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- Fig Tree-Induced Phytophotodermatitis: A Case Report on the Perils of a HobbyPublication . Pinto, Ana Raquel; Machado Cunha, Inês; Rebelo Gomes, EvaPhytophotodermatitis, a condition that results from sequential skin exposure to phototoxic chemicals contained within plants, followed by exposure to solar ultraviolet radiation, has been described with several plants and plant-based foods, namely members of the Moraceaefamily, which include Ficus carica L. This tree's branches, leaves, and fruit skin exude a milky sap or latex containing proteolytic enzymes and furocoumarins known to be photoirritants, easily absorbed upon skin contact. Oxygen-dependent and independent toxic reactions subsequent to sun exposure promote cell membrane damage and oedema, consequently leading to cell death. The diagnosis is confirmed with a detailed anamnesis, and photopatch testing is often useful to rule out a differential diagnosis. It is typically a self-limited condition, with few cases requiring treatment with topical or systemic corticosteroids. We report on a 55-year-old male patient who, following picking figs and pruning a fig tree while exposed to sunlight, developed erythematous and pruritic maculopapular lesions that progressed to blisters with residual hyperpigmentation. The diagnosis was further corroborated through photopatch testing, and the patient was recommended to avoid this recreational activity without symptoms' relapse. This case highlights the importance of considering phytophotodermatitis as a differential diagnosis when evaluating cases of dermatitis on exposed body surfaces and the importance of an exhaustive anamnesis. Identification of specific plant triggers and the performance of photopatch tests are essential to help confirm the diagnosis and guide avoidance recommendations
- Socioeconomic circumstances and lung function growth from early adolescence to early adulthoodPublication . Rocha, Vânia; Severo, Milton; Ramos, Elisabete; Falcão, Helena; Stringhini, Silvia; Fraga, SílviaBackground: A reduced lung function in early adulthood is associated with respiratory and non-respiratory diseases and is a long-term predictor of mortality. This study investigated the association between early socioeconomic circumstances (SEC) and lung function growth trajectories from early adolescence until early adulthood. Methods: We analysed data from the EPITeen population-based study, including adolescents born in 1990. Study waves occurred at 13, 17 and 21 years of age. Information on sociodemographic, behavioural and health factors, anthropometry and spirometry was collected. Early-life SEC were assessed using maternal education and paternal occupational position. The forced expiratory volume in the first second (FEV1) growth trajectories were drawn considering sex-and-height interactions over an 8-year period. Our sample included 2022 participants with complete information for the relevant variables. Results: Participants from most disadvantaged SEC presented lower FEV1 at early adolescence compared to high-SEC counterparts, but differences seem to diminish with height growth. The effect of paternal occupational position in lung function growth trajectories was moderated by height, thus individuals from fathers with less advantaged occupational position had lower FEV1 at early adolescence, but they had a faster FEV1 growth over time. Conclusions: Individuals from most disadvantaged SEC presented lower lung function at early adolescence compared to high-SEC counterparts; nevertheless, a catch-up growth was observed. Impact: Lower socioeconomic circumstances were previously associated with reduced lung function and a higher risk of respiratory diseases in adults. Fewer studies analysed the effects of early-life socioeconomic circumstances in lung function growth during adolescence. Disadvantaged socioeconomic circumstances were associated with lower lung function in early adolescence. However, social differences diminished over adolescence, suggesting a catch-up growth of lung function among those from lower socioeconomic circumstances. An improved understanding of the mechanism underlying lung function catch-up (or the absence of catch-up) might support interventions to narrow social inequalities in respiratory health and should be further investigated.
- Profiling Persistent Asthma Phenotypes in Adolescents: A Longitudinal Diagnostic Evaluation from the INSPIRERS StudiesPublication . Amaral, Rita; Jácome, Cristina; Almeida, Rute; Pereira, Ana Margarida; Alves-Correia, Magna; Mendes, Sandra; Rodrigues, José Carlos Cidrais; Carvalho, Joana; Araújo, Luís; Costa, Alberto; Silva, Armandina; Teixeira, Fernanda; Ferreira-Magalhães, Manuel; Alves, Rodrigo Rodrigues; Moreira, Ana Sofia; Fernandes, Ricardo M.; Ferreira, Rosário; Pinto, Paula Leiria; Neuparth, Nuno; Bordalo, Diana; Bom, Ana Todo; Cálix, Maria José; Ferreira, Tânia; Gomes, Joana; Vidal, Carmen; Mendes, Ana; Vasconcelos, Maria João; Silva, Pedro Morais; Ferraz, José; Morête, Ana; Pinto, Claúdia Sofia; Santos, Natacha; Loureiro, Claúdia Chaves; Arrobas, Ana; Marques, Maria Luís; Lozoya, Carlos; Lopes, Cristina; Cardia, Francisca; Loureiro, Carla Chaves; Câmara, Raquel; Vieira, Inês; Silva, Sofia da; Silva, Eurico; Rodrigues, Natalina; Fonseca, João A.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.
