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com relatos inclusive em crian&#231;as de idades mais precoces&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4&#44;5</span></a> Estudos recentes t&#234;m mostrado uma eleva&#231;&#227;o na preval&#234;ncia da DAC nas crian&#231;as sintom&#225;ticas variando de 27&#37; a 95&#37;&#44; 6&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#8211;8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Dada &#224; disfun&#231;&#227;o da barreira cut&#226;nea que diminui a prote&#231;&#227;o contra agentes ambientais&#44; a dermatite de contato irritativa &#40;DCI&#41; e a dermatite al&#233;rgica de contato &#40;DAC&#41; s&#227;o problemas significativos entre os indiv&#237;duos com DA&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Clinicamente&#44; a DA e a DAC podem ser indistingu&#237;veis&#59; as rea&#231;&#245;es al&#233;rgicas concomitantes foram descritas como poss&#237;veis causas de dermatite at&#243;pica recalcitrante ou resistente &#224; terapia&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;10&#44;11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Embora n&#227;o haja diretrizes consensuais baseadas em evid&#234;ncias para o teste de contato &#40;TC&#41; em crian&#231;as&#44; essa &#233; uma ferramenta segura e &#250;til para identificar a sensibiliza&#231;&#227;o cut&#226;nea&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;12</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A maioria dos estudos sobre preval&#234;ncia e caracter&#237;sticas cl&#237;nicas e epidemiol&#243;gicas da DAC em crian&#231;as e adolescentes com DA s&#227;o retrospectivos e provenientes de centros norte&#8208;americanos e europeus&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2&#44;5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">No Brasil&#44; h&#225; poucos trabalhos sobre DAC na popula&#231;&#227;o pedi&#225;trica e todos realizaram TC utilizando a s&#233;rie padr&#227;o brasileira utilizada em adultos ou s&#233;ries de cosm&#233;ticos&#44; at&#233; o momento n&#227;o h&#225; registros de estudo que tenha utilizado s&#233;rie pedi&#225;trica no Brasil&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;13&#8211;15</span></a> Cabe ressaltar a import&#226;ncia do conhecimento dos sensibilizantes em cada pa&#237;s&#44; face &#224; variabilidade de exposi&#231;&#245;es e diferen&#231;as entre regi&#245;es do mundo&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O presente estudo tem como objetivo verificar os sensibilizantes e a presen&#231;a da DAC em crian&#231;as e adolescentes com DA recalcitrante&#44; al&#233;m do perfil epidemiol&#243;gico e cl&#237;nico dos mesmos&#44; provindos de uma amostra sul Brasileira que foi submetida aos testes de contato com uma s&#233;rie pedi&#225;trica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiais e m&#233;todos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Trata&#8208;se de um estudo transversal&#44; prospectivo&#44; com testes de contato em pacientes com dermatite at&#243;pica recalcitrantes&#44; entre 4 a 18 anos&#44; atendidas no Ambulat&#243;rio de Dermatologia Sanit&#225;ria&#44; Porto Alegre&#44; RS &#40;Brasil&#41;&#44; entre fevereiro de 2019 e mar&#231;o de 2020&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Esse estudo foi aprovado pelos Comit&#234;s de &#201;tica em Pesquisa da Secretaria da Sa&#250;de do Estado do Rio Grande do Sul e da Universidade Federal de Ci&#234;ncias da Sa&#250;de de Porto Alegre &#40;pareceres de n&#250;meros 3&#46;091&#46;016 e 3&#46;084&#46;699&#44; respectivamente&#41;&#46; Foram avaliados apenas os pacientes cujos respons&#225;veis legais assinaram os termos de consentimento&#46; A anamnese e o exame f&#237;sico foram realizados na primeira consulta&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Os pacientes selecionados foram aqueles diagnosticados com dermatite at&#243;pica&#44; seguindo os crit&#233;rios de Hanifin e Radjka modificados<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> e que apresentavam hist&#243;ria de dermatite recalcitrante &#40;ou que recorria logo ap&#243;s a suspens&#227;o do tratamento t&#243;pico&#41; e&#44; portanto&#44; com suspeita cl&#237;nica de dermatite al&#233;rgica de contato&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">10&#8211;12</span></a> Foram exclu&#237;dos os pacientes em uso de corticosteroides ou imunomoduladores t&#243;picos nos &#250;ltimos sete dias&#44; imunossupressores sist&#234;micos ou corticosteroides dentro de 30 dias&#44; exposi&#231;&#227;o &#224; radia&#231;&#227;o ultravioleta 