M G Castel-Branco

Publications of M G Castel-Branco

• Clinical efficacy of web-based versus standard asthma self-management.

  Authors: L Araújo, T Jacinto, A Moreira, M G Castel-Branco, L Delgado, A Costa-Pereira, J Fonseca

  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(1):28-34.

  Guided self-management is an important component of asthma care. Most trials have evaluated paper-based strategies. The effectiveness of new communication technologies remains uncertain. To compareGuided self-management is an important component of asthma care. Most trials have evaluated paper-based strategies. The effectiveness of new communication technologies remains uncertain. To compare the feasibility and clinical outcomes of a standard paper-based asthma self-management strategy with web-based strategies. In a crossover trial, 21 patients using inhaled corticosteroids and long-acting B2-agonists (mean [SD] age 29 [10] years) were randomly assigned to use a sequence of web-based and paper-based diary and action plan. Quality of life, asthma control, lung function, and airway inflammation were assessed using the Asthma Life Quality Questionnaire (ALQ), Asthma Control Questionnaire (ACQ-5), Mini Asthma Quality of Life Questionnaire (Mini AQLQ), and office spirometry. The ratio of forced expiratory volume in the first second of expiration (FEV1) to peak expiratory flow (PEF) rate (PiKo-1) and fraction of exhaled nitric oxide (FE(NO)) were monitored. The main clinical outcomes were asthma control and FE(NO). Quality of data and adherence to monitoring tools were the main process outcomes. Significant improvements were observed in the AQL and ACQ scores, although lung function did not change. FE(NO) was significantly reduced only after a web-based strategy but a significant period effect occurred (P = .006). There were no differences in clinical outcomes between web-based and paper-based management. No intervention-related adverse effects were observed. Adherence seemed higher with the paper-based strategy (P < .001). However, paper data were unreliable when compared to automatic daily electronic FEV1/PEF records. Twelve patients were very interested in continuing self-management with the web-based approach compared with 2 in using paper tools (P = .002). Web-based management was feasible, safe, and preferred by patients. Short-term outcomes were at least as good, and data quality was improved.

• Use of a common food frequency questionnaire (FFQ) to assess dietary patterns and their relation to allergy and asthma in Europe: pilot study of the GA2LEN FFQ.

  Authors: V Garcia-Larsen, M Luczynska, M L Kowalski, H Voutilainen, M Ahlström, T Haahtela, E Toskala, A Bockelbrink, H-H Lee, E Vassilopoulou, N G Papadopoulos, R Ramalho, A Moreira, L Delgado, M G Castel-Branco, P C Calder, C E Childs, I Bakolis, R Hooper, P G Burney

  European journal of clinical nutrition. 03/2011; 65(6):750-6.

  Comparable international data on food and nutrient intake is often hindered by the lack of a common instrument to assess food intake. The objective of this study was within the Global Allergy andComparable international data on food and nutrient intake is often hindered by the lack of a common instrument to assess food intake. The objective of this study was within the Global Allergy and Asthma European Network of Excellence (GA(2)LEN), we developed and piloted a food frequency questionnaire (FFQ) to assess its validity in Europe. Five countries participating in GA(2)LEN took part in the pilot study. A total of 200 adults aged 31-75 years were invited to complete a FFQ in two occasions and to give a blood sample. The intra-class correlation coefficient (ICC) was used to assess repeatability of the FFQ. Plasma phospholipid fatty acids (FAs) were analysed by gas chromatography. Pearson correlation was used to analyse the correlation between estimated dietary FA intake and plasma phospholipid FA levels. A total of 177 participants (89%) had complete data on FFQ(1) and plasma phospholipid FAs. In all, 152 participants (76%) completed both FFQs. ICCs between macronutrients ranged from 0.70 (saturated FAs) to 0.78 (proteins) and between 0.70 (retinol) and 0.81 (vitamin D) for micronutrients. Dietary n-3 FAs showed a good correlation with total plasma phospholipid n-3 FAs and with docosahexaenoic acid in the whole sample (0.40) and in individual countries. Poor correlations were observed for other FAs. The GA(2)LEN FFQ is an appropriate tool to estimate dietary intake for a range of nutrients across Europe regardless of cultural and linguistic differences. The FFQ seems to be useful to estimate the intake of n-3 FAs but not other FAs.

