RESUMO
Resumen La urticaria es un patrón distintivo de respuesta inflamatoria de piel y/o mucosas caracterizada por la aparición súbita de ronchas evanescentes, angioedema o ambos, asociados a prurito. Las formas agudas son frecuentes y se limitan a brotes de menos de 6 sema nas; mientras que las crónicas tienen una prevalencia menor al 1%, mayor duración y pueden ser espontáneas o inducibles. Los mecanismos etiopatogénicos involucrados en esta enfermedad incluyen la autoalergia, la autoinmunidad y la inflamación con la activación celular, principalmente del mastocito, lo que lleva a su degranulación con libe ración de mediadores vasoactivos. En su abordaje son fundamentales la confirmación diagnóstica; la búsqueda de indicadores de su etiopa togenia; la detección de cofactores que pueden modular su actividad; el reconocimiento de comorbilidades; la evaluación de posibles biomarcadores y, el impacto en la calidad de vida, el registro de la actividad y el control de la enfermedad. El manejo farmacológico tiene por objetivo controlar los síntomas, mientras la urticaria resuelve de forma espontánea. Este se describe de forma escalonada con una complejidad creciente.
Abstract Urticaria is a distinctive pattern of inflammatory re sponse of the skin and/or mucous membranes charac terized by the sudden appearance of vanishing wheals, angioedema, or both, associated with pruritus. Acute forms are frequent and limited to outbreaks of less than 6 weeks; while the chronic ones have a prevalence of less than 1%, longer duration and can be spontaneous or inducible. The etiopathogenic mechanisms involved in this disease include autoallergy, autoimmunity, and inflam mation with cell activation, mainly of the mast cell, leading to its degranulation with the release of vasoac tive mediators. Along its approach, diagnostic confirmation, search for indicators of its etiopathogenesis, detection of cofactors that can modulate its activity, recognition of comorbidi ties, evaluation of possible biomarkers and the assess ment of disease activity, impact and control are essential. The pharmacological management aims to control the symptoms, until the urticaria, which is self-resolv ing, is gone. This is described in a stepwise fashion with increasing complexity.
RESUMO
Urticaria is a distinctive pattern of inflammatory response of the skin and/or mucous membranes characterized by the sudden appearance of vanishing wheals, angioedema, or both, associated with pruritus. Acute forms are frequent and limited to outbreaks of less than 6 weeks; while the chronic ones have a prevalence of less than 1%, longer duration and can be spontaneous or inducible. The etiopathogenic mechanisms involved in this disease include autoallergy, autoimmunity, and inflammation with cell activation, mainly of the mast cell, leading to its degranulation with the release of vasoactive mediators. Along its approach, diagnostic confirmation, search for indicators of its etiopathogenesis, detection of cofactors that can modulate its activity, recognition of comorbidities, evaluation of possible biomarkers and the assessment of disease activity, impact and control are essential. The pharmacological management aims to control the symptoms, until the urticaria, which is self-resolving, is gone. This is described in a stepwise fashion with increasing complexity.
La urticaria es un patrón distintivo de respuesta inflamatoria de piel y/o mucosas caracterizada por la aparición súbita de ronchas evanescentes, angioedema o ambos, asociados a prurito. Las formas agudas son frecuentes y se limitan a brotes de menos de 6 semanas; mientras que las crónicas tienen una prevalencia menor al 1%, mayor duración y pueden ser espontáneas o inducibles. Los mecanismos etiopatogénicos involucrados en esta enfermedad incluyen la autoalergia, la autoinmunidad y la inflamación con la activación celular, principalmente del mastocito, lo que lleva a su degranulación con liberación de mediadores vasoactivos. En su abordaje son fundamentales la confirmación diagnóstica; la búsqueda de indicadores de su etiopatogenia; la detección de cofactores que pueden modular su actividad; el reconocimiento de comorbilidades; la evaluación de posibles biomarcadores y, el impacto en la calidad de vida, el registro de la actividad y el control de la enfermedad. El manejo farmacológico tiene por objetivo controlar los síntomas, mientras la urticaria resuelve de forma espontánea. Este se describe de forma escalonada con una complejidad creciente.
