Background and objective: Determination of asthma phenotypes, particularly inflammatory phenotypes, helps guide treatment and management of this heterogeneous disease. Induced sputum cytology has been the gold standard for determination of inflammatory phenotypes, but sputum induction is fairly invasive and technically challenging. Blood and nasal lavage cytology have been suggested as substitutes, but have not been fully verified. The aim of this study is to determine the accuracy of blood and nasal lavage cytometry as indicators of inflammatory phenotypes in asthma. Methods: Clinical evaluation, Asthma Control Questionnaire (ACQ) and spirometry were performed for 121 adult asthma patients, and blood, nasal lavage and induced sputum samples were taken. Eosinophils and neutrophils were counted in three samples from each subject. Inflammatory phenotypes (eosinophilic, neutrophilic, mixed and paucicellular) and cells counts were analysed using Venn diagram and receiver operating characteristic (ROC) curve, respectively. Results: ACQ score, spirometry and bronchodilator response did not differ among subjects with different inflammatory phenotypes. Inflammatory phenotypes defined by nasal lavage cytometry were in better concordance than those defined by blood cell counts with phenotypes determined by sputum cytology, and were significantly correlated with sputum phenotypes. For eosinophilia, nasal lavage cytology showed better accuracy than blood cytology (area under the curve (AUC): 0.89 vs 0.65). For all phenotypes, sensitivity and positive and negative predictive power were higher for nasal lavage cytometry than for blood. Blood cell counts gave a high level of false positives for all inflammatory phenotypes. Conclusion: We recommend nasal lavage cytology over blood cell count as a substitute for sputum cytology to identify inflammatory phenotypes in asthma.
BackgroundCases of drug induced hypersensitivity syndrome are reported under various names and case definition for this reaction pattern is regularly poorly applied. Our aim was to analyze series of cases of Drug Reaction with Eosinophilic Hypersensitivity Syndrome (DRESS) and their clinical and demographic data.MethodsA prospective study was developed in Allergy Clinics of 2 Services in São Paulo, Brazil, from November 2008 to June 2011. The patients were studied based on history of DRESS based on standardized scoring systems and using an adapted ENDA (European Network of Drug Allergy) questionnaire. Clinical and demographic data were analysed.ResultsTwenty-nine cases were validated as probable or definitive DRESS, 20 females (69%) and the mean age was 43.6. The reactions generally started with fever and exanthema. All cases had exanthema, mucosal involvement was found in 4 patients (13%). Fever >38°C was present in 89% and lymphadenopathy in 55%. Involvement of a single internal organ (69%) or variable combination of 2 or more internal organs (17%) was common, predominantly related to liver (79%), kidney (17%) and lung (6.8%). Eighty percent of patients with renal involvement required dialysis. Eosinophilia was documented in 89% and atypical lymphocytes in 31%. Sixty-nine percent were related with antiepileptics, 10% with sulfonamides and 6.8% with allopurinol, 6.8% with β-lactams antibiotics and 6.8% with non-steroidal anti-inflammatory drugs. The mean interval between the intake of the suspected drug and the reaction was 27.6. In all patients the duration of the reaction was protracted (>15 days). Forty-eight patients reported the intake of more than 2 drugs at the same time of the reaction, but in all cases there was 01 drug suspected. No fatalities occurred.ConclusionsThis series confirmed the clinical variability of DRESS, highlighting skin, fever, lymphadenopathy, internal organs involvement and eosinophilia. There was severe internal organ involvement, but no fatalities occurred. Clinical characters and time of onset of the reactions differs from others non-immediate hypersensitivity reactions, it supports that DRESS is an original phenotype. Prospective long-term multicentric epidemiological studies may be important for better understanding of this syndrome.
BackgroundTen-to-twenty percent of hospitalized patients experience drug adverse reactions. There are few epidemiological data of drug hypersensitivity in inpatients in brazilian population. Our aim was to analyze the main clinical and epidemiological data of drug hypersensitivity reactions in hospitalized patients and to assess the importance of the allergist's evaluation.MethodsA prospective study was developed in an Allergy Clinic of a Service in São Paulo, Brazil, from January 2010 to January 2011. We evaluated the cases in which the allergist was assessed. The patients were studied based on history of hypersensitivity reactions to drugs (HRD) using an adapted ENDA (European Network of Drug Allergy) questionnaire. We analyzed clinical and epidemiological data of drug hypersensitivity reactions and assessed differences of the allergist evaluation.ResultsOf all 80 cases in which the allergist was assessed, 65 (81%) were for HRD. The mean age was 57 years, 49 (75%) were women. Fifty (89%) experienced non-immediate reactions, 8 of them were severe adverse cutaneous reactions. Eight (12%) had just positive history of HRD, without reaction at the time of the evaluation. Neurosurgery (15), Infectious Diseases (11), Vascular surgery (8) were the main Clinics who assessed our specialty. Non-steroidal anti-inflammatory drugs (21), antiepileptics (16) and non-β-lactams antibiotics (15) were the most important pharmacological groups. Thirty (46%) patients were in use of more than 5 drugs at the time of the reaction, but in 46 (70%) evaluations there was 01 culprit drug suspected by the allergist. There was discordance between the allergist and the non-allergist opinion about the suspected drug in 13 (20%) cases. In 50% of cases other Clinics were assessed for the same reason. Eleven (17%) patients had history of HRD with the same pharmacological group before.ConclusionsHRD is the main cause why the allergist is assessed. The pharmacological groups related to these HRD were different from the previously described. The history of HRD is still not appropriate asked from the non-allergists. The evaluation of the allergist can help to manage HRD properly.
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