15 dias antes do teste&#44; dermatite no local do teste&#44; hist&#243;ria de anafilaxia&#44; dist&#250;rbios psiqui&#225;tricos ou gravidez&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As vari&#225;veis coletadas foram&#58; idade&#44; sexo&#44; idade de in&#237;cio e dura&#231;&#227;o da dermatite&#44; presen&#231;a de outras doen&#231;as at&#243;picas associadas e hist&#243;ria familiar de doen&#231;as at&#243;picas&#46; Al&#233;m dessas&#44; foram avaliados&#58; o fototipo da pele&#44; a topografia da dermatite e a gravidade da DA por meio do &#205;ndice de &#193;rea e Gravidade do Eczema&#44; o EASI&#58; extens&#227;o por regi&#227;o corporal &#40;face e pesco&#231;o&#44; membros superiores&#44; membros inferiores e tronco&#41; que pode variar de 0 a 100&#37;&#59; intensidade de cada les&#227;o &#40;eritema&#44; edema ou p&#225;pulas&#44; escoria&#231;&#227;o e liquenifica&#231;&#227;o&#41;&#44; em uma escala de 0&#8211;3&#46; A soma dos pontos classifica a doen&#231;a em muito leve &#40;0&#44;1 a 1&#41;&#59; leve &#40;1&#44;1 a 7&#41;&#59; moderada &#40;7&#44;1 a 20&#41;&#59; grave &#40;21&#44;1 a 50&#41;&#59; ou muito grave 50&#44;1 a 72&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Os TC foram realizados com uma bateria pedi&#225;trica modificada&#44; baseada no consenso da For&#231;a&#8208;Tarefa da Dermatite Al&#233;rgica de Contato em Crian&#231;as da Academia Europeia de Alergologia e Imunologia Cl&#237;nica &#40;EAACI&#41; sobre recomenda&#231;&#245;es para o teste de contato com uma s&#233;rie dos principais al&#233;rgenos no grupo pedi&#225;trico&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> A bateria foi elaborada pela empresa IPI &#8208;ASAC Brasil&#174; e adaptada conforme a disponibilidade dos produtos no Brasil&#46; Essa &#233; composta por 20 subst&#226;ncias&#44; incluindo al&#233;rgenos e misturas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> Algumas subst&#226;ncias est&#227;o presentes na bateria padr&#227;o brasileira&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> mas outras n&#227;o existem regionalmente&#44; como o bufexamac &#40;anti&#8208;inflamat&#243;rio&#41; e o pivolato de tixocortol &#40;corticosteroide do grupo A&#41;&#44; que foram removidos&#46; Esse foi substitu&#237;do pela hidrocortisona &#40;mesmo grupo A&#41;&#46; Um componente da mistura de <span class="elsevierStyleItalic">Compositae</span> tamb&#233;m foi exclu&#237;do por falta de mat&#233;ria&#8208;prima&#46; Os al&#233;rgenos foram inseridos nas c&#226;maras de 8<span class="elsevierStyleHsp" style=""></span>mm em contensores Alergo Chamber &#40;Neoflex&#174;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Os procedimentos foram realizados de acordo com as recomenda&#231;&#245;es do Grupo Internacional de Dermatite de Contato &#40;ICDRG&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> Os contensores foram aplicados no dorso dos pacientes e removidos em 48 horas&#46; As leituras foram realizadas em 48<span class="elsevierStyleHsp" style=""></span>h e em 96 horas&#44; ambas pelos mesmos dermatologistas&#46; Os testes com rea&#231;&#245;es classificadas como &#43;&#44; &#43;&#43; ou &#43;&#43;&#43; foram considerados positivos&#46; Somente os resultados das leituras de 96<span class="elsevierStyleHsp" style=""></span>h foram inclu&#237;dos na an&#225;lise estat&#237;stica&#46; Foram considerados pacientes com DAC aqueles que apresentavam os testes positivos em 96 horas com al&#233;rgenos relevantes na atualidade &#40;exposi&#231;&#227;o aos al&#233;rgenos que explicasse o quadro cl&#237;nico do momento&#41;&#46; Os que n&#227;o apresentavam relev&#226;ncia atual foram classificados como sensibilizados&#44; mas n&#227;o portadores de DAC&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A an&#225;lise dos dados foi realizada por meio de software estat&#237;stico para ci&#234;ncias sociais &#40;SPSS&#41; vers&#227;o 25&#46; O teste do Qui&#8208;Quadrado ou o teste de Fisher foram usados para vari&#225;veis categ&#243;ricas&#46; Para as vari&#225;veis cont&#237;nuas&#44; utilizou&#8208;se o teste de Mann Whitney&#46; Valores de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foram considerados estatisticamente significativos&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Foram avaliados 54 pacientes com DA&#46; Utilizando a classifica&#231;&#227;o da Organiza&#231;&#227;o Mundial da Sa&#250;de&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> a amostra foi dividida em dois grupos et&#225;rios&#58; crian&#231;as &#40;4 a 9 anos&#41; e adolescentes &#40;10 a 18 anos&#41;&#59; 