CRISTINA MIUKI ABE JACOB
Projetos de Pesquisa
Unidades Organizacionais
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
28 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 28
conferenceObject Evolution of milk-specific IgE antibody levels and its fractions during tolerance development in cow's milk allergic patients(2012) BECK, C.; CASTRO, A.; GUSHKEN, A.; WATANABE, L.; BRANDAO, A.; YONAMINE, G.; PASTORINO, A.; JACOB, C.Background: Food allergy affects about 6% of children and cow’s milk (CM) is the most important allergen. The majority of patients used to become tolerant during the first 3 years of life, but nowadays tolerance is being achieved later. Casein (C), alpha-lactalbumin (α) and beta-lactoglobulin (β) are considered as some of the major allergens. Until now, no study has evaluated the correlation among the whole cow’s milk (WCM) IgE antibody levels (IgE ab) and its fractions (C, α and β) during the tolerance development in CMA patients. Method: It was a retrospective study that included patients with previous diagnosis of CMA who developed tolerance during follow-up. It was included 31 IgE-mediated CMA patients (19 male: 12 female), median age of the first symptoms was 1 year. CMA was defined as a positive double blind placebo-controlled food challenge, open challenge or confirmed anaphylaxis plus cow’s milk-specific IgE positive (higher than 3.5 JU/l or positive skin prick test), and tolerance was defined as acceptance of cow milk without previous symptoms. Specific IgE analysis to WCM, α, β, and C were performed at three moments: initial (time 1), in the middle of the follow-up (time 2) and at the tolerance diagnosis (time 3). The chosen point during follow-up was that which corresponded to half of the period until tolerance was reached. The correlations among whole mil IgE ab and its fractions in those moments were evaluated with Spearman correlation test. Result: Ther values for whole cow’s milk IgE ab and each fraction according Spearman test are described in the following Table 1 Among all analysis, the correlation between whole cow’s milk and casein IgE ab and whole cow’s milk and alfalacto-albumin IgE ab showed adequater values at all moments of evaluations. Conclusion: These results can indicate that casein and alfalacto-albumin IgE ab showed similar behavior to WCM, and then the sequential evaluation through whole cow’s milk IgE ab levels may be enough for monitoring CMA patients until the tolerance development. Time Alpha-lactalbumin IgE ab Beta-lactoglobulin IgE ab Casein IgE ab 1 0.81 (0.63–0.90) 0.71 (0.46–0.85) 0.81 (0.64–0.91) 2 0.82 (0.65–0.91) 0.66 (0.39–0.82) 0.82 (0.65–0.91) 3 0.82 (0.64–0.91) 0.79 (0.60–0.90) 0.76 (0.54–0.90)- Common Variable Immunodeficiency Associated with Hepatosplenic T-Cell Lymphoma Mimicking Juvenile Systemic Lupus Erythematosus(2011) JESUS, A. A.; JACOB, C. M. A.; SILVA, C. A.; DORNA, M.; PASTORINO, A. C.; CARNEIRO-SAMPAIO, M.Common variable immunodeficiency (CVID) is a heterogeneous disorder with susceptibility to infections, autoimmune manifestations, and cancer. To our knowledge, CIVD with T-cell lymphoma mimicking juvenile systemic lupus erythematosus (JSLE) was not described in the literature, and one case was reported herein. An 8-year-old female was admitted in our Pediatric Immunology Unit with a clinical history of hypogammaglobulinemia, recurrent upper respiratory infections, and pneumonias. She had a marked decrease of three serum immunoglobulin isotypes, and the diagnosis of CVID was established. At the age of 17 years, she presented with oral ulceration, nonerosive arthritis, nephritis, serositis, cytopenia, positive antiphospholipid antibodies, and positive antinuclear antibody fulfilling the American College of Rheumatology (ACR) criteria for SLE. She was treated with intravenous methylprednisolone for three consecutive days, and intravenous immunoglobulin, and maintenance therapy of chloroquine, azathioprine and prednisone 40mg/day. Two months later, she died of septic shock secondary to acute pneumonia. The necropsy showed hepatosplenic T-cell lymphoma with diffuse involvement of bone marrow, spleen, liver, and lungs. The lymphoma cells were positive for CD3 immunostaining and negative for CD20 and lysozyme. In conclusion, the association of CVID and hepatosplenic T-cell lymphoma may simulate JSLE diagnosis.