Assuntos
Angioedema , Urticária Crônica , Urticária , Humanos , Urticária/diagnóstico , Urticária/tratamento farmacológico , Urticária/etiologia , Urticária Crônica/diagnóstico , Urticária Crônica/tratamento farmacológico , Doença CrônicaRESUMO
The ideal rice phenotype is that of plants exhibiting fewer panicles with high biomass, large grain number, flag leaf area with small insertion angles, and an erected morphology improving light interception. The sunflower transcription factor HaHB11, homeodomain-leucine zipper I, confers increased seed yield and abiotic stress tolerance to Arabidopsis and maize. Here, we report the obtaining and characterization of rice plants expressing HaHB11 driven by its promoter or the 35S constitutive one. Transgenic p35S:HaHB11 plants closely resembled the ideal high-yield phenotype, whereas those carrying the pHaHB11:HaHB11 construct were hard to distinguish from the wild type. The former had an erected architecture, enhanced vegetative leaf biomass, rolled flag leaves with a larger surface, sharper insertion angles insensitive to brassinosteroids, and higher harvest index and seed biomass than the wild type. The combination of the distinct features exhibited by p35S:HaHB11 plants, including the increased number of set grains per panicle, supports the high-yield phenotype. We wondered where HaHB11 has to be expressed to achieve the high-yield phenotype and evaluated HaHB11 expression levels in all tissues. The results indicate that its expression is particularly necessary in the flag leaf and panicle to produce the ideal phenotype.
Assuntos
Arabidopsis , Oryza , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo , Oryza/genética , Oryza/metabolismo , Plantas Geneticamente Modificadas/genética , Plantas Geneticamente Modificadas/metabolismo , Fenótipo , Arabidopsis/genética , Grão Comestível/genética , Regulação da Expressão Gênica de Plantas , Proteínas de Plantas/genética , Proteínas de Plantas/metabolismoRESUMO
This is Part 1 of an updated follow-up review of a World Allergy Organization (WAO) position paper published in 2012 on the diagnosis and treatment of urticaria and angioedema. Since 2012, there have been advances in the understanding of the pathogenesis of chronic urticaria, and greater experience with the use of biologics, such as omalizumab, in patients with severe refractory disease. For these reasons, the WAO decided to initiate an update targeted to general practitioners around the world, incorporating the most recent information on epidemiology, immunopathogenesis, comorbidities, quality of life, clinical case presentations, and the management of chronic spontaneous and chronic inducible urticaria, including urticaria in special situations such as childhood and pregnancy. A special task force of WAO experts was invited to write the different sections of the manuscript, and the final document was approved by the WAO Board of Directors. This paper is not intended to be a substitute for current national and international guidelines on the management of urticaria and angioedema but to provide an updated, simplified guidance for physicians around the world who manage patients with this common ailment.
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The International Classification of Diseases (ICD) provides a common language for use worldwide as a diagnostic and classification tool for epidemiology, clinical purposes and health management. Since its first edition, the ICD has maintained a framework distributing conditions according to topography, with the result that some complex conditions, such as allergies and hypersensitivity disorders (A/H) including anaphylaxis, have been poorly represented. The change in hierarchy in ICD-11 permitted the construction of the pioneer section addressed to A/H, which may result in more accurate mortality and morbidity statistics, including more accurate accounting for mortality due to anaphylaxis, strengthen classification, terminology and definitions. The ICD-11 was presented and adopted by the 72nd World Health Assembly in May 2019, and the implementation is ongoing worldwide. We here present the outcomes from an online survey undertaken to reach out the allergy community worldwide in order to peer review the terminology, classification and definitions of A/H introduced into ICD-11 and to support their global implementation. Data are presented here for 406 respondents from 74 countries. All of the subsections of the new A/H section of the ICD-11 had been considered with good accuracy by the majority of respondents. We believe that, in addition to help during the implementation phase, all the comments provided will help to improve the A/H classification and to increase awareness by different disciplines of what actions are needed to ensure more accurate epidemiological data and better clinical management of A/H patients.
