Graça Pires

Centro Hospitalar de Lisboa Central, Lisboa, Lisbon, Portugal

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Publications (20)88.68 Total impact

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    Revista Portuguesa de Imunoalergologia 03/2014; 22(1):43-54.
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    ABSTRACT: Background: Anaphylaxis incidence is increasing, especially in the pediatric age group, being the characterization of this entity hampered by underdiagnosis and underreporting. Aim: To determine the frequency of anaphylaxis in an Immunoallergy outpatient department, allowing to a better understanding regarding aetiology, clinical manifestations and management, in children and adolescents. Methods: From 3646 patients up to 18 years old observed in our Immunoallergy department during 2011, we included those with history of anaphylaxis voluntarily reported by the clinical staff (“at least one episode of severe systemic reaction”). Results: During the one year period, 64 children had history of anaphylaxis (prevalence of 1.8%). Mean age was 8.1±5.5 years, with 61% being male. The majority (91%) had personal history of allergic disease, and 44% had asthma as co‑morbidity. Median age of the first anaphylactic episode was 3 years (1 month to 17 years old). In 14 children the first anaphylactic reaction occurred in the first year of life. The majority of patients had food‑induced anaphylaxis (84%): milk (n=22), egg (n=7), peanut (n=6), tree nuts (n=6), fresh fruits (n=6), crustaceans (n=4), fish (n=4) and wheat (n=2). Food‑associated exercise‑induced anaphylaxis was reported in 2 adolescents. Drug‑induced anaphylaxis occurred in 8%: non‑steroidal anti‑inflammatory drugs (n=4) and amoxicillin (n=1). Three children had cold‑induced anaphylaxis, one adolescent had anaphylaxis to latex and latex‑fruit syndrome, and one child had anaphylaxis to insect sting. The majority (73%) had no previous diagnosis of the etiologic factor. Symptoms reported were mainly mucocutaneous (94%) and respiratory (84%), followed by gastrointestinal (42%) and cardiovascular (25%); 86% beginning in the first 30 minutes after exposure to trigger agent. Fifty‑one (80%) patients were admitted to emergency department, although only 33% were treated with epinephrine. Recurrence of anaphylaxis occurred in 26 patients (3 or more episodes in 14 children). Conclusions: In our pediatric population, the main triggering agent of anaphylaxis was IgE‑mediated food allergy. Epinephrine is clearly underused, as has been reported by others. Often, children have several episodes before being assessed by an allergist. We stress the importance of systematic notification of anaphylaxis and improvement of educational programmes in order to achieve a better preventive and therapeutic management of this life‑threatening entity.
    Revista Portuguesa de Imunoalergologia 01/2014; 22(1):43-54.
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    31st Congress of the European Academy of Allergy and Clinical Immunology, Geneve, Switzerland; 06/2012
  • Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología 01/2012; 22(6):450-1. · 2.64 Impact Factor
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    XXXII Reunião Anual da Sociedade Portuguesa de Alergologia e Imunologia Clínica, Porto, Portugal; 10/2011
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    ABSTRACT: Rosaceae fruits are an important cause of food allergy in the Southern Europe, being the peach the most commonly impli-cated in anaphylaxis. We describe two less usual case reports of anaphylaxis to apple. From the allergological study performed, we highlight positive skin prick tests to apple and peach peel, positive specific IgE to apple, peach and lipid transfer protein (LTP) of peach (rPru p 3), and positive ImmunoCAP ISAC ® to cross -reactive LTPs (nPru p 3, rCor a 8 and rPar j 2). We confirm sensitization to LTPs, thermally stable and resistant to peptic digestion panallergens present in apple and peach peel. We emphasize the fact that clinical reactions to apple were of greater severity, and we hypothesize this may be due to the quantity of ingested LTPs or to cofactors that might amplify an anaphylactic episode as fasting and exercise.
    Revista Portuguesa de Imunoalergologia 01/2011; 19(4):223-227.
