MARCELO VIVOLO AUN
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/60 - Laboratório de Imunologia Clínica e Alergia, Hospital das Clínicas, Faculdade de Medicina
LIM/60 - Laboratório de Imunologia Clínica e Alergia, Hospital das Clínicas, Faculdade de Medicina
36 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 36
- Drug-induced anaphylaxis: is it an epidemic?(2018) GIAVINA-BIANCHI, Pedro; AUN, Marcelo V.; KALIL, JorgePurpose of reviewThe present review addresses the epidemiology, analyzes the current data and promotes global awareness of drug-induced anaphylaxis.Recent findingsAnaphylaxis is a medical emergency that may cause death! In the last decade, studies have shown an increasing incidence and prevalence of anaphylaxis.SummaryDrug-induced anaphylaxis fatalities have increased, and this syndrome remains underdiagnosed and undertreated.
conferenceObject Esophagogastroduodenal Mucosal Behavior after Bronchial Challenge with House Dust Mites in Allergic Asthmatic Patients(2015) AGONDI, Rosana C.; NAVARRO-RODRIGUEZ, Tomas; BARBUTI, Ricardo; BISACCIONI, Carla; AUN, Marcelo Vivolo; KALIL, Jorge; GIAVINA-BIANCHI, Pedro- Vocal cord dysfunction diagnosis may be improved by a screening check list(2016) PINTO, Lucia Helena Eduardo; AUN, Marcelo Vivolo; CUKIER-BLAJ, Sabrina; STELMACH, Rafael; CUKIER, Alberto; KALIL, Jorge; AGONDI, Rosana Camara; GIAVINA-BIANCHI, PedroBackground: Many patients with vocal cord dysfunction (VCD), with or without asthma, receive inappropriate treatment because they are misdiagnosed as having difficult-to-control asthma alone. We developed a clinical screening check list designed to aid the diagnosis of VCD. Methods: A prospective observational study involving 80 patients aged >= 8 years, diagnosed with severe asthma. After anamnesis and physical examination, physicians completed a check list with 6 questions to identify VCD, for which the answer ""yes"" counted one point. Then patients underwent spirometry and laryngoscopy. On the basis of the laryngoscopic findings, we created three patient groups: VCD (vocal cord adduction during inspiration, n = 14); unconfirmed VCD (inconclusive findings, n = 29); and control (normal findings, n = 37). We attempted to determine whether any of those groups were associated with the responses to individual questions or sets of questions on the check list. Results: The proportion of affirmative answers to the question ""Does pulmonary auscultation reveal wheezing, predominantly in the cervical region, and/or stridor?"" was significantly higher for the VCD group than for the other two groups (P = 0.006), notably in elderly patients. The variable ""4 or more affirmative answers"" was more common in VCD and unconfirmed VCD groups in comparison to controls (P = 0.022). Conclusions: A finding of wheezing or stridor on auscultation of the cervical region is suggestive of vocal cord dysfunction, especially in elderly patients, and such dysfunction can be confirmed through laryngoscopy. Our VCD screening check list proved to be useful in the screening of VCD among patients with severe asthma.