31 &#40;57&#44;4&#37;&#41; eram crian&#231;as e 23 &#40;42&#44;6&#37;&#41; eram adolescentes &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; O sexo feminino predominou com 35 pacientes &#40;64&#44;8&#37;&#41;&#44; assim como os fototipos III e IV&#44; com 15 &#40;27&#44;8&#37;&#41; e 21 &#40;38&#44;9&#37;&#41; dos pacientes&#44; respectivamente&#46; A m&#233;dia de idade de in&#237;cio da DA foi de 2&#44;63 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;7&#41;&#44; com mediana de 1&#44;5 anos&#46; A dura&#231;&#227;o m&#233;dia da DA foi de 6&#44;57 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;2&#41; com a mediana de 5 anos&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Outras doen&#231;as at&#243;picas estavam presentes em 45 pacientes &#40;83&#44;3&#37;&#41; e havia hist&#243;ria familiar de atopia em 35 pacientes &#40;64&#44;8&#37;&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; gravidade da DA&#44; a maioria dos pacientes apresentava EASI leve e moderado &#40;35&#44;2&#37; e 46&#44;3&#37;&#44; respectivamente&#41;&#46; Nove &#40;16&#44;7&#37;&#41; tinham doen&#231;a grave e havia apenas um com DA muito grave&#46; As &#225;reas corporais mais acometidas foram&#58; membros inferiores &#40;96&#44;3&#37;&#41;&#44; membros superiores &#40;85&#44;2&#37;&#41;&#44; tronco &#40;68&#44;5&#37;&#41; face e pesco&#231;o &#40;63&#37;&#41;&#46; A dermatite afetava tr&#234;s ou mais &#225;reas em 42 pacientes &#40;78&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Vinte rea&#231;&#245;es positivas em 96 horas foram registradas nos 54 pacientes testados&#44; ou seja&#44; encontramos uma taxa de sensibiliza&#231;&#227;o de 37&#44;07&#37; &#40;20&#47;54&#41;&#46; O &#237;ndice de relev&#226;ncia foi de 75&#37;&#44; ou seja&#44; em 15 pacientes a exposi&#231;&#227;o atual ao sensibilizante respondia pelo quadro cl&#237;nico atual&#46; Dessa forma&#44; a preval&#234;ncia de DAC na nossa amostra foi de 27&#44;7&#37; &#40;15&#47;54&#41; &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tabelas 2 e 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Foi constatado que 11 das 31 crian&#231;as &#40;35&#44;5&#37;&#41; e quatro dos 23 adolescentes &#40;17&#44;4&#37;&#41; apresentaram testes positivos&#44; por&#233;m essa diferen&#231;a n&#227;o alcan&#231;ou signific&#226;ncia estat&#237;stica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;107&#41;&#46; Do mesmo modo&#44; os testes estat&#237;sticos n&#227;o mostraram maior sensibiliza&#231;&#227;o associada &#224;s seguintes vari&#225;veis&#58; fototipo&#44; hist&#243;rico pessoal ou familiar de atopia&#44; idade de in&#237;cio da DA&#44; localiza&#231;&#227;o e gravidade da doen&#231;a&#46; O sexo feminino apresentou uma tend&#234;ncia estat&#237;stica a mais testes positivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;077&#41;&#46; Um per&#237;odo menor de dura&#231;&#227;o da DA &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;5 anos&#59; DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;60 &#91;mediana 3&#44;2 anos&#93;&#41; foi associado a maior frequ&#234;ncia de testes positivos quando comparada com uma dura&#231;&#227;o mais longa da DA &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#44;3 anos&#44; DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;25 &#91;mediana 6 anos&#93;&#41;&#44; com p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Os al&#233;rgenos com maior frequ&#234;ncia de sensibiliza&#231;&#227;o foram&#58; sulfato de n&#237;quel &#40;16&#44;7&#37;&#41;&#44; azul disperso &#40;5&#44;6&#37;&#41; e a mistura de fragr&#226;ncias I &#40;5&#44;6&#37;&#41;&#46; O perfil geral dos al&#233;rgenos &#233; exibido na tabela &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Nenhum al&#233;rgeno foi associado a uma faixa et&#225;ria espec&#237;fica&#59; por&#233;m&#44; foi demonstrada associa&#231;&#227;o entre a sensibiliza&#231;&#227;o ao n&#237;quel e o sexo feminino &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;19&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A s&#237;ndrome da pele excitada &#40;&#8220;<span class="elsevierStyleItalic">angry back syndrome</span>&#8221;&#41; foi detectada em uma crian&#231;a&#46; Rea&#231;&#245;es irritativas apareceram em 11 pacientes &#40;20&#44;4&#37;&#41;&#44; sendo que 10 eram crian&#231;as &#40;entre 4 e 9 anos&#41;&#46; Fragr&#226;ncias e n&#237;quel foram as subst&#226;ncias irritativas mais comuns nas crian&#231;as&#46; N&#227;o havia adolescentes com exposi&#231;&#227;o ocupacional e apenas um com 16 anos apresentou uma rea&#231;&#227;o irritativa &#40;&#224; fragr&#226;ncia mix II&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0115" class="elsevierStylePara elsevierViewall">A rela&#231;&#227;o entre a DA e a DAC ainda n&#227;o &#233; totalmente compreendida&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;5&#44;20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">O Registro de Dermatite de Contato Pedi&#225;trica &#40;PCDR&#41; que cont&#233;m os dados da maior quantidade de TC pedi&#225;trico nos EUA relatou que dentre 49&#37; das crian&#231;as encaminhadas com DA&#44; 42&#37; tamb&#233;m apresentaram DCA&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">No geral&#44; a maioria dos autores n&#227;o encontrou diferen&#231;as significativas na preval&#234;ncia de DAC entre crian&#231;as e adolescentes at&#243;picos e n&#227;o at&#243;picos&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;4&#44;8&#44;13&#44;15&#44;21&#8211;23</span></a> No entanto&#44; muitos dos trabalhos publicados mostraram resultados controversos com rela&#231;&#227;o ao assunto&#46; As taxas de sensibiliza&#231;&#227;o variaram consideravelmente&#44; assim como o delineamento dos estudos em rela&#231;&#227;o ao tamanho e caracter&#237;sticas da amostra&#44; crit&#233;rios diagn&#243;sticos para DA&#44; metodologia de TC e al&#233;rgenos usados&#46; Al&#233;m disso&#44; um vi&#233;s de sele&#231;&#227;o pode ter ocorrido na maioria dos estudos porque as crian&#231;as sem DA foram mais encaminhadas para os testes devido a suspeita de DAC&#44; enquanto aquelas com DA podem ter sido encaminhadas em virtude de reca&#237;da da DA&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Poucos autores publicaram os resultados do TC e o perfil de crian&#231;as e adolescentes com DA&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;3&#44;6&#44;14&#44;24&#8211;35</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Independentemente das crian&#231;as com DA terem um risco aumentado de sensibiliza&#231;&#227;o em compara&#231;&#227;o &#224;s outras&#44; a DAC pode coexistir em at&#233; 30&#37; das crian&#231;as com DA&#44; de acordo com publica&#231;&#245;es recentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2&#44;11</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">As s&#233;ries utilizadas nos TC dos estudos pedi&#225;tricos apresentam varia&#231;&#245;es geogr&#225;ficas na sele&#231;&#227;o de al&#233;rgenos&#44; mas a maioria &#233; da Am&#233;rica do Norte e da Europa&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;5&#44;7</span></a> Este &#233; o primeiro estudo brasileiro a avaliar a preval&#234;ncia e o perfil da DAC em crian&#231;as e adolescentes com DA por meio dos TC com bateria pedi&#225;trica&#46; Nessa amostra&#44; a preval&#234;ncia de DAC foi de 27&#44;7&#37;&#44; coincidindo com as &#250;ltimas revis&#245;es da literatura internacional&#44; em que a preval&#234;ncia variou de 20 a 44&#37; nesse grupo&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;5&#44;7</span></a> Outros autores brasileiros encontraram preval&#234;ncia semelhante &#224; nossa&#44; em amostras n&#227;o extensas&#44; regionalizadas&#44; mas utilizando os testes da bateria padr&#227;o brasileira &#40;30 subst&#226;ncias&#41;&#44; n&#227;o com uma s&#233;rie pedi&#225;trica&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#8211;15</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Alguns estudos encontraram uma alta taxa de testes com rea&#231;&#245;es irritativas &#40;falso&#8208;positivas&#41; nos pacientes com DA&#44; provavelmente devido a um menor limiar de irritabilidade numa barreira cut&#226;nea defeituosa&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;9&#44;14&#44;36</span></a> Em nosso estudo tamb&#233;m apareceram rea&#231;&#245;es irritativas em 20&#44;4&#37; das crian&#231;as&#44; principalmente ao n&#237;quel e a fragr&#226;ncias&#44; na faixa et&#225;ria menor&#46; No entanto&#44; apesar de rea&#231;&#245;es falso&#8208;positivas serem frequentes nos pacientes com DA&#44; rea&#231;&#245;es positivas fracas podem ocorrer e devem ser consideradas positivas verdadeiras&#44; especialmente em pacientes com exacerba&#231;&#227;o da DA&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> Ademais&#44; muitos pacientes tamb&#233;m apresentaram rea&#231;&#245;es positivas fracas relevantes&#44; tal como um estudo pedi&#225;trico brasileiro que relatou 84&#44;2&#37; de TC positivos relevantes com rea&#231;&#245;es de intensidade 1&#43;&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Em nosso estudo&#44; 57&#44;4&#37; da amostra eram crian&#231;as entre 4 a 