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Anafilaxia , Síndrome de Hipersensibilidade a Medicamentos , Anafilaxia/diagnóstico , Anafilaxia/epidemiologia , Humanos , Classificação Internacional de Doenças , Organização Mundial da SaúdeRESUMO
There are cases of patients having urticaria that do not respond satisfactorily to antihistamine treatment suggested by guidelines. In order to expand the search for associated factors, research about possible related infections have been performed. This paper describes the case of two patients evaluated in our center for hives resistant to standard treatment in which syphilis was diagnosed, with remission of urticaria when specific antibiotic treatment was established.
Existen pacientes con urticaria que no se controlan satisfactoriamente con el tratamiento antihistamínico sugerido por las guías. Con el objetivo de ampliar la búsqueda de factores asociados, se realizaron investigaciones de infecciones como posibles implicados. Se describe el caso de dos pacientes atendidos en nuestro servicio por urticaria resistente al tratamiento habitual, en los que se diagnosticó sífilis, con remisión de la urticaria al administrar el tratamiento antibiótico específico.
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BACKGROUND: One main practice gap in allergology that has been detected in several regions of the world is the application of specific immunotherapy (SIT). The prescription and practice of SIT should characterize allergologic specialists, but there are regional discrepancies in such practice. A detailed knowledge of the regulatory and legislation aspects and drawbacks would help improve and harmonize SIT practice. OBJECTIVE: To describe in Latin America the level of allergy training and the characteristics of the use of SIT, including the medical and legal aspects. METHODS: Three sources were used: a 24-item questionnaire sent to 22 allergologic leaders in 11 Latin American countries, 2 face-to-face meetings, and information from health authorities involved in the approval of medical substances. RESULTS: In 56% of countries, the specialty of allergology is a third-level care specialty and/or a subspecialty. Two countries have a special training program for pediatric allergists. Passing a board examination is mandatory in 3 countries, and recertification every 2 to 5 years occurs without examination. Sublingual and subcutaneous SITs are available in all Latin American countries. No legislation restricts SIT prescription and it can be performed by nonspecialists in 7 of 11 countries. In 90% of countries, allergists use allergen extracts from the United States (subcutaneous immunotherapy) and Europe (sublingual and subcutaneous immunotherapies), and 50% also manufacture extracts locally. Only 1 country has legal requirements for the quality of raw materials. CONCLUSION: The present analysis helps to identify gaps in the field of allergologic training and SIT in Latin America, many of them amendable.
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Alergia e Imunologia/educação , Dessensibilização Imunológica , Educação de Pós-Graduação em Medicina , Hipersensibilidade/terapia , Humanos , Hipersensibilidade/imunologia , América Latina , Legislação Médica , Inquéritos e QuestionáriosRESUMO
Solanum tuberosum ssp. tuberosum (cv. Spunta) was transformed with a chimeric transgene containing the Potato virus Y (PVY) coat protein (CP) sequence. Screening for PVY resistance under greenhouse conditions yielded over 100 independent candidate lines. Successive field testing of selected lines allowed the identification of two genetically stable PVY-resistant lines, SY230 and SY233, which were further evaluated in field trials at different potato-producing regions in Argentina. In total, more than 2,000 individuals from each line were tested along a 6-year period. While no or negligible PVY infection was observed in the transgenic lines, infection rates of control plants were consistently high and reached levels of up to 70-80%. Parallel field studies were performed in virus-free environments to assess the agronomical performance of the selected lines. Tubers collected from these assays exhibited agronomical traits and biochemical compositions indistinguishable from those of the non-transformed Spunta cultivar. In addition, an interspecific out-crossing trial to determine the magnitude of possible natural gene flow between transgenic line SY233 and its wild relative Solanum chacoense was performed. This trial yielded negative results, suggesting an extremely low probability for such an event to occur.