conferenceObject Characterization of Asthmatic Patients with Vocal Cord Dysfunction(2013) AGONDI, Rosana C.; GALVAO, Violeta; AUN, Marcelo; BISACCIONI, Carla; KALIL, Jorge; GIAVINA-BIANCHI, PedroRATIONALE: The vocal cord dysfunction (VCD) is a syndrome characterized by paradoxical movement of the vocal folds that causes respiratory distress. Our goal is to analyze asthmatic patients with VCD. METHODS: This was an observational and cross-sectional study involving patients over 18 years of age who had been diagnosed with asthma according to the Global Initiative for Asthma guidelines. Eighty-five patients were analyzed. They were submitted to spirometry, and tested for total and specific IgE to aeroallergens (skin prick test and/or in vitro ). RESULTS: The mean age was 52.1 years, and 93% were female. Sixty- seven patients had moderate or severe persistent asthma. Spirometry was normal or showed mild obstructive respiratory disease in 81% of them. Spirometric alterations suggestive of VCD were observed in 24% of the patients. The mean serum total IgE was 303 IU/mL and the detection of specific IgE was present in 76% of them. Gastroesophageal reflux disease was observed in 65% of the patients. When classified according to gender, we found that men were younger, had higher total IgE and higher prevalence of specific IgE. CONCLUSIONS: There was a higher prevalence of the association asthma and VCD in women, suggesting that this association could be masked in men. However, we observed that the clinical characteristics were different between men and women. We found a high prevalence of atopy that could be another confounding factor. There was a weak association between asthma and spirometric severity classifications, suggesting a potential role for VCD in making difficult to the asthma control in some patients.conferenceObject Bordetella Pertussis Whole-Cell Vaccine Inhibits Specific IgE, Inflammation and Airway Remodeling in a Murine Model of Asthma(2015) AUN, Marcelo Vivolo; ARANTES-COSTA, Fernanda; SARAIVA-ROMANHOLO, Beatriz Mangueira; ALMEIDA, Francine Maria; REGINA-BRUEGGERMANN, Thayse; MARTINS, Milton Arruda; KALIL, Jorge; GIAVINA-BIANCHI, Pedro- Drug-induced anaphylaxis in children: Nonsteroidal anti-inflammatory drugs and drug provocation test REPLY(2014) AUN, Marcelo Vivolo; BLANCA, Miguel; GARRO, Laila Sabino; RIBEIRO, Marisa Rosimeire; KALIL, Jorge; MOTTA, Antonio Abilio; CASTELLS, Mariana; GIAVINA-BIANCHI, Pedro
- Specific questionnaire detects a high incidence of intra-operative hypersensitivity reactions(2018) GARRO, Laila S.; V, Marcelo Aun; SOARES, Iracy Silvia C.; RIBEIRO, Marisa R.; MOTTA, Antonio A.; KALIL, Jorge; CASTELLS, Mariana C.; CARMONA, Maria Jose C.; GIAVINA-BIANCHI, PedroOBJECTIVE: To assess the incidence of intra-operative immediate hypersensitivity reactions and anaphylaxis. METHODS: A cross-sectional observational study was conducted at the Department of Anesthesiology, University of Sao Paulo School of Medicine, Hospital das Clinicas, Sao Paulo, Brazil, from January to December 2010. We developed a specific questionnaire to be completed by anesthesiologists. This tool included questions about hypersensitivity reactions during anesthesia and provided treatments. We included patients with clinical signs compatible with immediate hypersensitivity reactions. Hhypersensitivity reactions were categorized according to severity (grades I-V). American Society of Anesthesiologists physical status classification (ASA 1-6) was analyzed and associated with the severity of hypersensitivity reactions. RESULTS: In 2010, 21,464 surgeries were performed under general anesthesia. Anesthesiologists answered questionnaires on 5,414 procedures (25.2%). Sixty cases of intra-operative hypersensitivity reactions were reported. The majority patients (45, 75%) had hypersensitivity reactions grade I reactions (incidence of 27.9:10,000). Fifteen patients (25%) had grade II, III or IV reactions (intra-operative anaphylaxis) (incidence of 7:10,000). No patients had grade V reactions. Thirty patients (50%) were classified as ASA 1. The frequency of cardiovascular shock was higher in patients classified as ASA 3 than in patients classified as ASA 1 or ASA 2. Epinephrine was administered in 20% of patients with grade III hypersensitivity reactions and in 50% of patients with grade II hypersensitivity reactions. CONCLUSIONS: The majority of patients had hypersensitivity reactions grade I reactions; however, the incidence of intra-operative anaphylaxis was higher than that previously reported in the literature. Patients with ASA 3 had more severe anaphylaxis; however, the use of epinephrine was not prescribed in all of these cases. Allergists and anesthesiologists should implement preventive measures to reduce the occurrence of anaphylaxis.
