L Delgado

Publications of L Delgado

• 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.

• Microarray based IgE detection in poly-sensitized allergic patients with suspected food allergy - an approach in four clinical cases.

  Authors: T Vieira, C Lopes, A M Pereira, L Araújo, A Moreira, L Delgado

  Allergologia et immunopathologia. 06/2011;

  BACKGROUND: Component-resolved diagnosis and microarray technology have been recently introduced into clinical allergy practice, and may be particularly useful in poly-sensitized allergic patients.BACKGROUND: Component-resolved diagnosis and microarray technology have been recently introduced into clinical allergy practice, and may be particularly useful in poly-sensitized allergic patients. METHODS: We compare the clinical usefulness of a microarray-based IgE detection assay (ISAC(®)) with skin tests and specific IgE with standard allergens (sIgE) or their monocomponents in four case reports of patients poly-sensitized to aeroallergens and food. RESULTS: Case 1: a woman with rhinitis, oral allergy syndrome to several fruits and anaphylaxis to cherry. Diagnostic tests supported non-specific lipid transfer proteins (nsLTPs) primary sensitization. Case 2: a woman with exercise-induced asthma, rhino-conjunctivitis and oral allergy syndrome to fresh fruits of different families. A diagnosis of primary grass and weed pollen allergy with profilin and pathogenesis-related protein family 10 (PR-10) cross-reactive food allergy was proposed. Case 3: a man with atopic eczema, asthma, rhinitis, and multiple anaphylactic episodes with cashew nuts and oral allergy syndrome to fruits. The diagnostic workup supported a primary birch pollen allergy with PR-10 and nsLTPs cross-reactive food allergy. Case 4: a woman with rhino-conjunctivitis, per-operative anaphylaxis due to latex and recent pharyngeal angio-oedema episodes. The diagnosis was a primary grass and weed pollen allergy with equivocal profilin sensitization and no obvious cross-reactivity mediated by nsLTPs sensitization. CONCLUSIONS: The possibility to carry out multiple sIgE measurements with single protein allergens, in particular with the microarray technique, is a useful, simple and non-invasive diagnostic tool in complex poly-sensitized allergic patients.

• 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.

• Induced sputum in children: success determinants, safety, and cell profiles.

  Authors: L Araújo, A Moreira, C Palmares, M Beltrão, J Fonseca, L Delgado

  Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología. 01/2011; 21(3):216-21.

  Sputum induction is a noninvasive method for the assessment of airway inflammation. To evaluate the safety of the procedure and the clinical predictors of successful induction, and to analyze theSputum induction is a noninvasive method for the assessment of airway inflammation. To evaluate the safety of the procedure and the clinical predictors of successful induction, and to analyze the relationship between sputum cell counts and clinical features in asthmatic and nonasthmatic children. We reviewed sputum inductions performed in our department between 2006 and 2008 in individuals under 18 years; 34 asthmatic and 24 nonasthmatic children were included. Sputum induction was performed with 4.5% saline for 5-minute periods with salbutamol pretreatment. The most viscid portions were selected for processing. Inductions which were tolerated for less than 4 minutes or which produced a sample volume of less than 1 mL or a sample with a squamous cell percentage of over 80% were considered unsuccessful. Sputum induction was successful in 43 (74%) of the 58 children studied.The total median induction time was 15 minutes (interquartile range, 10-15 minutes). Only 7 individuals (12%) experienced mild symptoms, which were easily reversed with salbutamol inhalation in all cases. The mean (SD) overall PEF variation with induction was -2.5% (7%), with no significant differences between asthmatics and nonasthmatics. Asthmatics had significantly higher total cell counts (P = .007), macrophages (P = .033), and relatively fewer neutrophils (P = .003) than nonasthmatics; metachromatic cells were rare and seen only in asthmatics (P = .026). We found a positive correlation between exhaled nitric oxide and sputum eosinophil count (r = 0.363, P = .017). Sputum induction is a safe, noninvasive, and feasible procedure that allows the direct assessment of airway inflammation in most children.

