Papers by Luis Taborda-Barata
BMJ Open, May 1, 2023
Objectives Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spai... more Objectives Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms. Methods This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built. Results According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression. At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.
BMJ Open, May 1, 2020
for his willingness to assist with planned searches for this systematic review in Cochrane Librar... more for his willingness to assist with planned searches for this systematic review in Cochrane Library. Contributors All authors contributed to the design and conceptualisation of this review. MA drafted the protocol with primary support from BIN (review guarantor) and LT-B. TM, PC, JMRG, BIN, MB and LT-B were involved in checking various steps of the search strategy, including keywords, as well as the final version of the protocol. JMRG was involved in the statistical strategy for data analysis. MA, TM, JMRG and LT-B were involved in establishing eligibility criteria and data extraction forms. All authors provided feedback on the manuscript, at all stages.
Current Opinion in Allergy and Clinical Immunology, Sep 14, 2022
Allergy, Asthma & Clinical Immunology, Sep 6, 2017
Background: The prevalence of adverse food reactions (AFR) has been increasing in the western wor... more Background: The prevalence of adverse food reactions (AFR) has been increasing in the western world. Clinical manifestations are diversified and it may not be possible to clinically discriminate between IgE and non-IgE mediated AFR. In Portugal, the prevalence of AFR and food allergies in children is not known. Thus, the objectives of this study were to determine the prevalence of AFR in central Portugal. Methods: Point prevalence study in 3-11 year-old schoolchildren from Central Portugal. Food-related questionnaires, skin prick tests (SPT) with foods and determination of food-specific IgE levels were performed. Results: Of 4045 schoolchildren, 2474 (61.2%) accepted to be included in the study. Global prevalence of AFR was 7.1% (95% CI 6.2-8.1), based upon the initial questionnaire, 4.6% (95% CI 3.9-5.5), based upon a confirmatory questionnaire and the prevalence of probable food allergy (IgE-associated AFR: positive history + positive SPT and/or positive specific IgE) was 1.4% (95% CI 0.9-1.9). Most frequently implicated foods were fresh fruits, fish and egg. A first episode at an earlier age, mucocutaneous and anaphylactic reactions were more frequent in IgE-associated AFR. The prevalence of probable food allergy in 3-11 year old Portuguese children from central Portugal is low and parents over-report its frequency. Most frequently implicated foods were fresh fruit and fish. Immediate type, polysymptomatic, and more severe reactions may commence at an earlier age and be more frequent in IgE-associated than in non-IgE associated reactions.
Clinical & Experimental Allergy, Nov 1, 2001
ABSTRACT Macrophage inflammatory protein (MIP)-1alpha binds to C-C chemokine receptor (CCR)-1 wit... more ABSTRACT Macrophage inflammatory protein (MIP)-1alpha binds to C-C chemokine receptor (CCR)-1 with high affinity. CCR-1 is expressed on neutrophils, eosinophils, monocytes, T lymphocytes and basophils; cells characteristic of atopic allergic inflammation. In vitro, MIP-1alpha is chemotactic for monocytes, T cells and basophils and is also a potent histamine-releasing factor for basophils and mast cells. Although increased levels of MIP-1alpha were shown in atopic allergic disorders, the kinetics of expression of these CC chemokines in vivo is largely unknown. To investigate the kinetics of expression of MIP-1alpha and receptor CCR-1 and the relationships between the expression and infiltration of inflammatory cells in allergen-induced cutaneous late-phase reactions in atopic subjects. Cryostat sections, obtained from skin biopsies from 10 human atopic subjects at 6, 24, 48, 72 h and 7 days after allergen challenge, were processed for immunohistochemistry and in situ hybridization using 35S-labelled riboprobes. The peak expression of allergen-induced mRNA for MIP-1alpha and CCR-1 was 6 h. This was maintained at 24 h, and gradually returned to base line at 7 days. At 6 h, the number of cells expressing MIP-1alpha mRNA significantly correlated with elastase+ neutrophils and BB-1+ basophils. At 24 h, the MIP-1alpha mRNA+ cells significantly correlated with CD68+ macrophages. There were significant inverse correlations between the numbers of MIP-1alpha mRNA cells and the numbers of Tryptase+ mast cells at 6 and 24 h after allergen challenge. Allergen-induced cutaneous late-phase reactions in humans were associated with increased expression of MIP-1alpha and CCR-1. This may be relevant to the infiltration of neutrophils, eosinophils, basophils and macrophages.