9 anos de idade e&#44; embora n&#227;o seja significativo&#44; foram encontrados mais resultados positivos nesse grupo mais jovem&#46; Esse achado acompanha os relatos de outros autores sobre altas taxas de sensibiliza&#231;&#227;o em crian&#231;as de faixas et&#225;rias menores&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;4&#44;31</span></a> Por outo lado&#44; como a exposi&#231;&#227;o a al&#233;rgenos aumenta com a idade&#44; mais DAC foi relatada no grupo de adolescentes em diversos estudos&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;13&#44;15</span></a> Ainda em rela&#231;&#227;o &#224; faixa et&#225;ria&#44; s&#227;o descritas diferen&#231;as significativas com alguns al&#233;rgenos&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> Um amplo estudo norte&#8208;americano relatou que crian&#231;as menores foram mais sensibilizadas a ingredientes dos produtos de higiene pessoal&#44; enquanto a sensibiliza&#231;&#227;o ao azul disperso e ao ouro foi mais comum em crian&#231;as maiores&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Em nossa amostra&#44; a idade de in&#237;cio da DA nas crian&#231;as com TC positivos n&#227;o diferiu estatisticamente daquelas com TC negativos&#44; coincidindo com os achados de Labadie et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> Da mesma maneira&#44; n&#227;o encontramos associa&#231;&#227;o entre o fototipo e mais TC positivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;361&#41;&#46; Poucos estudos inclu&#237;ram essa vari&#225;vel e um sugeriu que as tend&#234;ncias &#233;tnicas e culturais&#44; como <span class="elsevierStyleItalic">body piercing</span>&#44; poderiam influenciar na incid&#234;ncia de DAC&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Como v&#225;rios estudos&#44; tamb&#233;m observamos maior n&#250;mero de pacientes do sexo feminino encaminhados &#40;64&#44;8&#37;&#41; e com maior tend&#234;ncia a TC positivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;077&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;13&#44;15&#44;21&#44;26</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Em nosso estudo&#44; uma menor dura&#231;&#227;o da DA &#40;mediana de 3&#44;2 anos&#41; foi associada a mais testes positivos do que uma dura&#231;&#227;o mais longa&#46; Isso pode ser decorrente do predom&#237;nio de crian&#231;as menores referidas &#40;57&#44;4&#37; com idades entre 4 a 9 anos&#41;&#46; O maior estudo pedi&#225;trico norte&#8208;americano tamb&#233;m encontrou mais TC positivos naquelas com dermatite de menor dura&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">A associa&#231;&#227;o entre a presen&#231;a de outras doen&#231;as at&#243;picas ou hist&#243;rico familiar e maior sensibiliza&#231;&#227;o n&#227;o foi encontrada na nossa amostra&#46; Outros trabalhos tamb&#233;m n&#227;o relataram diferen&#231;as significativas entre atopia e os grupos et&#225;rios com TC positivos&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;8&#44;25</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">A maioria dos nossos pacientes apresentava les&#245;es de DA em mais de duas regi&#245;es corporais&#44; como no estudo de Rodrigues et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> Outros autores tamb&#233;m relataram dermatite mais difusa &#40;espalhada&#41; dentre aquelas crian&#231;as testadas&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;7</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Associa&#231;&#245;es significativas foram descritas entre DA&#44; DAC e eczema de m&#227;os em adolescentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;9&#44;35</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">No presente trabalho&#44; como havia mais pacientes com DA leve a moderada&#44; nenhuma correla&#231;&#227;o foi poss&#237;vel entre maior gravidade da doen&#231;a e maior sensibiliza&#231;&#227;o al&#233;rgica&#46; Da mesma maneira&#44; Ozceker et al&#46; n&#227;o encontraram mais DAC nas crian&#231;as com DA grave&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> No entanto&#44; outros autores relataram associa&#231;&#227;o entre mais TC positivos e doen&#231;a mais grave&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;32&#44;34</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">De fato&#44; alguns trabalhos sugeriram que o limiar de sensibiliza&#231;&#227;o estaria inversamente relacionado &#224; gravidade da DA&#46; Uma menor positividade nas rea&#231;&#245;es dos TC em pacientes com DA grave poderia ser explicada pelo aumento da c&#233;lula T helper 2 &#40;Th2&#41; em