ANA PAULA BELTRAN MOSCHIONE CASTRO
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
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- 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.
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.- Interleukin 10 (IL10) and transforming growth factor beta 1 (TGF beta 1) gene polymorphisms in persistent IgE-mediated cow's milk allergy(2013) JACOB, Cristina Miuki Abe; PASTORINO, Antonio Carlos; OKAY, Thelma Suely; CASTRO, Ana Paula B. M.; GUSHKEN, Andrea Keiko F.; WATANABE, Leticia Aki; FRUCCHI, Vanessa C. Z.; OLIVEIRA, Lea Campos deOBJECTIVES: The aim of this cross-sectional study was to evaluate whether interleukin 10 (IL10) and transforming growth factor beta 1 (TGF beta 1) gene polymorphisms were associated with persistent IgE-mediated cow's milk allergy in 50 Brazilian children. The diagnostic criteria were anaphylaxis triggered by cow's milk or a positive double-blind, placebo-controlled food challenge. Tolerance was defined as the absence of a clinical response to a double-blind, placebo-controlled food challenge or cow's milk exposure. METHOD: The genomic DNA of the 50 patients and 224 healthy controls (HCs) was used to investigate five IL10 gene polymorphisms (-3575A/T, -2849A/G, -2763A/C, -1082G/A, -592C/A) and one TGF beta 1 polymorphism (-509C/T). RESULTS: Among the five IL10 polymorphisms analyzed, homozygosis for the G allele at the -1082 position was significantly higher in the patients compared with the healthy controls (p = 0.027) and in the persistent cow's milk allergy group compared with the healthy controls (p = 0.001). CONCLUSIONS: Homozygosis for the G allele at the IL10 -1082G/A polymorphism is associated with the persistent form of cow's milk allergy.
- Primary Immunodeficiency Diseases in Different Age Groups: A Report on 1,008 Cases from a Single Brazilian Reference Center(2013) CARNEIRO-SAMPAIO, Magda; MORAES-VASCONCELOS, Dewton; KOKRON, Cristina M.; JACOB, Cristina M. A.; TOLEDO-BARROS, Myrthes; DORNA, Mayra B.; WATANABE, Leticia A.; MARINHO, Ana Karolina B. B.; CASTRO, Ana Paula Moschione; PASTORINO, Antonio C.; SILVA, Clovis Artur A.; FERREIRA, Mauricio D.; RIZZO, Luiz V.; KALIL, Jorge E.; DUARTE, Alberto J. S.Primary immunodeficiencies (PIDs) represent a large group of diseases that affect all age groups. Although PIDs have been recognized as rare diseases, there is epidemiological evidence suggesting that their real prevalence has been underestimated. We performed an evaluation of a series of 1,008 infants, children, adolescents and adults with well-defined PIDs from a single Brazilian center, regarding age at diagnosis, gender and PID category according to the International Union of Immunological Societies classification. Antibody deficiencies were the most common category in the whole series (61 %) for all age groups, with the exception of <2-year-old patients (only 15 %). In the >30-year-old group, antibody deficiencies comprised 84 % of the diagnoses, mostly consisting of common variable immunodeficiency, IgA deficiency and IgM deficiency. Combined immunodeficiencies represented the most frequent category in <2-years-old patients. Most congenital defects of phagocytes were identified in patients <5 -years of age, as were the diseases of immune dysregulation, with the exception of APECED. DiGeorge syndrome and ataxia-telangiectasia were the most frequent entities in the category of well-defined syndromes, which were mostly identified in patients <10-years of age. Males represented three-quarters and two-thirds of <2 -years-old and 2-5-years -old patients, respectively, whereas females predominated among the >30-year-old patients. Our data indicated that some PIDs were only detected at early ages, likely because affected patients do not survive long. In addition, our data pointed out that different strategies should be used to search for PIDs in infants and young children as compared to older patients.
- Obesidade e asma: associação ou epifenômeno?(2013) ANDRADE, Larissa Smiljanic; ARAÚJO, Andrea Cristina T. B.; CAUDURO, Tatiana Moraes; WATANABE, Letícia Aki; CASTRO, Ana Paula B. M.; JACOB, Cristina Miuki A.; PASTORINO, Antonio CarlosOBJECTIVE: To relate obesity and asthma by comparing gender, age, initial classification of asthma, clinical control, basal forced expiratory volume in one second (FEV1) and forced expiratory flow between 25 and 75% (FEF25-75%) with rates of body mass index (BMI) in asthmatic adolescents. METHODS: Cross-sectional study involving 120 asthmatics patients (1.9 male: 1 female) with a mean age of 14.1 years (9 to 20.1 years of age), classified according to asthma severity and control, and evaluated by spirometry using their basal FEV1 and FEF25-75%. The data were described by frequency, mean and standard deviation or median and range and analyzed by ANOVA, unpaired t test, Fischer's exact test, Kruskal-Wallis and Pearson's correlation, considering significant p<0.05. RESULTS: There was no difference between gender in relation to the initial classification and the level of asthma control; 91.7% (100 cases) received initial classification as persistent and 106 cases (88.3%) were partially or totally controlled. There was no statistical difference between controlled patients and the others in relation to BMI. No significant correlations were found between zBMI and FEV1 and between zBMI and FEF25-75%, analyzing all patients and only patients with overweight or obese. CONCLUSIONS: In this study, no significant correlation was found between overweight/obesity and asthma using clinical, anthropometric and spirometric parameters.
- Double-blind, placebo-controlled food challenges in Brazilian children: Adaptation to clinical practice(2013) GUSHKEN, A. K. F.; CASTRO, A. P. M.; YONAMINE, G. H.; CORRADI, G. A.; PASTORINO, A. C.; JACOB, C. M. A.Background: A double-blind, placebo-controlled food challenge (DBPCFC) is considered the gold standard for diagnosing food allergy, but because of methodological difficulties it is rarely conducted in clinical practice, especially in paediatric patients. The purpose of the study was to propose a DBPCFC protocol that is adapted to our conditions for the diagnosis of an IgE-mediated cow's milk allergy (CMA) in a Brazilian reference centre for paediatric allergies. Methods: This study includes the experimental phase (choice of materials, adjustments made to protocols described in the literature) and the test execution phase. DBPCFCs were performed in 58 patients aged 1-15 years who were separated into two groups: Group 1 (n = 39), sex 1.6 M:F, 5.3 years median age, suggestive history of IgE-mediated CMA; and Group 2 (n = 19), sex 1.4 M:F, 8.3 years median age with symptoms not associated with milk ingestion and laboratory data not compatible with IgE-mediated CMA. Results: The materials were standardised for testing: containers and disposable products, low-lactose cow's milk (CM) and vehicles, such as natural fruit juice, vegetable soup and soybean-based beverages. Each DBPCFC was performed in a single day with two blind, randomised phases with a 2-h interval between them. The milk doses were gradually increased and offered in regular intervals of 15-30 min. Following negative or inconclusive results, patients underwent an open oral challenge test with 200 mL of low-lactose CM. Conclusions: The proposed adaptation for the DBPCFC allowed to implement this important test for the diagnosis of IgE-mediated CMA in a reference centre for paediatric allergies. It was considered feasible and safe if performed in an appropriate setting with physician supervision.