Journal of Experimental Medicine, Jun 1, 1995
The C-C chemokines RANTES and monocyte chemotactic protein-3 (MCP-3) are potent chemoattractants ... more The C-C chemokines RANTES and monocyte chemotactic protein-3 (MCP-3) are potent chemoattractants in vitro for eosinophils and other cell types associated with allergic reactions. We tested the hypothesis that the aUergen-induced infiltration of eosinophils, T cells, and macrophages in the skin of atopic subjects is accompanied by the appearance of mRNA + cells for RANTES and MCP-3. Cryostat sections were obtained from skin biopsies from six subjects 6, 24, and 48 h after allergen challenge. Tissue was processed for immunocytochemistry (ICC) and for in situ hybridization using 3SS-labeled riboprobes for RANTES and MCP-3. In contrast to diluent controls, allergen provoked a significant increase in mKNA + cells for MCP-3, which peaked at 6 h and progressively declined at 24 and 48 h. This paralleled the kinetics of total (major basic protein positive [MBP] +) and activated (cleaved form of eosinophil cationic protein [EG2] +) eosinophil infiltration. The aUergen-induced expression of cells mRNA + for RANTES was also clearly demonstrable at 6 h. However, the numbers were maximal at 24 h and declined slightly at the 48-h time point. The number of mRNA + cells for RANTES paralleled the kinetics of infiltration of CD3 +, CD4 +, and CD8 + T cells whereas the number of CD68 § macrophages was still increasing at 48 h. These data support the view that MCP-3 is involved in the regulation of the early eosinophil response to specific allergen, whereas RANTES may have more relevance to the later accumulation of T cells and macrophages.
Expert Opinion on Drug Safety, Oct 31, 2019
Objectives: Biological drugs have been successfully tested in asthma, especially in the most seve... more Objectives: Biological drugs have been successfully tested in asthma, especially in the most severe forms of the disease. The goal of this study was to characterize the safety profile of biologicals used in asthma. Methods: Retrospective and descriptive analysis of spontaneous reports (SRs) involving omalizumab and mepolizumab, sent to the Portuguese Pharmacovigilance System, since market launch until October 2018. Results: A total of 127 SRs for omalizumab and 10 SRs mepolizumab were found. Most patients were female (75.6% omalizumab and 90.0% mepolizumab), and aged 18-64 years (61.4% and 50.0%, respectively). 71.7% of the reports for omalizumab were serious, with 2 cases of anaphylaxis, 12 malignant neoplasms and 2 abortions. Only 20.0% of the reports for mepolizumab were considered serious. A total of 391 adverse drug reactions (ADRs) for omalizumab and 20 ADRs for mepolizumab were found. Most reported ADRs belonged to System organ class (SOC) groups: 'respiratory, thoracic and mediastinal disorders' and 'investigations', for omalizumab; 'musculoskeletal and connective tissue disorders' and 'general disorders and administration site conditions' for mepolizumab. Conclusion: Over the years, there was an increasing trend of SRs with these biological drugs. However, it is necessary to continue to develop educational programs in order to get a better reporting system.
European annals of allergy and clinical immunology, Nov 1, 2020
We assessed adherence to treatment and management needs of adults with persistent asthma and thei... more We assessed adherence to treatment and management needs of adults with persistent asthma and their interest in using apps for asthma management. Secondarily, we explored patients' opinions about an app to assess and improve adherence to treatment. METHODS: A cross-sectional study was conducted with 40 adults with persistent asthma (49.9±15.8 years) recruited at outpatient clinics from a district hospital. Participants answered a survey on sociodemographic, asthma control, treatment adherence and use of mobile devices, social networks and apps. Four patients participated in a prospective extension of the study, in which they were invited to use the InspirerMundi app. RESULTS: 48% of the participants had at least ≥1 exacerbation in the previous year and 85% had uncontrolled asthma. Self-reported adherence to treatment showed that one in four participants had low adherence. At least daily, 55% of participants navigated on the internet with their smartphone/tablet, 35% used apps and 93% social networks. Nine (22%) participants had previously used health/fitness apps and 65% would like to use apps to improve inhaler adherence. CONCLUSIONS: Most participants had uncontrolled asthma, reported high adherence to treatment and were daily users of social networks and the internet. Only 1/4 used apps but 2/3 would like to use apps to support asthma management.