• Outdoor allergenic fungal spores: comparison between an urban and a rural area in northern Portugal.

  Authors: M Oliveira, H Ribeiro, L Delgado, J Fonseca, M G Castel-Branco, I Abreu

  Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología. 01/2010; 20(2):117-28.

  The frequency and concentration of many airborne fungal spores associated with respiratory allergy symptoms are influenced by geographical and climatic characteristics. The aim of this work was toThe frequency and concentration of many airborne fungal spores associated with respiratory allergy symptoms are influenced by geographical and climatic characteristics. The aim of this work was to monitor the distribution of 11 potentially allergenic fungal spore types in 2 regions with different urbanization levels in Northern Portugal: Porto (urban area) and Amares (rural area). Airborne fungal spore levels were monitored from 2005 to 2007 using Hirst-type spore traps. The Spearman correlation test was used to analyze the influence of meteorological factors (temperature, relative humidity, and rainfall) on spore concentration. Meteorological data from both areas were compared using the t test, and spore concentrations were compared using the sign test. In both areas, Cladosporium, Agaricus, Aspergillus/Penincillium, Altemaria, Coprinus, and rusts were the most abundant fungal types observed. Most of the analyzed spore types presented maximum values during the summer months, with the exception of Polythrincium, Stemphylium, and Torula, which reached a peak earlier in the year, whereas Aspergillus/Penicillium and Botrytis showed a wider distribution. Temperature had a positive effect on most spore concentrations, and relative humidity and rainfall negatively influenced concentrations ofAlternaia, Cladosporium, Epicoccum, and Torula. The concentration of all selected spore types was higher in the rural than in the urban area, with higher values registe summer and autumn and lower values found during winter and spring. rainfall, influence airborne concentrations of major allergenic fungal spores.

• Prevalence of aeroallergen sensitization and increased exhaled nitric oxide values in schoolchildren of different socioeconomic status.

  Authors: R Silva, L Cruz, T Vieira, A Leblanc, A Ferreira, J Fonseca, A Moreira, M G Castel-Branco

  Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología. 01/2010; 20(3):210-3.

  Screening for allergic diseases allows an early diagnosis to be made, thus reducing socioeconomic burden and enhancing quality of life. We determined the prevalence of elevated exhaled nitric oxideScreening for allergic diseases allows an early diagnosis to be made, thus reducing socioeconomic burden and enhancing quality of life. We determined the prevalence of elevated exhaled nitric oxide (eNO) levels and sensitization to common airborne allergens in schoolchildren from different socioeconomic backgrounds. The study population comprised 271 children (136 boys) aged between 8 and 12 years in whom we applied skin prick tests and determined eNO levels. Thirty-five percent of the children were identified as atopic. There was a significantly higher prevalence of atopy in boys (43% vs. 27%). Among the children with a high socioeconomic status, 37% were atopic, compared with 30% of those with a low socioeconomic status. We observed a significantly lower prevalence of pollen sensitization in children of lower socioeconomic status (10% vs. 20%). In the atopic group, 51% had elevated eNO levels, while in the nonatopic group this value was 4%. The mean (SD) eNO level was 33.4 (26.6) ppb in the atopic group and 11.9 (6.4) ppb in the nonatopic group. No differences were found for eNO values in terms of gender or socioeconomic status. Our results emphasize the high prevalence of atopy in our population and suggest that determination of eNO levels could help to provide an early diagnosis. We also observed the following: (a) a significant difference in mean eNO values between atopic and nonatopic children; (b) a significantly lower prevalence of pollen sensitization in children of lower socioeconomic status; and (c) a higher prevalence of atopy in boys.

• Immediate hypersensitivity to penicillins with negative skin tests--the value of specific IgE.

  Authors: R Silva, L Cruz, C Botelho, E Castro, S Cadinha, M G Castel-Branco, J Rodrigues

  European annals of allergy and clinical immunology. 08/2009; 41(4):117-9.

