brazilian Society of Pediatrics to update the 2012 document. RESULTS: The update of the last Brazilian Consensus on Rhinitis incorporated and adapted the relevant information published in all "Allergic Rhinitis and its Impact on Asthma" Initiative documents to the Brazilian scenario, bringing new concepts such as local allergic rhinitis, new drugs and treatment evaluation methods. CONCLUSION: A flowchart for allergic rhinitis treatment has been proposed.

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Objetivo: Determinar o impacto da Dermatite Atópica (DA) no estado nutricional e metabolismo ósseo em crianças.Métodos: Quarenta e nove crianças com DA moderada ou grave (4-12 anos) e 48 crianças saudáveis foram avaliadas por z-escore altura/idade, z-escore peso/idade, z-escore IMC, duração e gravidade da doença, uso de Glicocorticoides (GC) tópico e parâmetros ósseos. Conteúdo mineral ósseo (CMO), densidade mineral óssea (DMO) e z-escores foram medidos por absormetria de dupla emissão de raios-X (DXA). Níveis séricos de cálcio, fósforo, fosfatase alcalina, cortisol e telopeptídeo carboxiterminal do colágeno tipo 1 (CTX), e níveis plasmáticos de 25 hidroxivitamina D (25OHD) e hormônio da paratireoide (PTH), foram determinados.Resultados: Crianças com DA apresentaram menor altura para idade quando comparadas às crianças controle (p = 0,007). Menor CMO em coluna lombar [16,5 (6,4) vs. 19,8 (8,3)g, p = 0,027] e fêmur total [12,2 (4,0) vs. 14,2 (5,0)g, p = 0,029] foi encontrado em crianças com DA. Níveis de CTX foram menores em pacientes com DA [1,36 (0,59) vs. 1,67 (0,79)ng/mL, p = 0,026] e tendência a níveis mais baixos de fosfatase alcalina foi observada em crianças com DA [228 (75,3) vs. 255 (70,7) ng/mL, p = 0,074]. Crianças com DA apresentaram níveis mais baixos de cortisol que crianças saudáveis [9,06 (4.8) 10,57 vs. (4,9), p = 0,061], sem diferença significante.Conclusões: Redução em altura para idade, remodelamento ósseo e conteúdo mineral ósseo em crianças com DA moderada ou grave poderia estar associada a fatores incluindo determinantes genéticos, baixa exposição solar, inflamação crônica e uso crônico do GC tópico.

Objective: To determine the impact of atopic dermatitis (AD) on nutritional status and bonemetabolism parameters in children. Methods: Forty-nine children with moderate to severe AD (4-12 years old) and 48 healthy children were assessed using height/age z-scores, weight/agez-scores, body mass index z-scores, disease activity and severity, topical use of glucocorticoids (GC), and bone parameters. Bone mineral content (BMC), bone mineral density (BMD), andz-scores were measured using dual-energy X-ray absorptiometry (DXA). Serum levels ofcalcium, phosphorus, alkaline phosphatase, cortisol, and carboxy terminal telopeptide of type1 collagen (CTX), and plasma levels of 25 hidroxy vitamin D (25OHD) and parathyroid hormone,were determined. Results: AD children presented lower height/age z-score, as compared tocontrols (p = 0.007). Lower BMC at lumbar spine [16.5(6.4) vs. 19.8(8.3)g, p = 0.027] and totalfemur [12.2(4.0) vs. 14.2 (5.0) g, p = 0.029] was found in AD children. CTX levels were lower in ADpatients, as compared to healthy children [1.36(0.59) vs. 1.67(0.79)ng/mL, p = 0.026] and a trendto lower levels of alkaline phosphatase was observed in AD children [228(75.3) vs. 255 (70.7) ng/mL, p = 0.074]. Children with AD presented lower levels of serum cortisol in comparison to thehealthy group [9.06(4.8) vs. 10.57(4.9), p = 0.061], without statistical significance. Conclusions: Reduced height for age, BMD, and bone turnover in children with moderate to severe AD couldbe associated with genetic determinants, insufficient sun exposure, chronic inflammation, andchronic use of topical GC.

