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Article ; Online: Is allergen immunotherapy a model of personalized treatment in pediatric respiratory allergy?

Wandalsen, Gustavo Falbo / Aarestrup, Fernando Monteiro / Solé, Dirceu

Current opinion in allergy and clinical immunology

2024 Volume 24, Issue 2, Page(s) 88–93

Abstract: Purpose of review: To review recent evidence on allergen immunotherapy (AIT) as a model of personalized medicine in the treatment of children and adolescents with respiratory allergies.: Recent findings: Meta-analysis and systematic review studies ... ...

Abstract	Purpose of review: To review recent evidence on allergen immunotherapy (AIT) as a model of personalized medicine in the treatment of children and adolescents with respiratory allergies. Recent findings: Meta-analysis and systematic review studies continue to point out that AIT is an effective treatment for children with respiratory allergies. Molecular allergy allows the understanding of patient sensitization profiles that frequently change the prescription of AIT. There is still a lack of evidence showing that this personalized prescription of AIT is associated with better clinical outcomes. The nasal allergen challenge has extended the indications of AIT for a new group of subjects with local allergic rhinitis. Patient selection of allergens involved in the increasingly personalized composition of extracts to be used in AIT increasingly characterizes it as personalized medicine. Summary: Despite the numerous studies carried out to identify the best biomarker to evaluate the response to AIT, there is still much disagreement, and clinical assessment (symptoms, quality of life, among others) continues to be the best way to evaluate the therapeutic success of AIT.
MeSH term(s)	Adolescent ; Humans ; Child ; Precision Medicine ; Quality of Life ; Desensitization, Immunologic ; Rhinitis, Allergic/therapy ; Allergens/therapeutic use
Chemical Substances	Allergens
Language	English
Publishing date	2024-02-12
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2088710-3
ISSN	1473-6322 ; 1528-4050
ISSN (online)	1473-6322
ISSN	1528-4050
DOI	10.1097/ACI.0000000000000968
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Article ; Online: Rapid maxillary expansion and nasal patency in mouth breathing children with maxillary atresia due to or not due to allergic rhinitis.

Carvalho, Paulo de Tarso Almeida / Junior, Mario Cappellette / Wandalsen, Gustavo Falbo / Solé, Dirceu

Allergologia et immunopathologia

2023 Volume 51, Issue 4, Page(s) 55–62

Abstract: Aim: To evaluate the effects of rapid maxillary expansion (RME) on nasal patency in mouth breathing (MB) children with maxillary atresia due to or not due to allergic rhinitis (AR) associated with asthma.: Methods: Fifty-three MB children/adolescents ...

Abstract	Aim: To evaluate the effects of rapid maxillary expansion (RME) on nasal patency in mouth breathing (MB) children with maxillary atresia due to or not due to allergic rhinitis (AR) associated with asthma. Methods: Fifty-three MB children/adolescents (aged 7-14 years) with mixed or permanent dentition and maxillary atresia participated, with or without unilateral or bilateral crossbite. They formed the groups: RAD (AR + asthma; clinical treatment, RME); RAC (AR + asthma; clinical treatment, no RME); and D (mouth breathers; RME only). RAD and RAC patients received topical nasal corticosteroid and/or systemic H1 antihistamine (continuous use) and environmental exposure control. All were evaluated before RME (T1) and 6 months after (T2) with the CARATkids score, acoustic rhinometry, and nasal cavity computed tomography (CT). Patients RAD and D underwent RME (Hyrax® orthopedic appliance). Results: A significant reduction in the CARATkids score occurred in the RAD (-4.06; Conclusion: In MB patients with AR, asthma, and maxillary atresia, RME increased nasal cavity volume and improved respiratory symptoms. However, it should not be used as the only treatment for managing patients with respiratory allergies.
MeSH term(s)	Adolescent ; Humans ; Child ; Mouth Breathing/therapy ; Palatal Expansion Technique ; Nose ; Rhinitis, Allergic/therapy ; Asthma
Language	English
Publishing date	2023-07-01
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	193144-1
ISSN	1578-1267 ; 0301-0546
ISSN (online)	1578-1267
ISSN	0301-0546
DOI	10.15586/aei.v51i4.853
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Article ; Online: Local allergic rhinitis in children: A systematic review.

Matsumoto, Fausto Yoshio / Gonçalves, Tessa Rachel Tranquillini / Solé, Dirceu / Wandalsen, Gustavo Falbo

Allergologia et immunopathologia

2022 Volume 50, Issue 2, Page(s) 40–47

Abstract: Background: Local allergic rhinitis (LAR) is a well-defined and reported phenotype in adults, but data is scarce for children and adolescents, and it is probably an undiagnosed and highly underestimated condition in childhood.: Objectives: The ... ...