  The determination of specific IgE in patients with history of penicillins hypersensitivity is simple, safe and widely available. The positive and negative predictive values of this determination,The determination of specific IgE in patients with history of penicillins hypersensitivity is simple, safe and widely available. The positive and negative predictive values of this determination, however, are not yet established. In order to evaluate them, we performed specific IgE determination and diagnostic drug challenges in a group of 22 patients with a clear history of immediate penicillins hypersensitivity but negative skin tests. In this sample, the positive and negative predictive values were 29% and 87%, respectively. This seems to indicate that a positive specific IgE is not enough to confirm the diagnosis, and further study is necessary.

• Anaphylaxis to mango fruit and crossreactivity with Artemisia vulgaris pollen.

  Authors: R Silva, C Lopes, E Castro, J Ferraz de Oliveira, B Bartolomé, M G Castel-Branco

  Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología. 01/2009; 19(5):420-2.

• Physical training does not increase allergic inflammation in asthmatic children.

  Authors: A Moreira, L Delgado, T Haahtela, J Fonseca, P Moreira, C Lopes, J Mota, P Santos, P Rytilä, M G Castel-Branco

  The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 09/2008;

  We studied the effects of a 3-month physical training program on airway inflammation and clinical outcomes in school-aged children with asthma.Thirty four subjects, 12.7+/-3.4 years, with persistentWe studied the effects of a 3-month physical training program on airway inflammation and clinical outcomes in school-aged children with asthma.Thirty four subjects, 12.7+/-3.4 years, with persistent allergic asthma were randomly allocated into training and control groups. Exercise consisted of twice-weekly 50 minutes sessions for 12 weeks. Inflammation was assessed by exhaled nitric oxide, blood eosinophils, eosinophil cationic protein, C-reactive protein, total and mite specific IgE. Lung volumes and bronchial responsiveness to metacholine were determined. Paediatric Asthma -and Caregiver's- Quality of Life Questionnaires were used to evaluate activity restrictions, symptoms and emotional stress. Efficacy of the training was assessed by accelerometry.After the program, exercise children had double daily minutes in moderate-to-vigorous activities compared to controls. No differences in changes were seen between groups for asthma outcomes. However, total IgE decreased more in the exercise group, as did mite specific IgE.Training did not increase inflammation in children with persistent asthma, and may have decrease both total and allergen specific IgE levels. We conclude there is no reason to discourage asthmatic children with a controlled disease to exercise.

• Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control.

  Authors: R Barros, A Moreira, J Fonseca, J Ferraz de Oliveira, L Delgado, M G Castel-Branco, T Haahtela, C Lopes, P Moreira

  Allergy. 07/2008; 63(7):917-23.

  BACKGROUND: The traditional Mediterranean diet is claimed to possess antioxidant and immune-regulatory properties in several chronic diseases. Typical Mediterranean foods have recently beenBACKGROUND: The traditional Mediterranean diet is claimed to possess antioxidant and immune-regulatory properties in several chronic diseases. Typical Mediterranean foods have recently been associated with improvement of symptoms of asthma and rhinitis in children. However the effect of adherence to Mediterranean diet on adult asthma outcomes is unknown. We aimed to investigate the association between adherence to Mediterranean diet and asthma control. METHODS: Cross sectional study of 174 asthmatics, mean (SD) age of 40 (15) years. The patients were defined as controlled, in contrast to noncontrolled, if they showed FEV1 >or= 80% of predicted, exhaled nitric oxide (NO) <or=35 ppb, and Asthma Control Questionnaire score <1. Dietary intake was obtained by a food frequency questionnaire, and Mediterranean diet was assessed by alternate Mediterranean Diet (aMED) Score. Logistic regression models adjusting for confounders were performed to estimate the association between Mediterranean diet and asthma control. RESULTS: Controlled asthmatics (23%) had significantly higher aMED Score, intake of fresh fruit, and lower intake of ethanol compared to noncontrolled (77%). High adherence to Mediterranean diet reduced 78% the risk of noncontrolled asthma after adjusting for gender, age, education, inhaled corticosteroids and energy intake (OR = 0.22; 95% CI = 0.05-0.85; P-trend = 0.028). The higher intake of fresh fruit decreased the probability of having noncontrolled asthma (OR = 0.29; 95% CI = 0.10-0.83; P-trend = 0.015), while the higher intake of ethanol had the opposite effect (OR = 3.16; 95% CI = 1.10-9.11; P-trend = 0.035). CONCLUSION: High adherence to traditional Mediterranean diet increased the likelihood of asthma to be under control in adults. The study introduces a novel link between diet and asthma control, as measured by symptoms, lung function and exhaled NO.