Assuntos
Resistência à Doença , Fluxo Gênico , Plantas Geneticamente Modificadas/genética , Potyvirus/patogenicidade , Solanum tuberosum/genética , Agrobacterium tumefaciens/genética , Agrobacterium tumefaciens/metabolismo , Argentina , Proteínas do Capsídeo/genética , Proteínas do Capsídeo/imunologia , Proteínas do Capsídeo/metabolismo , Produtos Agrícolas/genética , Produtos Agrícolas/imunologia , Produtos Agrícolas/virologia , Cruzamentos Genéticos , Vetores Genéticos , Doenças das Plantas/imunologia , Doenças das Plantas/virologia , Plantas Geneticamente Modificadas/imunologia , Plantas Geneticamente Modificadas/virologia , Potyvirus/genética , Potyvirus/imunologia , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/metabolismo , Alcaloides de Solanáceas/análise , Alcaloides de Solanáceas/metabolismo , Solanum tuberosum/imunologia , Solanum tuberosum/virologia , Transformação Genética , TransgenesRESUMO
Sugarcane mosaic virus (SCMV) and sorghum mosaic virus (SrMV) diversity studies are important to characterize virus populations in sugarcane producing areas, enabling (i) identification of shifts in predominant strains, (ii) detecting associations of strains with specific varieties, and (iii) possibly exposing the appearance of new strains which may affect the performance of varieties in a region. Recent studies have shown significant sequence variability within SCMV populations around the world, indicating that isolate identification would be best achieved by direct analysis of sequence data. Because virus sequence-based studies that require the characterization of large numbers of isolates may be impractical using standard sample preparation and processing methodology, a simple protocol that yields quality sequence information, requiring neither viral RNA purification nor cloning of RT-PCR products was developed. Rapid virus release extracts are obtained by submerging a portion of leaf tissue into an extraction buffer, followed by a brief incubation at 95 degrees C. An aliquot of the extract is pipetted into an RT-PCR amplification mix for the detection of SCMV and the SrMV coat protein gene fragments. RT-PCR fragments are sequenced directly using oligonucleotide primers similar to the RT-PCR primers, yielding sequence information of an adequate quality. This rapid, cost effective protocol is practical for large scale virus diversity and evolutionary studies.
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Doenças das Plantas/virologia , Potyvirus/classificação , Potyvirus/isolamento & purificação , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Saccharum/virologia , Análise de Sequência de DNA/métodos , Proteínas do Capsídeo/genética , Primers do DNA/genética , RNA Viral/genética , Sensibilidade e EspecificidadeRESUMO
PURPOSE OF REVIEW: Allergic rhinitis and asthma are some of the most prevalent chronic diseases in children. Meticulous evaluations of the therapeutic options and interventions are needed to control this burden. The central pathogenic mechanism is an immediate hypersensitivity reaction, followed by interventions in the allergic cascade. Once inflammation is established, potent anti-inflammatory agents or mediator antagonists could help control the phenomenon and reduce the characteristic symptoms related to severity. RECENT FINDINGS: Monoclonal antibody against IgE has demonstrated its efficacy in reducing the symptoms of asthma and rhinitis. In difficult-to-treat asthma patients it allows a reduction in the dose of inhaled steroids, the number of exacerbations, emergency visits and hospitalizations. Its broad implementation is limited by its high cost because adverse events are not a concern. Specific sublingual immunotherapy gave promising results in clinical trials, while modifying immunoglobulins and cytokine profiles, also inducing T-cell tolerance. Safety issues of subcutaneous immunotherapy have been surpassed by the sublingual route, with equivalent efficacy. The new inhaled steroid ciclesonide is effective in established inflammation, is activated only in the respiratory system, and has negligible systemic effects. SUMMARY: Robust evidence on the efficacy and safety of several novel therapies in rhinitis and asthma is available.