- Algorithm to guide re-exposure to penicillin in allergic pregnant women with syphilis: Efficacy and safety(2021) GARCIA, Juliana Foes Bianchini; AUN, Marcelo Vivolo; MOTTA, Antonio Abilio; CASTELLS, Mariana; KALIL, Jorge; GIAVINA-BIANCHI, PedroResults: Ninety-one patients were enrolled. Allergy to penicillin was confirmed in 7.69% of pregnant women with syphilis and clinical history of allergy to penicillin; in all cases the diagnosis was made through intradermal testing, which predicted 100% of the breakthrough reactions observed during rapid drug desensitization (p < 0.001). Risk stratification based on the initial clinical reaction and skin testing to guide penicillin re-introduction through drug challenge or desensitization was safe (97.8%) and effective (97.8%). Conclusion: We developed and showed the efficacy and safety of an algorithm to guide reexposure to penicillin in pregnant women with syphilis and labeled as allergic to this drug. Intradermal test is an excellent biomarker in the diagnosis of immediate hypersensitivity reaction to penicillin and to predict breakthrough reaction during rapid drug desensitization. Further studies Background: Gestational syphilis is underdiagnosed and undertreated, leading to stillbirth, prematurity, low birthweight, neonatal death, and congenital syphilis. Most patients who label as allergic to penicillin are misdiagnosed. Objective: To assess the efficacy and safety of an algorithm to guide re-exposure to penicillin in pregnant women with syphilis and reporting allergy to the antibiotic. Methods: We performed a prospective study assessing pregnant women with syphilis and labeled as allergic to penicillin. Based on clinical history, patients were divided in two groups: high risk and low-risk to penicillin allergy. Low-risk patients with negative skin testing and negative serum specific IgE to penicillin underwent drug provocation test. The remaining patients underwent desensitization. Results: Ninety-one patients were enrolled. Allergy to penicillin was confirmed in 7.69% of pregnant women with syphilis and clinical history of allergy to penicillin; in all cases the diagnosis was made through intradermal testing, which predicted 100% of the breakthrough reactions observed during rapid drug desensitization (p < 0.001). Risk stratification based on the initial clinical reaction and skin testing to guide penicillin re-introduction through drug challenge or desensitization was safe (97.8%) and effective (97.8%). Conclusion: We developed and showed the efficacy and safety of an algorithm to guide re exposure to penicillin in pregnant women with syphilis and labeled as allergic to this drug. Intradermal test is an excellent biomarker in the diagnosis of immediate hypersensitivity reaction to penicillin and to predict breakthrough reaction during rapid drug desensitization. Further studies may confirm the greater safety of the intravenous protocol compared to the oral protocol.
- Use of pdC1-INH concentrate for long-term prophylaxis during pregnancy in hereditary angioedema with normal C1-INH(2018) GARCIA, Juliana F. B.; TAKEJIMA, Priscila; VERONEZ, Camila Lopes; AUN, Marcelo V.; MOTTA, Antonio A.; KALIL, Jorge; PESQUERO, Joao Bosco; GIAVINA-BIANCHI, Pedro
article 3 Citação(ões) na Scopus Anafilaxia perioperatória: A experiência brasileira(2016) AUN, Marcelo Vivolo; GARRO, Laila Sabino; RIBEIRO, Marisa Rosimeire; MOTTA, Antônio Abílio; KALIL, Jorge; GIAVINA-BIANCHI, PedroPerioperative anaphylaxis is a rare hypersensitivity reaction, but it has a rapid onset and is potentially fatal. The true incidence is not well known and varies in accordance with the country from 1:1 250 to 1:13 000 surgeries. It may occur through an allergic (IgE-mediated or not) or non-allergic mechanism, but it is believed that the IgE-mediated reactions are the most common and severe. Any product or drug used in the procedure has the potential to be the cause of a reaction, but neuromuscular blocking agents are the most frequently reported, followed by latex and antibiotics. In this mini-review we discuss some key points of the management of these patients and w present Brazilian data, which suggest that an active search for cases by working together with anesthesiologists could lead to an increase in diagnosis and, therefore, better prevention of future reactions