• Training does not affect exhaled nitric oxide in competitive swimmers.

  Authors: A Moreira, L Delgado, T Haahtela, J A Silva, L Araújo, F Beça, J Fonseca, M G Castel-Branco

  Allergy. 06/2008; 63(5):623-4.

• Competitive swimmers with allergic asthma show a mixed type of airway inflammation.

  Authors: A Moreira, L Delgado, C Palmares, C Lopes, T Jacinto, P Rytilä, J A Silva, M G Castel-Branco, T Haahtela

  The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 06/2008; 31(5):1139-41.

• Asthma patients are willing to use mobile and web technologies to support self-management.

  Authors: J A Fonseca, A Costa-Pereira, L Delgado, L Fernandes, M G Castel-Branco

  Allergy. 04/2006; 61(3):389-90.

• Double-blind comparison of levocabastine eye drops with sodium cromoglycate and placebo in the treatment of seasonal allergic conjunctivitis.

  Authors: M Azevedo, M G Castel-Branco, J F Oliveira, E Ramos, L Delgado, J Almeida

  Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology. 12/1991; 21(6):689-94.

  The efficacy and tolerance of topical administration (one drop in each eye q.i.d.) of levocabastine (0.5 mg/ml) was compared with that of sodium cromoglycate (20 mg/ml) and placebo in a 4-weekThe efficacy and tolerance of topical administration (one drop in each eye q.i.d.) of levocabastine (0.5 mg/ml) was compared with that of sodium cromoglycate (20 mg/ml) and placebo in a 4-week double-blind trial in patients with seasonal allergic conjunctivitis. The investigator rated the treatment as globally good or excellent in significantly more patients treated with levocabastine (89%) than with cromoglycate (67%, P = 0.03) or placebo (48%, P = 0.007). The patients felt that the treatment was more efficacious in 95% (levocabastine), 35% (cromoglycate) and 36% (placebo) of the cases in which they had taken previous antiallergic medication. Total symptom severity according to the patients' diary data was consistently lower with levocabastine than with cromoglycate or placebo for all ocular symptoms. The difference was mainly apparent at the beginning of treatment. The percentage of symptom-free days was higher in the levocabastine group (53%) than in the cromoglycate (31%, P = 0.02) and the placebo group (34%, P = 0.08). Particularly at high-pollen days, levocabastine was superior to cromoglycate in eliminating moderate or severe symptoms. Adverse effects did not occur more frequently with levocabastine or cromoglycate than with placebo. It is concluded that levocabastine is an efficacious, fast-acting and well-tolerated drug in the management of seasonal allergic conjunctivitis.

• Helium-oxygen mixtures and acute severe asthma.

  Authors: L Cruz, A R Ferreira, A Coimbra, M G Castel-Branco

  Allergologia et immunopathologia. 37(4):216-7.

• Desensitization to methylphenidate - The relevance of continued drug intake for a successful outcome.

  Authors: J Rodrigues, C Botelho, S Cadinha, M G Castel-Branco

  Allergologia et immunopathologia. 36(5):303-5.