- Establishing a cut-off for the serum levels of specific IgE to milk and its components for cow's milk allergy: Results from a specific population(2015) CASTRO, A. P.; PASTORINO, A. C.; GUSHKEN, A. K. F.; KOKRON, C. M.; FILHO, U. D.; JACOB, C. M. A.Background: Cow's milk allergy diagnosis many times requires double-blind placebo-controlled food challenge (DBPCFC), which presents high accuracy but involves risks, specifically in infants and anaphylactic patients. The identification of the cut-off values for specific IgE to milk or its components would contribute to cow's milk allergy (CMA) diagnosis. The aim of this study was to compare discriminating concentration of a cow's milk specific IgE and its fractions (alpha-lactoalbumin, beta-lactoglobulin, casein) in children for the CMA diagnosis. Methods: this study included 123 patients (M:F= 1.3:1) median age at diagnosis = 1.91 years, (3.5 m to 13.21 y) with CMA diagnosis via DBPCFC (n = 26), proven anaphylaxis due to cow's milk (n = 46) or a suggestive clinical history associated with a positive skin prick test (n = 51) and open oral food challenge. The control group included 61 patients (1 male: 1.1 female) ages ranging from 0.66 to 16.7 years (median = 6.83 years). Receiver operator characteristics (ROC) curves were constructed to determine the best cut-offs that guarantees high specificity (>95%) for cow's milk and its components. Results: considering 98% specificity, cut-off points were: 3.06 kU/L for cow's milk, 2.06 kU/L for a-lactalbumin, 1.85 kU/L for beta-lactoglobulin and 1.47 kU/L for casein. The best ROC curve (area under the curve = 0.929) was obtained evaluating cow's milk. Conclusion: this study showed that the cut-off point detected for whole cow's milk revealed a better discriminatory capacity for CMA diagnosis without the necessity of the milk components testing.
- Baked milk tolerant patient: Is there any special feature?(2017) BARBOSA, C. P. G.; CASTRO, A. P. M.; YONAMINE, G. H.; GUSHKEN, A. K. F.; BECK, C. M. L.; MACEDO, P. R. C.; DORNA, M. B.; SANTOS, C. J. N.; PASTORINO, A. C.; JACOB, C. M. A.Background: Determining whether patients with cow's milk allergy (CMA) can tolerate foods produced with baked milk could provide a better quality of life, a better prognosis, and an option for desensitization. Objectives: The aim of this study was to identify which patients over four years of age with persistent CMA could tolerate baked milk, to compare the clinical and laboratory characteristics of reactive and non-reactive groups and to describe their clinical evolution. Materials and methods: A cross-sectional study was conducted (January/13 to November/14) that included all the patients followed at a food allergy center who met the inclusion criteria. The patients underwent an oral food challenge (OFC) with a muffin (2.8 g of cow's milk protein). To exclude cow's milk (CM) tolerance, the patients were subsequently challenged with unheated CM. Results: Thirty patients met all the inclusion criteria. Fourteen patients (46.7%) were considered non-reactive to baked milk and reactive to unheated CM. When the groups that were reactive and non-reactive to baked milk were compared, no statistically significant differences in clinical features were found. The prick test for alpha-lactalbumin (p = 0.01) and casein (p = 0.004) and the serum specific IgE for casein (p = 0.05) presented statistical differences. After one year, none of the patients who were reactive to baked milk were ingesting CM, while 28% of the tolerant patients were consuming fresh CM (p= 0.037). Conclusions: Baked milk can be tolerated by patients with CMA, especially those with lower levels of casein and a-lactalbumin. This option can improve quality of life and accelerate tolerance.