• Duration of breastfeeding and the risk of childhood asthma in children living in urban areas.

  Authors: M J Fonseca, A Moreira, P Moreira, L Delgado, V Teixeira, P Padrão

  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(4):357-8.

• 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.

• The CONSORT statement checklist in allergen-specific immunotherapy: a GA2LEN paper.

  Authors: P J Bousquet, J Brozek, C Bachert, T Bieber, S Bonini, P Burney, M Calderon, G W Canonica, E Compalati, J P Daures [......] H J Malling, H Merk, N Papadopoulos, G Passalacqua, H U Simon, M Worms, U Wahn, T Zuberbier, H J Schünemann, J Bousquet

  Allergy. 12/2009; 64(12):1737-45.

  The methodology of randomized clinical trials is essential for the critical assessment and registration of therapeutic interventions. The CONSORT (Consolidated Standards of Reporting Trials)The methodology of randomized clinical trials is essential for the critical assessment and registration of therapeutic interventions. The CONSORT (Consolidated Standards of Reporting Trials) statement was developed to alleviate the problems arising from the inadequate reporting of randomized controlled trials. The present article reflects on the items that we believe should be included in the CONSORT checklist in the context of conducting and reporting trials in allergen-specific immunotherapy. Only randomized, blinded (in particular blinding of patients, health care providers, and outcome assessors), placebo-controlled Phase III studies in this article. Our analysis focuses on the definition of patients' inclusion and exclusion criteria, allergen standardization, primary, secondary and exploratory outcomes, reporting of adverse events and analysis.

• Assessing asthma control: questionnaires and exhaled nitric oxide provide complementary information.

  Authors: C Lopes, J Fonseca, L Delgado, A Moreira, R Barros, P Moreira, M da G Castelo-Branco

  The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 12/2008; 32(5):1419-20.

• Exercise-induced hypersensitivity syndromes in recreational and competitive athletes: a PRACTALL consensus report (what the general practitioner should know about sports and allergy).

  Authors: L B Schwartz, L Delgado, T Craig, S Bonini, K H Carlsen, T B Casale, S Del Giacco, F Drobnic, R G van Wijk, M Ferrer, T Haahtela, W R Henderson, E Israel, J Lötvall, A Moreira, N G Papadopoulos, C C Randolph, A Romano, J M Weiler

  Allergy. 09/2008; 63(8):953-61.

  Exercise-induced (EI) hypersensitivity disorders are significant problems for both recreational and competitive athletes. These include EI-asthma, EI-bronchoconstriction, EI-rhinitis, EI-anaphylaxisExercise-induced (EI) hypersensitivity disorders are significant problems for both recreational and competitive athletes. These include EI-asthma, EI-bronchoconstriction, EI-rhinitis, EI-anaphylaxis and EI-urticaria. A group of experts from the European Academy of Allergology and Clinical Immunology and the American Academy of Allergy Asthma and Immunology met to discuss the pathogenesis of these disorders and how to diagnose and treat them, and then to develop a consensus report. Key words (exercise with asthma, bronchoconstriction, rhinitis, urticaria or anaphylaxis) were used to search Medline, the Cochrane database and related websites through February 2008 to obtain pertinent information which, along with personal reference databases and institutional experience with these disorders, were used to develop this report. The goal is to provide physicians with guidance in the diagnosis, understanding and management of EI-hypersensitivity disorders to enable their patients to safely return to exercise-related activities.

• 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.

• Treatment of exercise-induced asthma, respiratory and allergic disorders in sports and the relationship to doping: Part II of the report from the Joint Task Force of European Respiratory Society (ERS) and European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA(2)LEN.