  Methylphenidate is the treatment of choice in attention-deficit/hyperactivity disorder (ADHD). The authors report the case of a 7 year old boy with ADHD and psoriasis who developed generalisedMethylphenidate is the treatment of choice in attention-deficit/hyperactivity disorder (ADHD). The authors report the case of a 7 year old boy with ADHD and psoriasis who developed generalised erythema, pruritus and fever 5 hours after the first oral administration of methylphenidate. After 2 days of treatment the drug was discontinued with complete resolution of symptoms. Later on, the drug was re-introduced with recurrence of the same clinical symptoms. Patch tests were performed with negative results. Desensitization was proposed and performed because there is no alternative treatment for ADHD. After the therapeutic dose was achieved, the mother interrupted drug intake because of a misunderstanding of instructions, and a mild rash subsided when another pill was administered. After this event the same desensitization procedure was carefully repeated. Interruption of drug intake during desensitization and consequent recurrence of clinical symptoms highlights the importance of continued exposure to the culprit drug in this kind of procedure. This modified protocol may enable patients with cutaneous reactions to this drug, to maintain therapy without recurrent reactions.

• Allergic contact blepheroconjunctivitis with phenylephrine eyedrops--the relevance of late readings of intradermal tests.

  Authors: C Botelho, J Rodrigues, M G Castel-Branco

  Allergologia et immunopathologia. 35(4):157-8.

  Allergic reactions to midriatic eyedrops are rare despite extensively used by ophthalmologists. Phenylephrine is responsible for 54-95% of cases reported in literature. We present the case of aAllergic reactions to midriatic eyedrops are rare despite extensively used by ophthalmologists. Phenylephrine is responsible for 54-95% of cases reported in literature. We present the case of a 56-year-old man with blepharoconjunctivitis after instillation of phenylephrine 5%, tropicamide 0.5%, oxibuprocaine eyedrops. The patient reported good tolerance to the mentioned drugs. Immediate readings of prick and intradermal tests, performed with the suspected drugs, were negative. Late readings (48 and 72 hours) of epicutaneous tests were also negative. At 72 hours, prick and intradermal tests to phenylephrine were positive. Allergic blepharoconjunctivitis to phenylephrine was diagnosed. Phenylephrine is an extensively used midriatic that can act as a potent sensitizing agent and can be the cause of allergic contact reactions in exposed patients. With this case we illustrate the relevance of late readings of intradermal tests in the diagnosis of late hypersensitivity drug reactions. The authors discuss about possible mechanisms responsible for negative results of epicutaneous tests.

• Nimesulide-induced fixed drug eruption.

  Authors: D Malheiro, S Cadinha, J Rodrigues, M Vaz, M G Castel-Branco

  Allergologia et immunopathologia. 33(5):285-7.

  BACKGROUND: Nimesulide is a cyclooxygenase (COX) inhibitor with a high degree of selectivity to COX-2. It is a widely used and well tolerated nonsteroidal antiinflammatory drug that also hasBACKGROUND: Nimesulide is a cyclooxygenase (COX) inhibitor with a high degree of selectivity to COX-2. It is a widely used and well tolerated nonsteroidal antiinflammatory drug that also has analgesic and antipyretic properties. The most frequently reported side effects concern the gastrointestinal tract. Pruritus and skin rash are the most common cutaneous adverse reactions. There are only eight cases of fixed drug eruptions due to nimesulide, described in the literature. CASE REPORT: The authors report a case of a patient with a history of antihistamine hypersensitivity who developed a bullous form of pigmented fixed drug eruption after nimesulide ingestion. Patch tests performed on residual skin lesion were positive to nimesulide, confirming that this was the culprit drug. CONCLUSIONS: Fixed drug eruptions are common cutaneous drug reactions, often misdiagnosed. A detailed anamnesis and physical examination are the key to suspect this condition.

• Delayed hypersensitivity reactions to corticosteroids.

  Authors: S Cadinha, D Malheiro, J Rodrigues, E Castro, M G Castel-Branco

  Allergologia et immunopathologia. 33(6):329-32.