- Pediatric allergy and immunology in Brazil(2013) ROSARIO-FILHO, Nelson A.; JACOB, Cristina M.; SOLE, Dirceu; CONDINO-NETO, Antonio; ARRUDA, Luisa K.; COSTA-CARVALHO, Beatriz; COCCO, Renata R.; CAMELO-NUNES, Ines; CHONG-NETO, Herberto J.; WANDALSEN, Gustavo F.; CASTRO, Ana P. M.; YANG, Ariana C.; PASTORINO, Antonio C.; SARINHO, Emanuel S.The subspecialty of pediatric allergy and immunology in Brazil is in its early years and progressing steadily. This review highlights the research developed in the past years aiming to show the characteristics of allergic and immunologic diseases in this vast country. Epidemiologic studies demonstrated the high prevalence of asthma in infants, children, and adolescents. Mortality rates and average annual variation of asthma hospitalization have reduced in all pediatric age groups. Indoor aeroallergen exposure is excessively high and contributes to the high rates of allergy sensitization. Prevalence of food allergy has increased to epidemic levels. Foods (35%), insect stings (30%), and drugs (23%) are the main etiological agents of anaphylaxis in children and adolescents. Molecular diagnosis of primary immunodeficiencies (PID) showed a high incidence of fungal infections including paracoccidioidomycosis in X-linked hyper-IgM syndrome, and the occurrence of BCG adverse reactions or other mycobacterial infections in patients with chronic granulomatous disease. Education in pediatric allergy and immunology is deficient for medical students, but residency programs are effective in training internists and pediatricians for the practice of allergy. The field of PID requires further training. Last, this review is a tribute to Prof. Dr. Charles Naspitz, one of the pioneers of our specialty in Brazil.
bookPart Doença granulomatosa crônica e outras imunodeficiências primárias de fagócitos(2022) PASTORINO, Antonio Carlos; JACOB, Cristina Miuki AbeconferenceObject Sensitisation to foods and dust mite in Brazilian pediatric patients with atopic dermatitis(2012) SWENSSON, A.; CASTRO, A.; CASAGRANDE, R.; BITTENCOURT, T.; YONAMINE, G.; PASTORINO, A.; JACOB, C.Background: Atopic dermatitis (AD) is a complex disease that can be or not related to atopy. The IgE levels and the presence of sensitisation has been associated to AD severity. The aim of this study is to evaluate the allergen sensitisation profile in patients with moderate or severe atopic dermatitis in Brazilian patients from an allergy reference center. Methods: About 66 patients with diagnosis of atopic dermatitis according Hanifin e Rajka criteria (mean age 10 years) followed at a reference center for allergic disease in pediatric patients were included. The severity was evaluated according SCORAD (SCORing Atopic Dermatitis) criteria. Specific IgE was measured to the following allergens: Blomia tropicalis, D peteronyssinus, egg white, cow’s milk and its fractions. Sensitisation was considered positive when the ImmunoCAP values were ¡Y 0.35 kU/l and multi sensitisation was considered when patients presented positive specific IgE for all allergens tested. Table 1 Hapten Total, positive (n,%) Total, clinically relevant (n,%) Children, positive (n,%) Children, clinically relevant (n,%) Adolescents, positive (n,%) Adolescents, clinically relevant (n,%) Nickel sulphate 5% pet. 44 (34.6) 36 (28.3) 19 (29.7) 14 (21.9) 25 (39.7) 22 (34.9) Cobalt chloride 1% pet. 28 (22.0) 15 (11.8) 16 (25.0) 9 (14.1) 12 (19.0) 6 (9.5) Potassium dichromate 0.5% pet. 26 (20.5) 15 (11.8) 19 (29.7) 10 (15.6) 7 (11.1) 5 (7.9) Paraphenylenediamine 1% pet. 12 (9.4) 6 (4.7) 8 (12.5) 5 (7.8) 4 (6.3) 1 (1.6) Propolis 10% pet. 12 (9.4) 5 (3.9) 11 (17.2) 5 (7.8) 1 (1.6) 0 (0.0) Palladium chloride 2% pet. 12 (9.4) 4 (3.1) 6 (9.4) 2 (3.1) 6 (9.5) 2 (3.2) Fragrance Mix I 18% pet. 10 (7.9) 4 (3.1) 4 (6.3) 2 (3.1) 6 (9.5) 2 (3.2) Neomycin sulphate 20% pet. 6 (4.7) 2 (1.6) 4 (6.3) 2 (3.1) 2 (3.2) 0 (0.0) Balsam of Peru (Myroxylon pereirae ) 25% pet. 6 (4.7) 1 (0.8) 4 (6.3) 1 (1.6) 2 (3.2) 0 (0.0) Colophonium 20% pet. 5 (3.9) 4 (3.1) 2 (3.1) 2 (3.1) 3 (4.8) 2 (3.2) Wool alcohols (lanolin) 30% pet. 5 (3.9) 3 (2.4) 3 (4.7) 3 (4.7) 2 (3.2) 0 (0.0) Paraben Mix 16% pet. 4 (3.1) 4 (3.1) 3 (4.7) 3 (4.7) 1 (1.6) 1 (1.6) Kathon CG (MI/MCI) 0.01% aqua 4 (3.1) 2 (1.6) 3 (4.7) 2 (3.1) 1 (1.6) 0 (0.0) Results: Among 66 patients included, 12 presented severe AD and 54 moderated. Sixty two of the 66 (93%) patients studied showed positive sensitization to any of the allergens, being aeroallergens the most prevalent (53/56), followed by egg white (29/53) and milk (31/66). Serum levels of specific IgE to aerollergens were significantly higher than for food allergens (P< 0.001). Specific IgE levels did not differ according severity (P> 0.05 for all allergens evaluated About 23 patients presented multi sensitization (17 moderate and six severe) without significant difference between both groups. Conclusion: There was an elevate rate of sensitisation in this group of patients being aeroallergens the most frequent and with higher specific IgE levels. AD severity did not contribute to increase sensitisation. More studies should be performed in order to evaluate if these findings can lead to specific therapeutic strategies as specific immunotherapy or food avoidance.conferenceObject Pulmonary Morphologic and Functional Abnormalities in Patients with Primary Hypogammaglobulinemia(2012) DORNA, Mayra de Barros; CASTRO, Ana Paula B. Moschione; PASTORINO, Antonio Carlos; CARNEIRO-SAMPAIO, Magda M. Sales; JACOB, Cristina Miuki AbeRetrospective evaluation of 30 patients (21 M) aged 4.6–23.4 y (median 16.7 y) with predominantly humoral PID(9IDCV;14XLA;7HIGM).Mediantimeof follow-up9.2y(1.8–17.5). Median age of symptoms’ onset8mo(1–96 mo), age at diagnosis 5.8 y (7–175 mo) and diagnostic delay 4.7 y (0.2–13 y). Pneumonia was the main manifestation before diagnosis (24/30 patients) with frequency of 0.6/patient/year. After beginning IVIG, frequency of pneumonias decreased to 0.1 (p<0.001) and the frequency of sinusitis increased from0to0.55(p<0.001). Higher age at diagnosis and longer diagnostic delay were associated to bronchiectasis at diagnosis (p=0.016 and p<0.001). Seven patients developed bronchiectasis during follow-up. Spirometry (23/30 patients), 1–15 y after IVIG was abnormal in 13 (9 obstructive; 4 restrictive). Humoral PID often affects respiratory tract and IVIG reduces complications but pulmonary monitoring is essential to guarantee adequate therapeutic interventions.conferenceObject Hemophagocytic Syndrome Following Oral Rotavirus and Poliovirus Vaccination in Brazilian Perforin-deficient Twins(2013) JACOB, C. Miuki Abe; SANTOS, C. N.; PASTORINO, A. C.; DORNA, M. B.; FERNANDES, J. Fi; CASTRO, A. P. Bm; ROCHA, V.; HAMERCHLAK, N.; SAINT-BASILE, G. de; CARNEIRO-SAMPAIO, M.conferenceObject The Most Frequent Primary Immunodeficiency Diseases (PIDDs) in Different Age Groups(2013) CARNEIRO-SAMPAIO, M.; JACOB, C. M. Abe; PASTORINO, A. C.; WATANABE, L.; DORNA, M.; DORIA-FILHO, U.; KOKRON, C. M.; TOLEDO-BARROS, M.; MORAES-VASCONCELOS, D.; DUARTE, A.
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