  Authors: K H Carlsen, S D Anderson, L Bjermer, S Bonini, V Brusasco, W Canonica, J Cummiskey, L Delgado, S R Del Giacco, F Drobnic, T Haahtela, K Larsson, P Palange, T Popov, P Van Cauwenberge

  Allergy. 06/2008; 63(5):492-505.

  AIM: The aims of part II is to review the current recommended treatment of exercise-induced asthma (EIA), respiratory and allergic disorders in sports, to review the evidence on possible improvementAIM: The aims of part II is to review the current recommended treatment of exercise-induced asthma (EIA), respiratory and allergic disorders in sports, to review the evidence on possible improvement of performance in sports by asthma drugs and to make recommendations for their treatment. METHODS: The literature cited with respect to the treatment of exercise induced asthma in athletes (and in asthma patients) is mainly based upon the systematic review given by Larsson et al. (Larsson K, Carlsen KH, Bonini S. Anti-asthmatic drugs: treatment of athletes and exercise-induced bronchoconstriction. In: Carlsen KH, Delgado L, Del Giacco S, editors. Diagnosis, prevention and treatment of exercise-related asthma, respiratory and allergic disorders in sports. Sheffield, UK: European Respiratory Journals Ltd, 2005:73-88) during the work of the Task Force. To assess the evidence of the literature regarding use of beta(2)-agonists related to athletic performance, the Task Force searched Medline for relevant papers up to November 2006 using the present search words: asthma, bronchial responsiveness, exercise-induced bronchoconstriction, athletes, sports, performance and beta(2)-agonists. Evidence level and grades of recommendation were assessed according to Sign criteria. RESULTS: Treatment recommendations for EIA and bronchial hyper-responsiveness in athletes are set forth with special reference to controller and reliever medications. Evidence for lack of improvement of exercise performance by inhaled beta(2)-agonists in healthy athletes serves as a basis for permitting their use. There is a lack of evidence of treatment effects of asthma drugs on EIA and bronchial hyper-responsiveness in athletes whereas extensive documentation exists in treatment of EIA in patients with asthma. The documentation on lack of improvement on performance by common asthma drugs as inhaled beta(2)-agonists with relationship to sports in healthy individuals is of high evidence, level (1+). CONCLUSIONS: Exercise induced asthma should be treated in athletes along same principles as in ordinary asthma patients with relevance to controller and reliever treatment after careful diagnosis. There is very high level of evidence for the lack of improvement in athletic performance by inhaled beta2-agonists.

• 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.

• Exercise-induced asthma, respiratory and allergic disorders in elite athletes: epidemiology, mechanisms and diagnosis: part I of the report from the Joint Task Force of the European Respiratory Society (ERS) and the European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA2LEN.

  Authors: K H Carlsen, S D Anderson, L Bjermer, S Bonini, V Brusasco, W Canonica, J Cummiskey, L Delgado, S R Del Giacco, F Drobnic, T Haahtela, K Larsson, P Palange, T Popov, P Van Cauwenberge

  Allergy. 05/2008; 63(4):387-403.

  AIMS: To analyze the changes in the prevalence of asthma, bronchial hyperresponsiveness (BHR) and allergies in elite athletes over the past years, to review the specific pathogenetic features ofAIMS: To analyze the changes in the prevalence of asthma, bronchial hyperresponsiveness (BHR) and allergies in elite athletes over the past years, to review the specific pathogenetic features of these conditions and to make recommendations for their diagnosis. METHODS: The Task Force reviewed present literature by searching Medline up to November 2006 for relevant papers by the search words: asthma, bronchial responsiveness, EIB, athletes and sports. Sign criteria were used to assess level of evidence and grades of recommendation. RESULTS: The problems of sports-related asthma and allergy are outlined. Epidemiological evidence for an increased prevalence of asthma and BHR among competitive athletes, especially in endurance sports, is provided. The mechanisms for development of asthma and bronchial hyperresponsiveness in athletes are outlined. Criteria are given for the diagnosis of asthma and exercise induced asthma in the athlete. CONCLUSIONS: The prevalence of asthma and bronchial hyperresponsiveness is markedly increased in athletes, especially within endurance sports. Environmental factors often contribute. Recommendations for the diagnosis of asthma in athletes are outlined.