- Drug-Induced Anaphylaxis: An Update on Epidemiology and Risk FactorsPublication . Regateiro, Frederico S.; Marques, Maria Luís; Rebelo Gomes, EvaDrug hypersensitivity is one of the most frequent causes of anaphylaxis, particularly in adults and in hospitalized patients. Drug-induced anaphylaxis (DIA) is also associated with more severe outcomes than other anaphylaxis triggers, and drugs are responsible for the majority of deaths due to anaphylaxis. We here review the current knowledge on the incidence, prevalence, drugs involved, mortality, and mortality risk factors for DIA. The incidence of both anaphylaxis and DIA seems to be increasing worldwide. Antibiotics and analgesics are the most frequently reported triggers of DIA. However, the importance of other drug groups should be taken into account, especially in particular settings (e.g., peri-operative and oncology). The identification of risk factors, geographical variables, and drugs associated with higher risk for DIA may improve the outcomes of this entity.
- Intradermal Tests With Drugs: An Approach to StandardizationPublication . Barbaud, Annick; Weinborn, Marie; Garvey, Lene Heise; Testi, Sergio; Kvedariene, Violeta; Bavbek, Sevim; Mosbech, Holger; gomes, eva; Aberer, Werner; Elberink, Hanneke N. G. Oude; Torres, Maria Jose; Ponvert, Claude; Ayav, C.; Gooi, Jimmy; Brockow, KnutBackground: Intradermal tests (IDTs) are performed and interpreted differently in drug allergy centers making valid comparison of results difficult. Objective: To reduce method-related and intercenter variability of IDTs by the introduction of a standardized method. Materials and methods: In 11 centers of the European Network for Drug Allergy, IDTs were prospectively performed with saline and with amoxicillin (20 mg/ml) using (1) the local method and (2) the standardized European Network in Drug Allergy (ENDA) method (0.02 ml). The diameters of the initial injection wheal (Wi) for the different volumes and sites injected obtained from each center were analyzed. Results: The most reproducible method was to fill a syringe with test solution, then expel the excess fluid to obtain exactly 0.02 ml. The median Wi diameter with 0.02 ml injection using the standardized method was 5 mm [range 2-10 mm; interquartile range (IQR) 5-5 mm; n = 1,096] for saline and 5 mm (range 2-9 mm; IQR = 4.5-5 mm; n = 240) for amoxicillin. IDT injection sites did not affect the Wi diameter. Training improved precision and reduced the variability of Wi diameters. Conclusion: Using the standardized IDT method described in this multicenter study helped to reduce variability, enabling more reliable comparison of results between individuals and centers.
- Anaphylaxis to Agaricus bisporus ingestionPublication . Cunha, Inês Machado; Marques, Maria Luís; Abreu, Carmo; Bartolomé, Borja; gomes, EvaA 33-year-old male with house dust mite allergic rhinitis and asthma reported an episode of facial and lip angioedema, dyspnea, cough and dysphagia at the age of 25, minutes after eating a mushroom ( Agaricus bisporus ) pizza. He denied any drug intake, hymenoptera stings or other possible triggers, and no identifiable cofactors were present. Since then he avoided all types of mushrooms, however an accidental contact occurred with mushroom sauce that resulted in angioedema of the lip within minutes. The allergy workup included measurements of total IgE and specific IgE to mushroom, and skin prick test to aeroallergens sources, possible food allergen sources and mushroom extract, a prick to prick test with raw and cooked A. bisporus , in addition to a SDS-PAGE and immunoblotting assay. The study revealed a specific IgE to mushroom of 0.76kUA/L positive skin prick test to mushroom extract, and prick to prick test positive to white and brown A. bisporus (raw and cooked). The immunoblotting identified two IgE binding proteins with 10kDa and 27kDa. We report a case of A. bisporus anaphylaxis probably due to primary mushroom sensitization. We detected two IgE-reactive proteins with 10kDa and 27kDa as possible culprit allergens.
- Immediate Reactions to Fluorescein and Indocyanine Green in Retinal Angiography: Review of Literature and Proposal for Patient’s EvaluationPublication . Meira, Jorge; Marques, Maria Luís; Falcão-Reis, Fernando; Gomes, Eva; Carneiro, ÂngelaIntroduction: Contrast rapid sequence angiography with fluorescein or indocyanine green (ICG) is a diagnostic procedure commonly used in ophthalmology. Adverse reactions to fluorescein and ICG are rare and may be classified as toxic, of hypersensitivity and non-specific. The evaluation and management of a patient with an adverse reaction is a challenge for the majority of ophthalmologists, as is the assessment of risk factors that may contraindicate the procedure. Purpose: We aim to review the concepts underlying adverse reactions to fluorescein and ICG, especially those of hypersensitivity, and present a proposal or the evaluation of the patients in need to perform retinal angiography and for the treatment of immediate reactions to fluorescein and ICG. Methods: The available literature was examined using PubMed-Medline, and using the MeSH terms "fluorescein", "Indocyanine green", "ophthalmic dyes", "retinal angiography", "adverse reactions", and "allergic reaction". Conclusion: This review may help ophthalmologists to identify patients with higher risk of a hypersensitivity reaction and give them tools to recognize patients with suspected hypersensitivity that may benefit from an allergy study.