oposi&#231;&#227;o ao desvio da c&#233;lula T helper 1 &#40;Th1&#41; do sistema imune&#44; tradicionalmente observado na DAC&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;10&#44;30</span></a></p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Perfil de sensibiliza&#231;&#227;o aos al&#233;rgenos</span><p id="par0190" class="elsevierStylePara elsevierViewall">Os resultados dos trabalhos sobre a preval&#234;ncia de DAC e a frequ&#234;ncia dos al&#233;rgenos sensibilizantes em crian&#231;as e adolescentes com DA apresentaram varia&#231;&#245;es de acordo com a amostra selecionada&#44; o tempo de exposi&#231;&#227;o&#44; o tipo e a quantidade de subst&#226;ncias testadas&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;7&#44;37</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Importante ressaltar que h&#225; diferen&#231;as na sele&#231;&#227;o de al&#233;rgenos das baterias de TC utilizadas nos estudos pedi&#225;tricos mundiais&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> por&#233;m as mais aplicadas s&#227;o as do grupo norte&#8208;americano de dermatite de contato &#40;NACDG&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> e do Registro de Dermatite de Contato Pedi&#225;trica &#40;PCDR&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> Muitos estudos na Europa usaram s&#233;ries padr&#227;o ou regionais de acordo com o Sistema Europeu de Vigil&#226;ncia em Alergias de Contato &#40;ESSCA&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">38&#44;39</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Recentemente&#44; baseada em uma pesquisa de consenso&#44; a Sociedade Americana de Dermatite de Contato prop&#244;s uma s&#233;rie pedi&#225;trica para crian&#231;as de 6 a 18 anos&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">39&#44;40</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">No entanto&#44; essas baterias propostas n&#227;o s&#227;o direcionadas especificamente &#224;s crian&#231;as com DA&#46; O perfil de sensibiliza&#231;&#227;o aos al&#233;rgenos parece ser diferente nessa popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;5&#44;11&#44;23</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">Em nosso estudo&#44; todos os pacientes com DA foram testados com uma bateria pedi&#225;trica&#44; seguindo as recomenda&#231;&#245;es do EAACI&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> mas adaptada &#224; realidade brasileira &#40;substitui&#231;&#227;o de tr&#234;s subst&#226;ncias&#41;&#46; Os al&#233;rgenos com maiores taxas de sensibiliza&#231;&#227;o&#44; em ordem de frequ&#234;ncia&#44; foram&#58; sulfato de n&#237;quel&#44; azul disperso&#44; mistura de fragr&#226;ncias I e neomicina&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Uma recente publica&#231;&#227;o nos EUA sobre DCA em crian&#231;as ressaltou os principais al&#233;rgenos naquelas com DA&#58; n&#237;quel&#44; mistura de fragr&#226;ncias I&#44; b&#225;lsamo do Peru&#44; bacitracina&#44; lanolina&#44; formalde&#237;do e neomicina&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Teo et al&#46;&#44; numa extensa revis&#227;o de estudos comparando DAC em indiv&#237;duos sem DA e com DA&#44; destacaram nesses &#250;ltimos os 10 al&#233;rgenos mais comuns&#58; n&#237;quel&#44; fragr&#226;ncia mix I&#44; metilisotiazolinona &#40;MI&#41;&#44; cobalto&#44; colof&#244;nia&#44; neomicina&#44; p&#8208;fenilenodiamina &#40;PPD&#41;&#44; tiuram mix&#44; b&#225;lsamo do Peru e metabissulfito de s&#243;dio&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> Tr&#234;s desses &#40;n&#237;quel&#44; fragr&#226;ncias e neomicina&#41; tamb&#233;m foram os mais frequentes em nosso estudo&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Os pacientes com DA podem ter maior risco de sensibiliza&#231;&#227;o devido a uma barreira defeituosa e ao uso frequente de produtos t&#243;picos &#40;cuidados com a pele e medicamentos&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;2&#44;9&#44;37</span></a> Al&#233;m disso&#44; um grande estudo multic&#234;ntrico &#40;11 pa&#237;ses europeus&#41; sugeriu que as crian&#231;as com DA recalcitrante tamb&#233;m deveriam ser testadas para metais&#44; corantes dispersos e C<span class="elsevierStyleItalic">ompositae&#46;</span><a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Como constatado em v&#225;rias publica&#231;&#245;es&#44; no presente estudo&#44; o n&#237;quel foi tamb&#233;m o al&#233;rgeno mais sensibilizante<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;14&#44;26&#44;28&#44;29&#44;31</span></a> e o mais associado ao sexo feminino &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;11&#44;13&#44;31&#44;33</span></a> A sensibiliza&#231;&#227;o ao n&#237;quel tem sido relacionada ao h&#225;bito de furar orelhas &#40;<span class="elsevierStyleItalic">ear piercing&#41;&#46;</span> Brinquedos&#44; roupas &#40;z&#237;peres&#44; bot&#245;es etc&#46;&#41; e equipamentos eletr&#244;nicos &#40;<span class="elsevierStyleItalic">tablets</span> e telefones celulares&#41; s&#227;o fontes cont&#237;nuas de libera&#231;&#227;o de n&#237;quel&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;11</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">O corante azul disperso foi o segundo al&#233;rgeno frequente em nosso estudo&#46; Os corantes dispersos &#40;<span class="elsevierStyleItalic">disperse dyes</span>&#41;&#44; presentes em roupas de cores intensas ou brilhantes e em alguns cosm&#233;ticos infantis&#44; s&#227;o potenciais al&#233;rgenos em crian&#231;as&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;12</span></a> Embora tais subst&#226;ncias n&#227;o fa&#231;am parte da bateria padr&#227;o brasileira&#44; sua import&#226;ncia em crian&#231;as com DA vem sendo mencionada em estudos recentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">22&#44;25&#44;26</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Os emolientes s&#227;o os principais produtos de cuidados com a pele usados no tratamento da DA&#46; Dermatites de contato a fragr&#226;ncias e conservantes contidos nesses emolientes podem desempenhar um papel no agravamento da doen&#231;a&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;3&#44;11&#44;12</span></a> As fragr&#226;ncias mix I e II foram encontradas&#44; em ordem de frequ&#234;ncia&#44; como o terceiro e o quinto al&#233;rgeno&#44; respectivamente&#44; em nosso estudo&#46; As fragr&#226;ncias est&#227;o entre as principais subst&#226;ncias presentes em brinquedos e outros produtos perfumados voltados para crian&#231;as&#44; mesmo naqueles rotulados como &#8220;sem fragr&#226;ncia&#8221; que podem conter ingredientes relacionados&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">A neomicina&#44; o quarto al&#233;rgeno frequente em nosso estudo&#44; &#233; um antibi&#243;tico amplamente presente em prepara&#231;&#245;es e medicamentos t&#243;picos e h&#225; muito tempo figura entre os principais al&#233;rgenos em crian&#231;as&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;21&#44;25</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">Indiv&#237;duos com DA podem ter mais sensibiliza&#231;&#227;o aos conservantes&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> Sensibiliza&#231;&#227;o &#224; metilcloroisotiazolinona&#44; &#224; metilisotiazolinona e &#224; associa&#231;&#227;o MCI&#47;MI presentes em cosm&#233;ticos&#44; produtos de limpeza e de higiene vem aumentando em estudos recentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;28</span></a> O formalde&#237;do e os liberadores de formalde&#237;do tamb&#233;m s&#227;o conservantes comuns em produtos de uso di&#225;rio<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a> e est&#227;o entre os cinco principais al&#233;rgenos em um grande estudo pedi&#225;trico em DA&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> No entanto&#44; em nosso estudo&#44; somente um paciente apresentou sensibiliza&#231;&#227;o ao formalde&#237;do e outro &#224; associa&#231;&#227;o MCI&#47;MI&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Apesar de v&#225;rios autores mencionarem alergia aos corticosteroides t&#243;picos principalmente em pacientes com DA resistente ao tratamento&#44; em nossa amostra n&#227;o encontramos testes positivos aos corticosteroides menos potentes &#40;grupo A&#41; presentes na bateria pedi&#225;trica&#46; Alguns estudos atribuem esse resultado negativo ao fato de aqueles pacientes com doen&#231;a recalcitrante utilizarem mais os corticosteroides de maior pot&#234;ncia &#40;grupos B e D&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">Considerando que determinados al&#233;rgenos parecem apresentar padr&#245;es espec&#237;ficos conforme a idade&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;21&#44;26</span></a> alguns autores sugerem TC com diferentes s&#233;ries direcionadas &#224;s crian&#231;as e aos adolescentes&#58;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> s&#233;ries reduzidas nas crian&#231;as &#40;pela menor superf&#237;cie corporal&#41;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4&#44;6&#44;25&#44;29</span></a> e s&#233;ries estendidas nos adolescentes &#40;maior exposi&#231;&#227;o&#44; inclusive