• Epidemiology of rhinitis in Portugal: evaluation of the intermittent and the persistent types.

  Authors: A Todo-Bom, C Loureiro, M M Almeida, C Nunes, L Delgado, G Castel-Branco, J Bousquet

  Allergy. 09/2007; 62(9):1038-43.

  BACKGROUND: The prevalence of rhinitis is rapidly increasing in recent years and has become a major public health problem in developed countries. A new classification of allergic rhinitis has beenBACKGROUND: The prevalence of rhinitis is rapidly increasing in recent years and has become a major public health problem in developed countries. A new classification of allergic rhinitis has been proposed by the allergic rhinitis and its impact on asthma group. In this study we aimed to evaluate the prevalence of rhinitis, including different rhinitis subtypes and to describe the severity, rate of diagnosis and use of medication in this pathology. METHODS: A cross-sectional, population-based study including 6,859 questionnaire responses was performed. RESULTS: The estimated prevalence of rhinitis was 26.1% (48% for intermittent vs 52% for persistent rhinitis). Only about one-third of the rhinitis cases (31.9%) had done skin prick tests (35.3% for persistent rhinitis vs 21.5% for intermittent rhinitis: P < 0.001) or had medication prescribed in the last year (34%), (35.6% for persistent rhinitis vs 20.1% for intermittent rhinitis : P < 0.001). The prevalence of rhinitis was higher in women (28.2 vs 22.2%; P < 0.001). Intermittent/persistent rhinitis showed the following percentages : <or=25 years (65.6 vs 34.5, P = 0.001); 25-65 years (50.2 vs 49.5) >or= 65 years (52.1 vs 47.9). The estimated prevalence of rhino conjunctivitis was 18.4%. In a severity scale from 0 to 10, the mean value was 6.1 points (6.4 for persistent rhinitis vs 4.8 for intermittent rhinitis: P < 0.001). CONCLUSION: A significant prevalence of rhinitis and rhino conjunctivitis was identified in all age groups. The severity, the frequency and duration of the symptoms which classify the persistent type should be considered to establish a more effective treatment and improve the quality of life of the patients with rhinitis.

• Nutritional modulation of exercise-induced immunodepression in athletes: a systematic review and meta-analysis.

  Authors: A Moreira, R A Kekkonen, L Delgado, J Fonseca, R Korpela, T Haahtela

  European journal of clinical nutrition. 05/2007; 61(4):443-60.

  BACKGROUND: Heavy exercise induces marked immunodepression that is multifactorial in origin. Nutrition can modulate normal immune function. OBJECTIVE: To assess the efficacy of nutritionalBACKGROUND: Heavy exercise induces marked immunodepression that is multifactorial in origin. Nutrition can modulate normal immune function. OBJECTIVE: To assess the efficacy of nutritional supplements in exercise-induced immunodepression in athletes. DESIGN: Systematic review. REVIEW METHODS: Randomised and/or controlled trials of athletes undertaking nutritional supplements to minimise the immunodepression after exercise were retrieved. The primary outcome measure was incidence of upper respiratory tract (URT) illness symptoms after exercise, and secondary outcomes included cortisol, cell counts, plasma cytokine concentration, cell proliferative response, oxidative burst, natural killer cell activity and immunoglobulins. When data were available for a pooled estimate of the effect of intervention, meta-analyses were conducted for direct comparisons. RESULTS: Forty-five studies were included (1603 subjects). The studies were heterogeneous in terms of exercise interventions, selection of athletes, settings and outcomes. The overall methodological quality of most of the trials was poor. Twenty studies addressed carbohydrate supplementation, eight glutamine, 13 vitamin C and four others interventions. Three trials assessed the effect of intervention on prevention of URT infections. The pooled rate ratio for URT infections after vitamin C supplementation against placebo was 0.49 (0.34-0.71). Carbohydrate supplementation attenuated the increase in cortisol and neutrophils after exercise; vitamin C attenuated the decrease in lymphocytes after exercise. No other interventions had significant or consistent effect on any of the studied outcomes. CONCLUSIONS: Although the prevention of URT infections by vitamin C was supported by two trials, further studies are needed. The available evidence failed to support a role for other nutritional supplements in preventing exercise-induced immune suppression. Larger trials with clinically relevant and uniform end points are necessary to clarify the role of these nutritional interventions.

