ANTONIO CARLOS PASTORINO
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
17 resultados
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- Microbiological profile in chronic granutomatous disease patients in a single Brazilian primary immunodeficiencies center(2021) OLIVEIRA, Aimee Filippini Bifulco; PASTORINO, Antonio Carlos; DORNA, Mayra de Barros; CASTRO, Ana Paula Beltran Moschione; PEGLER, Jose Roberto Mendes; MORGENSTERN, Beni; CARNEIRO-SAMPAIO, Magda Maria SalesBackground: Chronic granulomatous disease (CGD) is a rare primary immunodeficiency. Infections of the lungs, skin, lymph nodes, and liver are the hallmark of CGD with frequent initial manifestations of the disease. The aim of the present study was to describe the sites of infections and their causative agents in 38 CGD pediatric patients. Methods: This was a retrospective single-center cohort study comprising CGD patients, and followed for over last 40 years at the Allergy and Immunology Unit of a tertiary hospital in Sao Paulo, Brazil. Sites of infections and their causative agents were described. Results: A total of 38 patients were included (36 males and 2 females). Median age at the onset of symptoms was 45 days (7 days-7 years) and that at the time of diagnosis was 23 months (1 month-12 years); 31.6% of the parents reported death of relatives during childhood and 21% (8 cases) had another mate family member with CDG. The most common infections were pneumonia (81.6%), skin infections (50.0%), adenitis (42.1%), and liver abscess (23.7%). In all, 188 cultures were positive (85.6% for bacteria and 14.4% for fungi). The most prevalent bacterial agents were Staphylococcus sp. (12.4%), Staphylococcus aureus (11.2%), and Klebsiella pneumoniae (9.3%). Aspergillus sp. and Candida sp. were 56% and 22.2% of the isolated fungi, respectively. Mycobacterium tuberculosis was isolated in 5.6% and Mycobacterium bovis in 0.9% (only in 1 patient) of cultures. Conclusion: Staphylococcus sp., Staphylococcus aureus, and Aspergillus sp. were the most frequent agents in this cohort. M. tuberculosis should be considered in endemic areas. Detection of infectious agents drives to find adequate treatment and benefits the evolution of patients with CGD. (C) 2021 Codon Publications.
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)- Inflammatory manifestations in children with chronic granulomatous disease(2021) TATEBE, Myris Satiko Shinzato; DORNA, Mayra de Barros; CASTRO, Ana Paula Beltran Moschione; PASTORINO, Antonio Carlos
- Laboratory screening test with inhalant and food allergens in atopic Brazilian children and adolescents: a performance(2021) REALI, Ana Carolina Rozalem; PIEROTTI, Felipe Faria; ARANDA, Carolina Sanchez; COCCO, Renata Rodrigues; SARINHO, Emanuel S. Cavalcanti; SANO, Flavio; PORTO NETO, Arnaldo; ROSARIO, Nelson A.; CHONG NETO, Herberto J.; GOUDOURIS, Ekaterini Simoes; MORAES, Lilian Sanches; WANDALSEN, Neusa Falbo; PASTORINO, Antonio Carlos; FRANCO, Jackeline Motta; CHAVARRIA, Maria Leticia; BORRES, Magnus P.; SOLE, DirceuThe Phadiatop Infant (R)) is a panel developed to assess allergic sensitization (immunoglobulin E [IgE]) in children aged <5 years and combines inhalant and food allergens. The test has not been evaluated outside Europe. This is a cross-sectional study conducted at 11 pediatric allergy centers to evaluate PhInf as an allergic disease screening method in Brazilian children. Children as controls and patients (aged 6 months-18 years) were grouped according to their primary disease and age group. PhInf and specific serum IgE (sIgE) screening was performed for Dermatophagoides pteronyssinus (DP), cat and dog epithelia, a mix of grasses and pollens, eggs, cow's milk, peanuts, and shrimp. Values >= 0.35 kU (A)/L (or PAU/L) were considered positive. A total of 470 children and adolescents, which included 385 patients and 85 controls, participated in the study (47.7% boys, average age: 6.3 years). In all, 72.6% of the participants had positive PhInf test (n = 341), with a higher proportion of those having food allergy (92.6%), atopic dermatitis (91.9%), and those aged >13 years having allergy (95%). The PhInf and sIgE agreement between patients (Kappa = 0.94, P < 0.001) and controls (Kappa = 0.84, P < 0.001) was high. PhInf and DP agreement in patients aged >13 years was excellent (Kappa = 0.936, P < 0.001). Compared with sIgE dosage, PhInf had high sensitivity (97%) and specificity (93%). Positivity of PhInf test in this population was high and had an excellent correlation with the allergens comprising the panel. It is a useful method for screening children suspected of having allergic diseases in a non-European country. (C) 2021 Codon Publications.