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    Cerebrospinal Fluid Research 01/2010; · 1.81 Impact Factor
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    ABSTRACT: Characterized native and recombinant Hevea brasiliensis (rHev b) natural rubber latex (NRL) allergens are available to assess patient allergen sensitization profiles. Quantification of individual IgE responses to the spectrum of documented NRL allergens and evaluation of cross-reactive carbohydrate determinants (CCDs) for more definitive diagnosis. Sera of 104 healthcare workers (HCW; 51 German, 21 Portuguese, 32 American), 31 spina bifida patients (SB; 11 German, 20 Portuguese) and 10 Portuguese with multiple surgeries (MS) were analysed for allergen-specific IgE antibody (sIgE) to NRL, single Hev b allergens and CCDs with ImmunoCAP technology. In all patient groups rHev b 5-sIgE concentrations were the most pronounced. Hev b 2, 5, 6.01 and 13 were identified as the major allergens in HCW and combined with Hev b 1 and Hev b 3 in SB. In MS Hev b 1 displayed an intermediate relevance. Different sIgE antibody levels to native Hevea brasiliensis (nHev b) 2 and rHev b 6.01 allowed discrimination of SB with clinical relevant latex allergy vs. those with latex sensitization. Sensitization profiles of German, Portuguese and American patients were equivalent. rHev b 5, 6.01 and nHev b 13 combined detected 100% of the latex-allergic HCW and 80.1% of the SB. Only 8.3% of the sera showed sIgE response to CCDs. Hev b 1, 2, 5, 6.01 and 13 were identified as the major Hev b allergens and they should be present in standardized latex extracts and in vitro allergosorbents. CCDs are only of minor relevance in patients with clinical relevant latex allergy. Component-resolved diagnostic analyses for latex allergy set the stage for an allergen-directed immunotherapy strategy.
    Clinical & Experimental Allergy 12/2007; 37(11):1657-67. · 4.32 Impact Factor
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    ABSTRACT: Childhood recurrent wheezing is a very prevalent heterogeneous clinical entity. An 8-year prospective study was performed to correlate the clinical outcome of recurrent wheezing in the first years of life with prognostic risk factors. A cohort of 308 children with recurrent wheezing, aged <7 years, were enrolled in 1993, studied using a questionnaire, skin-prick tests, and serum total IgE. According to the study protocol, in 1996 and 2001, the cohort was assessed. In 2001, 81% of the initial sample was reevaluated (n=249); 61% remained symptomatic. Prevalence of atopy was 48% in 1993, 65% in 1996, and 75% in 2001. By logistic regression analysis, we identified the following as independent risk factors for asthma symptoms in the last year of the follow-up: personal history of rhinitis (odds ratio [OR] = 15.8, 95% confidence interval [CI], 6.1-40.8; p < 0.001), paternal asthma (OR =, 7.2; 95% CI = 1.7-29.7; p = 0.007), personal history of atopic dermatitis (OR = 5.9, 95% CI = 2.2-15.7; p < 0.001), maternal asthma (OR = 5.4, 95% CI = 1.7-17.1; p = 0.004), allergen sensitization (OR = 3.4, 95% CI = 1.2-10.4; p = 0.03), and onset of symptoms in the 2nd year or later in preschool-aged children (OR = 2.1, 95% CI = 1.1-4.8; p = 0.04). Kindergarten attendance before 12 months was identified as a protective factor (OR = 0.4, 95% CI = 0.2-0.9; p = 0.04). Among the 128 nonatopic children in 1993, 52% developed allergen sensitization. We identified as prognostic risk factors for asthma symptoms personal history of allergic disease, parental asthma, atopy, and late onset of symptoms. In a significant number of children clinical symptoms can occur years before allergen sensitization.
    Allergy and Asthma Proceedings 03/2007; 28(2):183-9. · 3.35 Impact Factor
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    ABSTRACT: Barnacles are a type of seafood with worldwide distribution and abundant along the shores of temperate seas. They are particularly appreciated and regularly consumed in Portugal as well as in Spain, France and South America, but barnacle allergy is a rare condition of which there is only one reference in the indexed literature. The molecular allergens and possible cross-reactivity phenomena implicated (namely with mites) have not been established. To demonstrate the IgE-mediated allergy to barnacle and to identify the proteins implicated as well as possible cross-reactivity phenomena with mites. We report the clinical and laboratory data of five patients with documented IgE-mediated allergy to barnacle. The diagnosis was based on a suggestive clinical history combined with positive skin prick tests (SPT) to barnacle--prick to prick method. Two barnacle extracts were prepared (raw and cooked barnacle) and sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS-PAGE) and IgE-immunoblotting were performed. An immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done in order to evaluate cross-reactivity. All patients had mite-related asthma and the allergic rhinoconjunctivitis; they all experienced mucocutaneous symptoms. All of them had positive SPT to barnacle, and the immunoblotting showed several allergenic fractions with a wide molecular weight range (19 - 94 kDa). The D. pteronyssinus extract inhibited several IgE-binding protein fractions in the barnacle extract. We describe five patients with IgE-mediated barnacle allergy. We also describe a group of IgE-binding+proteins between 30 and 75 kDa as the allergenic fractions of this type of Crustacea. Cross-reactivity with D. pteronyssinus was demonstrated in two cases.
    Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología 02/2006; 16(2):117-22. · 2.64 Impact Factor
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    Allergy 02/2005; 60(1):129-30. · 6.00 Impact Factor
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    Allergy 08/2003; 58(7):683-4. · 6.00 Impact Factor
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    Allergy 07/2003; 58(6):533-4. · 6.00 Impact Factor
  • Journal of Allergy and Clinical Immunology 02/2003; 111(1). · 11.25 Impact Factor
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    Allergy 11/2002; 57(10):957-8. · 6.00 Impact Factor
  • Journal of Allergy and Clinical Immunology 01/2002; 109(1). · 11.25 Impact Factor
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    ABSTRACT: Children with spina bifida represent the major risk group for latex sensitization.Purpose: To determine the prevalence of latex sensitization in these children and to identify risk factors. We studied 57 patients with spina bifida. The mean age was 5.6 years and the male/female ratio was 0.8/1. In all patients a questionnaire, skin prick test (SPT) with latex (UCB-Stallergènes, Lofarma and ALK-Abelló), common aeroallergens and fruits (UCB-Stallergènes) and serum determination of total IgE (AlaSTAT) were performed. The prevalence of latex sensitization was 30 %; only two sensitized children (12 %) had symptoms after exposure. Risk factors for latex sensitization were age >/= 5 years (p = 0.008; OR = 6.0; 95 % CI = 1.7-22.1), having at least four previous surgical interventions (p < 0.0001; OR = 18.5; 95 % CI = 3.6-94.8), having undergone surgery in the first 3 months of life (p = 0.008; OR = 5.4; 95 % CI = 0.7-29.2) and total serum IgE >/= 44 IU/ml (p = 0.03; OR = 3.8; 95 %CI = 1.1-13.1). Multiple logistic regression analysis showed that only a history of four or more surgical interventions (p < 0.0001; OR = 26.3; 95 %CI = 2.9-234.2) and total serum IgE >/= 44 IU/ml (p = 0.02; OR = 8.6; 95 % CI = 1.4-53.4) were independently associated with latex sensitization. Sex, family and personal allergic history, hydrocephalus with ventriculoperitoneal shunt, cystourethrograms, intermittent bladder catheterization and atopy were not related to latex sensitization. In children with spina bifida, significant and independent risk factors identified for latex sensitization were multiple interventions and higher levels of total serum IgE. A prospective study will clarify the clinical evolution of assymptomatic children sensitized to latex.
    Allergologia et Immunopathologia 01/2002; 30(1):5-13. · 1.58 Impact Factor
  • Journal of Allergy and Clinical Immunology 01/2002; 109(1). · 11.25 Impact Factor
  • Journal of Allergy and Clinical Immunology 01/2002; 109(1). · 11.25 Impact Factor
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    ABSTRACT: Bronchial asthma is related to a high morbidity rate, leading to an increasing frequency of emergency room visits and hospital admissions. The aim of this study was to identify severity risk factors for childhood asthma related to hospitalization. The authors studied 124 children admitted to the hospital for asthma, during a 2-year period, correlating the obtained data with a sample of outpatients with asthma matched by age, gender, and socioeconomic status. A standardized questionnaire and skin-prick tests (SPTs) were performed on all children. The significant and independent risk factors identified for hospital admission were prior asthma hospitalization (OR = 7.63; 95% CI = 1.5-39.6; p = 0.01) and last-year admission (OR = 3.18; 95% CI = 1.1-8.9; p = 0.02), environmental tobacco-smoke exposure (OR = 6.63; 95% CI = 2.5-17.8; p = 0.002), allergen sensitization (OR = 3.86; 95% CI = 1.4-10.7; p = 0.009), family history of maternal asthma (OR = 3.58; 95% CI = 1.3-9.6; p = 0.01), and onset of symptoms before 12 months of age (OR = 2.76; 95% CI = 1.0-7.9; p = 0.06). Attendance at day care or kindergarten (OR = 0.38; 95% CI = 0.2-0.9; p = 0.04) and large family size (OR = 0.25; 95% CI = 0.1-0.8; p = 0.01) could be protective factors. Our results stress the importance of early diagnosis and specialized medical care of childhood asthma, mainly in high-risk children, with emphasis on medication planning and the establishment of preventive measures such as environmental tobacco smoke avoidance and limitation of aeroallergen exposure.
    Allergy and Asthma Proceedings 23(5):295-301. · 3.35 Impact Factor