At the age of 20, retired public servant Michele Avelino Benevides, 36, began to have a very uncomfortable dry cough. Every time she went to the hospital, she heard from the doctors that it was an allergy and was prescribed syrups. But none of them took effect, and her picture only evolved.
After a while, the resident of Santo André, in Greater São Paulo, also started to have a lot of shortness of breath and was advised to look for a pulmonologist to investigate the case. The diagnosis she received was mild asthma.
Despite following the indicated treatment, Michele’s seizures became more intense and frequent, to the point that she had to go to the emergency room twice in the same day on several occasions. During this period, she had some respiratory arrests and was intubated. According to her, there were more than 30 hospitalizations, which even resulted in her leaving her job and college.
“I’ve always been very active, I did everything by myself, but then I started to depend 100% on people, even to shower and change…”, she says. “I went to other doctors over the years and received a number of different diagnoses, such as cystic fibrosis and Churg-Strauss disease. I was even referred to a thoracic surgeon to assess whether to remove a piece of the lung.”
This specialist reported that she probably did have asthma, only a more severe type, and suggested that she look for a center specializing in the disease. Michele, then, sought the one from the HC-FMUSP (Hospital das Clínicas, Faculty of Medicine, University of São Paulo), and there, almost eight years after the onset of symptoms, he had confirmation: he suffered from eosinophilic asthma, a disease with more severe symptoms. strong and persistent and more difficult to control.
From then on, the retired public servant, who also suffers from rhinitis, sinusitis and atopic dermatitis —problems that emerged concomitantly with asthma—, underwent other treatments. The most recent is the use of oral and inhaled corticosteroids and immunobiological drugs.
“For 4 or 5 years, more or less, the situation has been calmer. Today, I can say that I am on the way to controlling the disease, but, even so, I will need to take care of it forever and live with the complications it has brought me”, complements.
Type 2 inflammation is behind severe asthma and other illnesses
Asthma, in the eosinophilic subtypes, such as Michele’s, allergic and mixed (allergic eosinophilic), together with atopic dermatitis and rhinosinusitis —the so-called atopic triad— are the main diseases related to an inflammation known as type 2.
It is a pathophysiology of the human body that causes an exaggerated response of the immune system against certain irritating elements or allergens and that is more complicated to treat than other types of inflammation.
In this type, explains Ana Caetano Faria, president of SBI (Brazilian Society of Immunology) and professor of immunology at UFMG (Federal University of Minas Gerais), the body overproduces eosinophil cells and IgE antibodies, important mediators of inflammatory processes associated with allergies, resulting in changes in the immune barrier.
“Basically, type 2 inflammation is the mechanism of allergic diseases, and it occurs in various organs and tissues, such as the lungs (asthma), skin (atopic dermatitis) and nasal mucosa (rhinosinusitis). at the same time. It also usually affects the esophagus (eosinophilic esophagitis) and is related to food allergies”, points out the doctor.
The causes of this exacerbated response of the organism are not yet fully known. But it is known that there is a genetic component involved – which explains the fact that some people develop it and others do not – and external triggering factors, such as mites, dust, strong smell, animal hair, cigarette smoke, pollen, mold, chemicals and pollution.
Another explanation, according to Pedro Giavina Bianchi, coordinator of the Scientific Department of Asthma at Asbai (Brazilian Association of Allergy and Immunology), is the contemporary lifestyle, with less exposure to microorganisms, excessive hygiene and uncontrolled use of antibiotics.
“In the past, deliveries were normal, and then the baby already had contact with all the flora of the mother’s vagina; breastfeeding was exclusively on the breast, generating a protection that is lost with the use of cow’s or artificial milk; there were more children in the family, so one passed the disease on to the other and this strengthened the immune system… Over time, all that changed, causing people to face more challenges to develop their immune profile”, highlights the specialist.
Treatment requires medication and lifestyle change.
The treatment of type 2 inflammation involves controlling the underlying pathology, the main ones being, as we mentioned, asthma, atopic dermatitis and rhinosinusitis. “The most common remedy is corticosteroids, which can be topical, inhaled, nasal or oral. The choice will depend on the disease. In addition, it is essential to avoid contact with triggering agents and have a life as healthy as possible”, indicates Jorge Humberto Ardila Veja, pulmonologist at Hospital São Rafael, in Salvador, belonging to Rede D’Or.
In more severe cases, when symptoms persist even after high doses of corticosteroids, the indication is to use immunobiological drugs (monoclonal antibodies), such as omalizumab and dupilumab. Applied subcutaneously or intravenously, they act by blocking the mediators of the inflammatory processes associated with allergies.
“Currently, with these more modern drugs, a good control of diseases and, consequently, of type 2 inflammation is achieved. It is just that it is very important to follow the treatment to the letter. complications, with a high impact on the patient’s quality of life”, observes Ardila Veja.
Among the possible complications are increased frequency of sinusitis and otitis, modification of the dental arch and recurrent pneumonia (rhinosinusitis); airway closure, permanent changes in lung function, and reduced ability to perform day-to-day activities (asthma); and infections of the skin and other tissues (atopic dermatitis).
In addition, patients tend to have emotional changes, depression, anxiety and insomnia, which impacts concentration and productivity and generates high rates of absenteeism from work or school.
“These pathologies are chronic and have no cure, so the goal of treatment is remission. And with the newest drugs that we have today, we can achieve it, control type 2 inflammation and ensure that people stay healthy. free of symptoms and have a better quality of life”, completes Bianchi.
Camila Ferreira Batista, 31, an environmental management analyst and content creator, is precisely at this stage: “I have severe atopic dermatitis, and the symptoms started in early childhood. Over the years I’ve had many treatments, but without good results. Now I am using an immunobiological and I have achieved control. Finally I can say that this is something achievable”.
The resident of São Paulo highlights that the result was not achieved overnight and that, in this process, she went through a lot of suffering. “Dealing with this disease is very painful and tiring; it impacts everything. Before the current treatment, I was ashamed, lived with my skin covered and felt a lot of pain, I didn’t sleep well, I had a bad mood, I missed work a lot and was always refusing invitations to go out. Now the story is different and I make a point of sharing it with people.”
30% of the population suffers from allergies
The incidence of allergies has been increasing year after year worldwide. In Brazil alone, it is estimated that they affect about 30% of the population. In the case of asthma and atopic dermatitis, national epidemiological studies indicate that 10% and 5%, respectively, of Brazilians have these diseases — there are no data on rhinosinusitis.
Learn a little more about each of these diseases below:
Asthma: causes inflammation and narrowing of the bronchi (ducts that connect the windpipe to the lungs), which makes it difficult for air to pass. Its symptoms include shortness of breath or difficulty breathing, wheezing (wheezing), coughing, and a feeling of tightness in the chest. The main triggers are respiratory infections, exercise and exposure to allergens. Asthma is classified as mild, moderate and severe.
Atopic dermatitis: disease that causes inflammation of the skin and has as characteristic number 1 dry skin and intense and constant itching. This condition leads to the appearance of lesions, crusting and peeling, and causes a lot of pain. Atopic dermatitis is not contagious, as many people believe, and among its risk factors are contact with allergens and irritants and stress.
Rhinosinusitis: inflammatory process of the mucosa of the nasal cavity and paranasal sinuses. The list of symptoms includes nasal obstruction and drip, cough, facial pain or pressure, headache, reduced or loss of sense of smell, and bad breath. It can have allergic, viral, bacterial or fungal causes and manifests itself due to contact with dust, animal hair and other substances, as well as changes in weather and smoking.