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Since allergic sensitization to snake venom has been reported, anaphylactic reactions to snake venom might be an underestimated factor contributing to fatal snakebites, independently from the toxicity of the venom itself. However, little information is available on the determinants of such reaction. Hence, we studied a group of workers exposed to Bothrops jararaca venom (BJV), in order to clarify the factors related with snake venom allergy. The aim of this work was to investigate the prevalence and predictors of venom allergy among workers exposed to BJV and to confirm the involvement of IgE-mediated mechanisms in this condition. Workers exposed to BJV were assessed for venom allergy using questionnaires and immunological tests. The presence of BJV sensitization was determined through quantification of specific IgE. Allergens were studied using the Western blots and inhibition assays. Of the 67 workers evaluated, 7 (10.4%) presented specific IgE antibodies to BJV. Of those, 6 presented typical symptoms of an IgE-mediated allergic reaction when exposed to BJV. Venom sensitization was associated with length of employment (P=0.042), high levels of total IgE (P=0.034), atopy (P=0.051), and specific tasks, primarily the handling of dried venom (P=0.014). Our observations suggest that exposure to BJV can result in allergic sensitization in snake handlers through IgE-mediated mechanisms. The prevalence rate of this condition appears to be high among these workers, and the handling of dried venom, total IgE level above 100 kU/L, length of employment, and probably history of atopy were predictors of its occurrence.

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Objetivo: Revisar a literatura para investigar a associação entre o uso dos esteróides inalados e a presença da doença periodontal. Fontes dos dados: Foi realizada uma revisão consultando a base de dados do Medline acessando o Pubmed; foram também consultadas as fontes de dados 880, Lilacs e Scielo, com as palavras-chaves: periodontal disease (gingivitis and periodontitis) - asthma - inhaled steroids. Síntese dos dados: Os esteróides inalados se constituem na medicação de primeira escolha para o tratamento da asma persistente, sendo bem documentado os efeitos adversos na cavidade bucal, como disfagia, faringite e candidíase. Existem alguns dados sobre os possíveis efeitos deletérios que os este¬róides inalados possam causar nos dentes e gengiva, como exacerbação da inflamação gengiva I, perda de inserção clínica periodontal e perda das unidades dentárias. Conclusão: Parece haver uma associação positiva entre o uso de esteróides inalados e alterações periodontais.

Objective: Review the literature to investigate the association between the use of inhaled steroids and the presence of periodontal disease. Source of data: Literature review was carried out in Medline, Lilacs, Scielo and BBO by Pubmed, using the key-words: periodontal disease (gingivitis and periodontitis) - asthma - inhaled steroids. Syntheses of data: Inhaled steroids are the main drug in the treatment of persistent asthma. Adverse side effects in the oral cavity are well documented, such as dysphagia, pharyngitis and candidiasis. There are some data on possible negative effects steroids cause to teeth and gums, like gingival inflammation, lack of clinical attachment and loss of teeth. Conclusion: The review suggests there is a positive association between the use of inhaled steroids and periodontal alterations.

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Objetivo: alguns pacientes alérgicos ao veneno de vespas apresentam pesquisa negativa de IgE específica com os extratos disponíveis. Para investigar esta falta de reação cruzada, este estudo pretende caracterizar os antígenos principais do veneno de uma das espécies encontradas no Brasil, a Agelaia pallipes, utilizando a análise proteômica. Método: realizamos eletroforese bidimensional com veneno de Agelaia pallipes. Na primeira dimensão utilizamos tiras de gel de 7 cm com gradiente de pH de 3.0 -10.0, e na segunda SDS-PAGE 15%. Com géis feitos em duplicata, o primeiro foi transferido para nitrocelulose e incubado com o soro de paciente sensibilizado (diluição 1:5). A imunodetecção foi realizada com anti-IgE humana biotinilada e ECL (Enhanced Chemiluminescence). No segundo gel, corado Coomassie, os spots correspondentes às proteínas reconhecidas pela IgE através do immuniblotting foram processados e analisados no espectrometro de massa do tipo MALDI-ToF. A identificação foi obtida por PMF - Peptide Mass Fingerprinting. Resultados: a eletroforese bidimensional com o veneno da Agelaia pallipes evidenciou várias proteínas com peso molecular (PM) abaixo de 20kDa. Com immunoblotting foram detectadas proteínas reconhecidas pela IgE com PM entre 20 e 38 kDa. Pela análise proteômica, estas proteínas foram identificadas principalmente como antígeno 5 e serino-proteases. Conclusão: este é o primeiro trabalho a identificar alérgenos de vespas neotropicais com análise proteômica. Além do antígeno 5, identificamos serino-proteases que apenas recentemente foram citadas neste tipo de amostra biológica, mostrando semelhança parcial entre estas proteínas de venenos de vertebrados (serpentes). Nosso projeto futuro será o sequenciamento das amostras.

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