- 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.
- Allergic sensitization pattern of patients in Brazil(2021) ARANDA, Carolina Sanchez; COCCO, Renata R.; PIEROTTI, Felipe F.; SARINHO, Emanuel; SANO, Flavio; PORTO, Arnaldo; ROSARIO, Nelson; CHONG NETO, Herberto J.; GOUDOURIS, Ekaterini; MORAES, Lillian S.; WANDALSEN, Neusa F.; MALLOZI, Marcia C.; PASTORINO, Antonio C.; FRANCO, Jackeline M.; CHAVARRIA, Maria L.; BORRES, Magnus; SOLE, DirceuObjective: Allergic sensitization is one of the key components for the development of allergies. Polysensitization seems to be related to the persistence and severity of allergic diseases. Furthermore, allergic sensitization has a predictive role in the development of allergies. The aim of this study was to characterize the pattern of sensitization of atopic patients treated at different pediatric allergy referral centers in Brazil. Methods: A nation-wide transversal multicenter study collected data on patients attended in Brazil. Peripheral blood samples were collected to determine the serum levels of allergen-specific IgE. If allergen-specific IgE was higher than 0.1 kUA/L, the following specific components were quantified. Results: A total of 470 individuals were enrolled in the study. Mite sensitization was the most frequent kind in all participants. A high frequency of sensitization to furry animals and grasses featured in the respiratory allergies. Regarding components, there was a predominance of sensitization to Der p 1 and Der p 2. It has been verified that having a food allergy, atopic dermatitis, or multimorbidity are risk factors for the development of more severe allergic disease. Conclusion: Studies on the pattern of allergic sensitization to a specific population offer tools for the more effectual prevention, diagnosis, and treatment of allergic diseases. Sensitization to dust mites house was the most prevalent in the evaluated sample. High rates of sensitization to furry animals also stand out. Patients with food allergy, atopic dermatitis, or multimorbidity appear to be at greater risk for developing more severe allergic diseases. (C) 2020 Sociedade Brasileira de Pediatria.
- Phadiatop, Phadiatop Infant and total IgE evaluated in allergic Brazilian children and adolescents(2020) PIEROTTI, Felipe Faria; ARANDA, Carolina Sanchez; COCCO, Renata Rodrigues; SARINHO, Emanuel; SANO, Flavio; PORTO, Arnaldo; ROSARIO, Nelson; CHONG NETO, Herberto Jose; GOUDOURIS, Ekaterini; MORAES, Lilian Sanches; WANDALSEN, Neusa Falbo; MALLOZI, Marcia Carvalho; PASTORINO, Antonio Carlos; FRANCO, Jackeline Motta; CHAVARRIA, Maria Leticia; BORRES, Magnus P.; SOLE, DirceuThe clinical history is of importance in the investigation of allergic diseases but does have limitations. Many allergic conditions will be over-diagnosed if anamnesis alone is used for diagnostic criteria. Serum total immunoglobulin E (TIgE) quantification, as well as panels containing allergens prevalent in the studied population, may serve as screening tests and facilitate the diagnosis of allergic disease or its exclusion. We assessed the positivity of two versions of these tests, Phadiatop Europe (R) (PhEU) and Phadiatop Infant (R) (PhInf), as well as total IgE (TigE) values in patients with a medical diagnosis of allergic disease and non-allergic individuals. Methods: A cross-sectional study performed in eleven Brazilian pediatric allergy centers with patients divided into groups according to the primary condition and a group of assessed control subjects. They were submitted to TIgE measurement and screening tests (PhEu and PhInf). Results: TIgE mean serum levels were significantly higher among allergic patients, especially those with asthma/rhinitis or atopic dermatitis. The positivity of the screening tests, considering the total population, was 63.8% for PhEU and 72.6% for PhInf. These increased when we evaluated only the allergic subjects. The concordance index of the two tests was Kappa=0.7 and higher among those of greater age. Conclusions: In the assessed population, there were significantly higher levels among those with positive screening tests and PhInf showed better performance in the identification of sensitized individuals, regardless of age. This is the first study to evaluate Phadiatop and Phadiatop Infant in the same population.
conferenceObject 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.