Abstract	Background: Local allergic rhinitis (LAR) is a well-defined and reported phenotype in adults, but data is scarce for children and adolescents, and it is probably an undiagnosed and highly underestimated condition in childhood. Objectives: The objectives of this systematic review were to identify original observational studies published on LAR in children and adolescents and to describe the prevalence and characteristics of this phenotype in the pediatric age group. Methods: A systematic search was performed in PubMed and EMBASE databases. The search was limited to publications on humans, written in English, published between January 1, 2000 and September 20, 2021. Participants had to be under 18 years old and with a diagnosis of LAR confirmed by nasal allergen provocation test (NAPT). Results: Ten articles were identified. Despite the wide variability of protocols, prevalence rates ranged from 3.7 to 83.3% among children previously diagnosed as having nonallergic rhinitis, being markedly lower in Eastern countries (3.7-16.6%) when compared to Western countries (22.3-83.3%). To date, no relevant clinical characteristics capable of differentiating LAR patients from other childhood rhinitis phenotypes have been identified. Conclusions: LAR is an allergic rhinitis phenotype also found in children. Population and regional differences and differences in NAPT protocols may explain the heterogeneity in LAR prevalence rates observed in different parts of the world. In addition to clarifying this large discrepancy, longitudinal studies are also needed to assess the clinical characteristics of the LAR phenotype in the pediatric age group, and its stability into adulthood must be confirmed.
MeSH term(s)	Adolescent ; Adult ; Allergens ; Child ; Humans ; Nasal Provocation Tests/methods ; Rhinitis/epidemiology ; Rhinitis, Allergic/diagnosis ; Rhinitis, Allergic/epidemiology ; Skin Tests
Chemical Substances	Allergens
Language	English
Publishing date	2022-03-01
Publishing country	Singapore
Document type	Journal Article ; Systematic Review
ZDB-ID	193144-1
ISSN	1578-1267 ; 0301-0546
ISSN (online)	1578-1267
ISSN	0301-0546
DOI	10.15586/aei.v50i2.560
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Article ; Online: VITAMIN D AND ASTHMA: A RELATIONSHIP TO BE CLARIFIED.

Wandalsen, Gustavo Falbo / Solé, Dirceu

Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo

2018 Volume 36, Issue 3, Page(s) 250–251

Title translation	VITAMINA D E ASMA: UMA RELAÇÃO AINDA POR ESCLARECER.
MeSH term(s)	Asthma/drug therapy ; Asthma/etiology ; Child ; Humans ; Vitamin D/physiology ; Vitamin D/therapeutic use ; Vitamin D Deficiency/complications ; Vitamin D Deficiency/drug therapy
Chemical Substances	Vitamin D (1406-16-2)
Language	Portuguese
Publishing date	2018-10-26
Publishing country	Brazil
Document type	Editorial
ZDB-ID	2560228-7
ISSN	1984-0462 ; 0103-0582
ISSN (online)	1984-0462
ISSN	0103-0582
DOI	10.1590/1984-0462/;2018;36;3;00020
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Article ; Online: Azithromycin in acute bronchiolitis.

Solé, Dirceu / Matsumoto, Fausto / Wandalsen, Gustavo Falbo

Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia

2020 Volume 46, Issue 3, Page(s) e20200285

MeSH term(s)	Azithromycin ; Bronchiolitis ; Bronchiolitis Obliterans ; Humans ; Respiratory Sounds
Chemical Substances	Azithromycin (83905-01-5)
Language	Portuguese
Publishing date	2020-07-06
Publishing country	Brazil
Document type	Editorial ; Comment
ZDB-ID	2223157-2
ISSN	1806-3756 ; 1806-3713
ISSN (online)	1806-3756
ISSN	1806-3713
DOI	10.36416/1806-3756/e20200285
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Article ; Online: COVID-19 and Pediatric Asthma: Clinical and Management Challenges.

Boechat, José Laerte / Wandalsen, Gustavo Falbo / Kuschnir, Fabio Chigres / Delgado, Luís

International journal of environmental research and public health

2021 Volume 18, Issue 3

Abstract: Asthma is the most frequent chronic condition in childhood and a current concern exists about asthma in the pediatric population and its risk for severe SARS-CoV-2 infection. Although all ages can be affected, SARS-CoV-2 infection has lower clinical ... ...