The Journal of Allergy and Clinical Immunology, 1996
There is increasing evidence of a pro-inflammatory role of macrophages in asthma. We tested the e... more There is increasing evidence of a pro-inflammatory role of macrophages in asthma. We tested the effect of two different methods of bronchial antigen challenge upon AM activation. Expression of 15 constitutive activation markers on AM was examined by flow cytometry in two groups of 10 asymptomatic allergic asthmatics prior to and 19 hr after either EB or WL challenge with ragweed or timothy grass extract. Late phase bronchial obstruction was greater after WL challenge, while changes in BAL cytology (eosinophil accumulation) were greater after EB challenge. Only HLA class I significantly increased after WL challenge (CD23 almost reached statistical significance, p=O.07). After EB challenge, levels of 10 out of 15 markers were significantly increased (by 33-234%, p<O.05) after challenge (CDlla, CDllb, CD14, CD18, CD23, CD32, CD63, CD64, HLA-I and HLA-DR). CD29, CD33, CD35, CD44, CD71 and HLA-DQ remained unchanged after EB challenge. Six markers (CD14, CD18, CD29, CD32, HLA-I and HLA DQ) correlated with methacholine-induced PD20 after EB challenge. We suggest that activation of AM occurs following antigen challenge in asthmatics. Differences in results between challenge protocols may reflect different distributions and local concentrations of allergen.
Clinical & Experimental Allergy
Revista Portuguesa de Imunoalergologia
Patient and Public Involvement (PPI) in research should focus on the engagement of patients/carer... more Patient and Public Involvement (PPI) in research should focus on the engagement of patients/carers in every stage of the research cycle. However, the inconsistent level of education and research experience may compromise this involvement and training and support are recommended. In Portugal, consistent training to empower patients in their health decisions, or to be involved in research is neither available nor adapted for the patients and public. Our main goal is to develop and deliver the first high-quality and comprehensive online educational programme for adult patients with asthma and their carers, based on patients’/carers’ needs and preferences. The project includes four tasks. In Task 1, we will identify and organise the most important topics on asthma and health research, based on the identification of educational needs of adult patients/carers with asthma and the expertise of asthma specialists, using Delphi methodology. In Task 2, we will design and implement a high-quali...
Allergy
Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly ove... more Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of “one‐airway‐one‐disease,” coined over 20 years ago, is a simplistic approach of the links between upper‐ and lower‐airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper‐ and lower‐airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the “Epithelial Barrier Hypothesis.” This review determined that the “one‐airway‐one‐disease” concept does not always...
Clinical and Translational Allergy
MASK‐air®, a validated mHealth app (Medical Device regulation Class IIa) has enabled large observ... more MASK‐air®, a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK‐air® is a Good Practice of DG Santé on digitally‐enabled, patient‐centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co‐operation and Development). MASK‐air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK‐air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as‐needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combin...
Allergy
IntroductionData from mHealth apps can provide valuable information on rhinitis control and treat... more IntroductionData from mHealth apps can provide valuable information on rhinitis control and treatment patterns. However, in MASK‐air®, these data have only been analyzed cross‐sectionally, without considering the changes of symptoms over time. We analyzed data from MASK‐air® longitudinally, clustering weeks according to reported rhinitis symptoms.MethodsWe analyzed MASK‐air® data, assessing the weeks for which patients had answered a rhinitis daily questionnaire on all 7 days. We firstly used k‐means clustering algorithms for longitudinal data to define clusters of weeks according to the trajectories of reported daily rhinitis symptoms. Clustering was applied separately for weeks when medication was reported or not. We compared obtained clusters on symptoms and rhinitis medication patterns. We then used the latent class mixture model to assess the robustness of results.ResultsWe analyzed 113,239 days (16,177 complete weeks) from 2590 patients (mean age ± SD = 39.1 ± 13.7 years). The...
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Papers by Luis Taborda-Barata