  BACKGROUND: Corticosteroids (CS) are widely used in the treatment of asthma, allergic disorders and other immunological diseases due to their anti-inflammatory and immunosuppressive properties.BACKGROUND: Corticosteroids (CS) are widely used in the treatment of asthma, allergic disorders and other immunological diseases due to their anti-inflammatory and immunosuppressive properties. Physicians seldom suspect them of causing allergic reactions. However, more and more cases of hypersensitivity reactions to CS have been described. Reports of delayed allergic reactions to CS in patients with asthma or allergic rhinitis are scarce. MATERIAL AND METHODS: We report the case of a 44-year-old woman with a history of mild persistent asthma and intermittent allergic rhinitis, treated with inhaled beclomethasone and salbutamol, who developed a delayed mucocutaneous and respiratory reaction after substitution of beclomethasone with budesonide. CONCLUSIONS: The interest of this case lies in the rarity of allergic reactions from inhaled CS in patients with asthma and/or rhinitis. These reactions therefore represent a diagnostic and therapeutic challenge.

• [Cockroach allergy: a study of its prevalence using skin tests with commercial extracts]

  Authors: C Cuesta, J L Plácido, L Delgado, M Miranda, J P Moreira Silva, M G Castel-Branco, M Vaz

  Allergologia et immunopathologia. 23(6):295-300.

  Cockroaches have been increasingly recognized as an important source of indoor allergens. In this study we assessed the prevalence of cockroach sensitization among an outpatient population observedCockroaches have been increasingly recognized as an important source of indoor allergens. In this study we assessed the prevalence of cockroach sensitization among an outpatient population observed at our Department (155 patients with a mean age of 29 +/- 12 years), based on skin "prick" tests with four commercial cockroach extracts along with a common battery of standardized inhalant allergens. We found a positive wheal to at least one of these four extracts in 27 patients: 26 (96.2%) to Blatta orientalis, 10 (37%) both to Blatella germanica and 1 (3.7%) exclusively to Blatella germanica, with no significant concordance between them. We also observed in patients with cockroach positive skin "prick" test an association with atopy (p < 0.001) and with cutaneous reactivity to other indoor allergens, namely house dust mites (p = 0.02), danders (p = 0.01) and fungi (p = 0.01). These data confirm the higher risk of cockroach sensitization among the atopic population sensitized to indoor allergens. However, the heterogeneity of the positive cutaneous responses obtained in this study, possibly reflecting the incomplete standardization of cockroach extracts, questions the real prevalence and clinical significance of this particular sensitization.

• Physical activity does not increase allergic inflammation in asthmatic children

  Authors: A Moreira, L Delgado, T Haahtela, J Fonseca, P Moreira, C Lopes, Jorge Mota, Maria Santos, P Rytilä, M G Castel-Branco

• T and B lymphocytes, total serum IgE and peripheral eosinophils in bronchial asthma.

  Authors: M Azevedo, M G Castel-Branco, A Mendes, J F Oliveira, A S Carvalho, J Almeida, F I Grenha

  Allergologia et immunopathologia. 8(3):189-96.

  Absolute T and B lymphocytes, assayed by E and EAC rosette techniques, serum IgE levels, total eosinophil counts and delayed hypersensitivity cutaneous reactions were studied in 39 asthmatic subjectsAbsolute T and B lymphocytes, assayed by E and EAC rosette techniques, serum IgE levels, total eosinophil counts and delayed hypersensitivity cutaneous reactions were studied in 39 asthmatic subjects (19 extrinsic asthmas and 20 intrinsic asthmas) and in 15 age-matched control subjects. The mean value of T lymphocytes was 1753 +/- 709 mm.3 in the extrinsic group, 1511 +/- +/- 530 mm.3 in the intrinsic, and 1609 +/- 451 mm.3 in the controls. There was no statistical difference between the two groups of patients and the controls (P > 0.05). There was also no statistical difference of B lymphocytes between the two groups of patients and the controls. Serum IgE was elevated in 8 extrinsic asthmatics (42.1%), in one intrinsic (5%), and in none of the control population. The mean value of eosinophils ws significantly higher (P < 0.01) in the extrinsic group as compared to the controls. The same was true of the intrinsic group, but not so significantly (P congruent to 0.02). No correlation was observed between the number of T lymphocytes and the skin tests, serum IgE and total eosinophil counts.