Abstract	Asthma is the most frequent chronic condition in childhood and a current concern exists about asthma in the pediatric population and its risk for severe SARS-CoV-2 infection. Although all ages can be affected, SARS-CoV-2 infection has lower clinical impact on children and adolescents than on adults. Fever, cough and shortness of breath are the most common symptoms and signs in children; wheezing has not been frequently reported. Published studies suggest that children with asthma do not appear to be disproportionately more affected by COVID-19. This hypothesis raises two issues: is asthma (and/or atopy) an independent protective factor for COVID-19? If yes, why? Explanations for this could include the lower IFN-α production, protective role of eosinophils in the airway, and antiviral and immunomodulatory proprieties of inhaled steroids. Additionally, recent evidence supports that allergic sensitization is inversely related to ACE2 expression. Obesity is a known risk factor for COVID-19 in adults. However, in the childhood asthma-obesity phenotype, the classic atopic Th2 pattern seems to predominate, which could hypothetically be a protective factor for severe SARS-CoV-2 infection in children with both conditions. Finally, the return to school activities raises concerns, as asymptomatic children could act as vectors for the spread of the disease. Although this is still a controversial topic, the identification and management of asymptomatic children is an important approach during the SARS-CoV-2 epidemic. Focus on asthma control, risk stratification, and medication adherence will be essential to allow children with asthma to return safely to school.
MeSH term(s)	Asthma/epidemiology ; Asthma/therapy ; COVID-19/epidemiology ; Child ; Humans ; Risk Factors
Language	English
Publishing date	2021-01-26
Publishing country	Switzerland
Document type	Journal Article ; Review
ISSN	1660-4601
ISSN (online)	1660-4601
DOI	10.3390/ijerph18031093
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Article ; Online: Psychological stress in asthma: repercussions on epigenetics-genetics, immune responses, and pulmonary function in the pediatric population.

Lira, Georgia Véras de Araújo Gueiros / da Silva, Giselia Alves Pontes / Wandalsen, Gustavo Falbo / Sarinho, Emanuel Sávio Cavalcanti

Allergologia et immunopathologia

2022 Volume 50, Issue 2, Page(s) 78–88

Abstract: In the assessment of childhood asthma, identifying the risk factors associated with exacerbations and broadening this view to understand psychological stress and its repercussions on the inflammatory process of asthma allow a different perspective on ... ...

Abstract	In the assessment of childhood asthma, identifying the risk factors associated with exacerbations and broadening this view to understand psychological stress and its repercussions on the inflammatory process of asthma allow a different perspective on this biopsychosocial disease. Psychological stress, as a risk factor for the onset and noncontrol of asthma, has been increasingly evaluated from the perspective of the repercussions on the body of the stimulus generated in the hypothalamic-pituitary axis and adrenal glands, with cortisol release and immune system action. These processes trigger changes in T helper 2 cells, which polarize allergic processes, and dysfunctions in immune tolerance mechanisms, with a decrease in regulatory T cells. Genetic and epigenetic changes in β
MeSH term(s)	Asthma ; Child ; Epigenesis, Genetic ; Humans ; Immunity ; Lung ; Stress, Psychological/complications
Language	English
Publishing date	2022-03-01
Publishing country	Singapore
Document type	Journal Article ; Review
ZDB-ID	193144-1
ISSN	1578-1267 ; 0301-0546
ISSN (online)	1578-1267
ISSN	0301-0546
DOI	10.15586/aei.v50i2.546
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Article ; Online: Behavioral disorders in children and adolescents with atopic dermatitis.

Moraes, Marília Magalhães / Vaz, Fernanda Pires Cecchetti / Roque, Raíssa Monteiro Soares Dos Anjos / Mallozi, Márcia de Carvalho / Solé, Dirceu / Wandalsen, Gustavo Falbo

Jornal de pediatria

2023 Volume 100, Issue 1, Page(s) 93–99

Abstract: Objectives: To assess the prevalence and pattern of behavioral problems in children and adolescents with atopic dermatitis (AD) and to study their associations with clinical data and severity.: Methods: This was a single-center, cross-sectional study ...

