Graça Pires

Hospital CUF Descobertas, Lisboa, Lisbon, Portugal

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Publications (29)94.32 Total impact

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    ABSTRACT: Aim. To determine the frequency of anaphylaxis in an allergy outpatient department, allowing a better understanding regarding aetiology, clinical manifestations and management, in children and adolescents. Methods. From among 3646 patients up to 18 years old observed during one-year period, we included those with history of anaphylaxis reported by allergists. Results. Sixty-four children had history of anaphylaxis (prevalence of 1.8%), with mean age 8.1 ± 5.5 years, 61% being male. Median age of the first anaphylactic episode was 3 years (1 month - 17 years). The majority of patients had food-induced anaphylaxis (84%): milk 22, egg 7, peanut 6, tree nuts 6, fresh fruits 6, crustaceans 4, fish 4 and wheat 2. Food-associated exercise-induced anaphylaxis was reported in 2 adolescents. Drug-induced anaphylaxis occurred in 8%: 4 non-steroidal anti-inflammatory drugs and 1 amoxicillin. Three children had cold-induced anaphylaxis, one adolescent had anaphylaxis to latex 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%). Fifty-one patients were admitted to the emergency department, although only 33% were treated with epinephrine. Recurrence of anaphylaxis occurred in 26 patients (3 or more episodes in 14). Conclusions. In our paediatric population, the main triggering agent of anaphylaxis was IgE-mediated food allergy. Epinephrine is underused, as reported by others. Often, children have several episodes before being assessed by an allergist. We stress the importance of systematic notification and improvement of educational programmes in order to achieve a better preventive and therapeutic management of this life-threatening entity.
    Full-text · Article · Nov 2015
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    Full-text · Article · Mar 2014 · Revista Portuguesa de Imunoalergologia
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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.
    Full-text · Article · Jan 2014 · Revista Portuguesa de Imunoalergologia
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    Full-text · Article · Oct 2012 · Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología
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    Full-text · Conference Paper · Jun 2012
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    Full-text · Conference Paper · Oct 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.
    Full-text · Article · Jul 2011 · Revista Portuguesa de Imunoalergologia
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    Full-text · Article · Dec 2010 · Cerebrospinal Fluid Research
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    ABSTRACT: Background: ImmunoCAP ISAC® (Immuno Solid-phase Allergen Chip) is an in vitro test designed to identify and determine semi-quantitatively, in the human serum or plasma, the presence of specific IgE (sIgE) antibodies to multiple allergenic components (immobilized in a solid substrate by microarray). Purpose: To evaluate the contribution of this method in the study of patients with food allergy probably related to cross-reactivity. Methods: We selected patients followed in the Outpatient Department of Immunoallergology at Dona Estefânia Hospital with clinical symptoms suggestive of the most important cross-reactivity syndromes, house-dust mite-crustaceans-molluscs, latex-fruit, pollen-food and allergy to Rosaceae fruits. All patients were evaluated through detailed clinical history, skin prick tests (commercial extract and/or fresh food) and sIgE determination (UniCAP®100). Subsequently, sIgE to allergen components was determined in all sera using ImmunoCAP ISAC® methodology. Results: A total of 24 patients were included in the study (seven with house-dust mite-crustaceans-molluscs syndrome, eight with latex-fruit syndrome, eight with pollen-food syndrome and one with allergy to Rosaceae fruits), with mean age of 25.5 years (± 12.4) and M:F ratio of 1:1. We identified sIgE antibodies to: tropomyosins (Der p 10, Pen i 1, Pen m 1, Hel as 1, Per a 7, Ani s 3) in 4/7 patients with house-dust mite-crustaceans-molluscs syndrome; latex allergens related to cross-reactivity with foods (Hev b 6.02, Hev b 5, Hev b 11) in 7/8 patients with latex-fruit syndrome; profilins (Bet v 2, Cyn d 12, Hev b 8, Mer a 1) and lipid transfer proteins - LTPs (Par j 2, Pru p 3) in, respectively, 2/8 and 4/8 patients with pollen-food syndrome; LTPs (Pru p 3) in the patient with allergy to Rosaceae fruits. Conclusions: The identification of the panallergens implicated in the clinical syndromes of cross-reactivity in 18 patients with food allergy demonstrates the usefulness of this new in vitro diagnostic test as an adjuvant in the confirmation of this type of situations.
    Full-text · Article · Jul 2010 · Revista Portuguesa de Imunoalergologia
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    ABSTRACT: Background: Exercise-induced anaphylaxis (EIA) is an unusual physical allergy that occurs after increased exercise activity. The true incidence and prevalence of EIA remains uncertain, and there are no published national data available. Aim: To estimate the frequency of EIA in an Immunoallergy Outpatient Clinic, and to improve knowledge of this pathology. Methods: Of 7699 patients observed in an Immunoallergy Outpatient Clinic during a period of 1 year, we included those with history of anaphylaxis reported by the clinical staff ("at least one episode of a severe systemic reaction"). Results: EIA was reported in five out of 103 patients with a history of anaphylaxis, corresponding to a rate of 0.06% in the population observed in the Clinic. The mean age of these patients was 20.2 ± 10.3 years old (range: 10 -37 years old). The male:female ratio was 4:1. Personal history of sensitisation to common aeroallergens was present in all patients; all had allergic rhinitis and two (40%) had asthma as co -morbidity. The activities associated with symptoms of EIA were jogging, football, swimming and dancing. All patients had food -dependent EIA. The foods implicated were cereals in three patients (wheat - two, barley - one) and legumes in two patients (peanut - one, beans - one); in all cases food sensitisation was documented by skin prick tests. Conclusions: EIA represents 5% of the reported cases of anaphylaxis. All identified cases were food -dependent EIA. These patients were managed with eviction of the foods in question 6 hours before exercising, and always having the self -administered epinephrine device available.
    Full-text · Article · Jan 2009 · Revista Portuguesa de Imunoalergologia
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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.
    Full-text · Article · Dec 2007 · Clinical & Experimental Allergy
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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.
    No preview · Article · Mar 2007 · Allergy and Asthma Proceedings
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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.
    Full-text · Article · Feb 2006 · Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología
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    Full-text · Article · Feb 2005 · Allergy
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    Full-text · Article · Aug 2003 · Allergy
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    Full-text · Article · Jul 2003 · Allergy

  • No preview · Article · Feb 2003 · Journal of Allergy and Clinical Immunology
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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.
    Full-text · Article · Dec 2002 · Allergologia et Immunopathologia
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    Full-text · Article · Nov 2002 · Allergy
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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.
    Full-text · Article · Sep 2002 · Allergy and Asthma Proceedings