• Pilot study of the effects of n-3 polyunsaturated fatty acids on exhaled nitric oxide in patients with stable asthma.

  Authors: A Moreira, P Moreira, L Delgado, J Fonseca, V Teixeira, P Padrão, 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. 02/2007; 17(5):309-13.

  BACKGROUND: The anti-inflammatory effects of n-3 polyunsaturated fatty acids (n-3 PUFA) have been demonstrated both in vitro and in vivo. The results of epidemiological studies suggest that fishBACKGROUND: The anti-inflammatory effects of n-3 polyunsaturated fatty acids (n-3 PUFA) have been demonstrated both in vitro and in vivo. The results of epidemiological studies suggest that fish consumption has a beneficial effect on lung function and prevalence of asthma. However, data from intervention trials have not revealed a beneficial effect of n-3 PUFA supplementation in patients with established disease. OBJECTIVE: To study the effects of short-term n-3 PUFA supplementation in addition to maintenance therapy on exhaled nitric oxide in asthmatic patients. METHODS: A double-blind, placebo-controlled trial was undertaken in 20 women with asthma. Patients received either a combination of eicosapentaenoic acid and docosahexaenoic acid plus 10 mg vitamin E or placebo twice daily for 2 weeks. The primary outcome measure was the fraction of exhaled nitric oxide (FeNO) and the secondary outcomes were asthma control (score on theAsthma Control Questionnaire [ACQI) and lung function (forced expiratory volume in 1 second [FEV1]). RESULTS: No significant differences were observed in FeNO, ACQ score, or FEV1 between patients receiving n-3 PUFA supplementation and those receiving placebo. CONCLUSIONS: Short-term dietary supplementation with n-3 PUFA in women with stable asthma was not associated with statistically significant changes in FeNO, asthma control, or lung function.

• Obesity and asthma in the Portuguese National Health Survey.

  Authors: P Moreira, A Moreira, P Padrão, L Delgado

  Allergy. 01/2007; 61(12):1488-9.

• Rhinitis and asthma in athletes: an ARIA document in collaboration with GA2LEN.

  Authors: S Bonini, M Bonini, J Bousquet, V Brusasco, G W Canonica, K H Carlsen, L Corbetta, J Cummiskey, L Delgado, S R Del Giacco [......] S Jaeger, C Moretti, P Palange, G Passalacqua, D Passali, B K Pedersen, T Popov, G Rasi, M T Ventura, A M Vignola

  Allergy. 07/2006; 61(6):681-92.

  This consensus document is aimed at reviewing evidence that the rhinitis-asthma links have peculiar features in athletes. Beside a review of epidemological data on the high prevalence of rhinitis andThis consensus document is aimed at reviewing evidence that the rhinitis-asthma links have peculiar features in athletes. Beside a review of epidemological data on the high prevalence of rhinitis and asthma in athletes, the effects on intense physical exercise on the immune system and repiratory functions are discussed, with special reference to the role of allergens and pollutants. In extending the Allergic Rhinitis and its Impact on Asthma (ARIA) recommendations to athletes, the issue is addressed of adapting diagnosis and management to criteria set by the International Olympic Committee (IOC) and regulations adopted by the World Anti-Doping Agency (WADA).