Abstract	Objectives: To assess the prevalence and pattern of behavioral problems in children and adolescents with atopic dermatitis (AD) and to study their associations with clinical data and severity. Methods: This was a single-center, cross-sectional study of patients (6-17 years) with AD. Assessment of competencies and syndrome scale scores of behavioral problems was performed by applying the Child Behavior Checklist 6-18 (CBCL 6-18) and AD severity using the Eczema Area Severity Index (EASI) score. Results: Of the 100 patients with AD, 56% were male, with a mean age of 11±3 years, and 43% had moderate/severe AD. Borderline or abnormal values were found in 75% of the patients for total social competence, 57% for internalization, 27% for externalization, and 18% for aggressive behavior. A higher prevalence of aggressive behavior (27.9% vs. 10.5%; p = 0.02) and sleep disorders (32.6% vs. 15.8%; p = 0.04) was observed in patients with moderate/severe AD than in those with mild AD. Children with current or previous use of immunosuppressants/immunobiological tests had a lower frequency of normal social competence (53% vs. 83%, p = 0.012). Regarding the critical questions, 8% responded affirmatively to suicidal ideation. Conclusion: A high prevalence of behavioral problems was observed among children and adolescents with AD, with a predominance of internalizing profiles, mainly anxiety and depression. Children with moderate/severe AD have a higher prevalence of aggressive behaviors and sleep disorders. These findings highlight the importance of multidisciplinary teams, including mental health professionals, in caring for patients with AD.
MeSH term(s)	Child ; Humans ; Male ; Adolescent ; Female ; Dermatitis, Atopic/epidemiology ; Cross-Sectional Studies ; Anxiety/epidemiology ; Sleep Wake Disorders/etiology ; Sleep Wake Disorders/complications ; Problem Behavior ; Severity of Illness Index
Language	English
Publishing date	2023-09-29
Publishing country	Brazil
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	731324-x
ISSN	1678-4782 ; 0021-7557
ISSN (online)	1678-4782
ISSN	0021-7557
DOI	10.1016/j.jped.2023.08.006
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Article ; Online: Growth and mouth breathers.

Morais-Almeida, Mario / Wandalsen, Gustavo Falbo / Solé, Dirceu

Jornal de pediatria

2019 Volume 95 Suppl 1, Page(s) 66–71

Abstract: Objective: To assess the relationship between mouth breathing and growth disorders among children and teenagers.: Data source: Search on MEDLINE database, over the last 10 years, by using the following terms: "mouth breathing", "adenotonsilar ... ...

Abstract	Objective: To assess the relationship between mouth breathing and growth disorders among children and teenagers. Data source: Search on MEDLINE database, over the last 10 years, by using the following terms: "mouth breathing", "adenotonsilar hypertrophy", "allergic rhinitis", "sleep disturbance" AND "growth impairment", "growth hormone", "failure to thrive", "short stature", or "failure to thrive". Data summary: A total of 247 articles were identified and, after reading the headings, this number was reduced to 45 articles, whose abstracts were read and, of these, 20 were deemed important and were included in the review. In addition of these articles, references mentioned in them and specific books on mouth breathing deemed important were included. Hypertrophy of palatine and/or pharyngeal tonsils, whether associated with allergic rhinitis, as well as poorly controlled allergic rhinitis, are the main causes of mouth breathing in children. Respiratory sleep disorders are frequent among these patients. Several studies associate mouth breathing with reduced growth, as well as with reduced growth hormone release, which are reestablished after effective treatment of mouth breathing (clinical and/or surgical). Conclusions: Mouth breathing should be considered as a potential cause of growth retardation in children; pediatricians should assess these patients in a broad manner.
MeSH term(s)	Child ; Growth Disorders/etiology ; Growth Disorders/physiopathology ; Humans ; Mouth Breathing/complications ; Mouth Breathing/physiopathology ; Nasal Obstruction/complications ; Nasal Obstruction/physiopathology ; Rhinitis/complications ; Sleep Wake Disorders/complications ; Sleep Wake Disorders/physiopathology
Language	English
Publishing date	2019-01-03
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	731324-x
ISSN	1678-4782 ; 0021-7557
ISSN (online)	1678-4782
ISSN	0021-7557
DOI	10.1016/j.jped.2018.11.005
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Article ; Online: Asthma is associated with lower respiratory tract involvement and worse clinical score in children with COVID-19.

Rabha, Anna Clara / Fernandes, Fátima Rodrigues / Solé, Dirceu / Bacharier, Leonard Benjamin / Wandalsen, Gustavo Falbo

Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology

2021 Volume 32, Issue 7, Page(s) 1577–1580

MeSH term(s)	Asthma/diagnosis ; Bronchi ; COVID-19 ; Child ; Humans ; Respiratory Tract Infections ; SARS-CoV-2
Language	English
Publishing date	2021-05-29
Publishing country	England
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	1057059-7
ISSN	1399-3038 ; 0905-6157 ; 0906-5784
ISSN (online)	1399-3038
ISSN	0905-6157 ; 0906-5784
DOI	10.1111/pai.13536
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