ocupacional&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">28&#44;40</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">No entanto&#44; os autores concordam na dificuldade de designar uma s&#233;rie de subst&#226;ncias ideal para triagem na popula&#231;&#227;o pedi&#225;trica e recomendam o uso de baterias regionais e personalizadas com subst&#226;ncias dos produtos do paciente baseadas no hist&#243;rico de exposi&#231;&#227;o e na relev&#226;ncia cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;28&#44;39&#44;40</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">O ponto forte deste estudo &#233; ser o primeiro no Brasil &#40;de nosso conhecimento&#41; a realizar testes de contato em crian&#231;as com DA com empregando bateria pedi&#225;trica para avaliar a preval&#234;ncia&#44; o perfil dos sensibilizantes e da DAC nesse grupo vulner&#225;vel&#46; As principais limita&#231;&#245;es desta pesquisa poderiam ser o tamanho amostral&#44; a aus&#234;ncia de grupo controle a ser testado com a bateria padr&#227;o brasileira para comparar com outros estudos e o fato de nossos pacientes serem provenientes de um servi&#231;o de sa&#250;de p&#250;blica &#40;influ&#234;ncias socioecon&#244;micas na exposi&#231;&#227;o a determinados al&#233;rgenos&#41;&#46; Por ser um estudo que abre a discuss&#227;o sobre o uso da s&#233;rie pedi&#225;trica em dermatite at&#243;pica recalcitrante&#44; o delineamento transversal &#233; o delineamento correspondente aos objetivos&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclus&#245;es</span><p id="par0275" class="elsevierStylePara elsevierViewall">A DAC pode coexistir e desempenhar um papel no agravamento da DA&#46; Quase 1&#47;3 das crian&#231;as e dos adolescentes com DA de uma amostra do Sul do Brasil atendidas no sistema p&#250;blico de sa&#250;de foi diagnosticada com DAC&#44; por meio dos testes de contato com bateria pedi&#225;trica&#46; Os al&#233;rgenos mais importantes nessa popula&#231;&#227;o foram o sulfato de n&#237;quel&#44; o azul disperse&#44; as fragr&#226;ncias e a neomicina&#46; Futuros estudos multic&#234;ntricos&#44; com amostras maiores&#44; grupos de controle e metodologias padronizadas s&#227;o necess&#225;rios&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Nosso estudo contribui para acrescentar informa&#231;&#245;es sobre sensibilizantes em crian&#231;as e adolescentes com DA recalcitrante&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Suporte financeiro</span><p id="par0285" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Contribui&#231;&#227;o dos autores</span><p id="par0290" class="elsevierStylePara elsevierViewall">Cristiane Almeida Soares Cattani&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Renan Rangel Bonamigo&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Kenselyn Oppermann&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Simone Perazzoli&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Nathalia Hoffmann Guarda&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Paula Bar&#233;a&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflito de interesses</span><p id="par0320" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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              "titulo" => "Perfil de sensibiliza&#231;&#227;o aos al&#233;rgenos"
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    "fechaRecibido" => "2021-06-04"
    "fechaAceptado" => "2021-08-11"
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          "palabras" => array:5 [
            0 => "Adolescente"
            1 => "Crian&#231;a"
            2 => "Dermatite al&#233;rgica de contato"
            3 => "Dermatite at&#243;pica"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A dermatite at&#243;pica &#233; a doen&#231;a cut&#226;nea inflamat&#243;ria mais comum na inf&#226;ncia e ocasiona importante impacto na qualidade de vida &#8211; principalmente as graves&#44; ou recalcitrantes aos tratamentos&#46; A sensibiliza&#231;&#227;o a al&#233;rgenos com potencial para o surgimento de dermatite al&#233;rgica de contato &#233; um fator associado &#224; recalcitr&#226;ncia da dermatite at&#243;pica&#46; Compreender a rela&#231;&#227;o entre a dermatite at&#243;pica&#44; al&#233;rgenos e dermatite al&#233;rgica de contato &#233; essencial para o tratamento dos pacientes&#46; No Brasil&#44; n&#227;o h&#225; estudos sobre a sensibiliza&#231;&#227;o a al&#233;rgenos utilizando&#8208;se testes de contato em crian&#231;as com dermatite at&#243;pica&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Verificar os principais sensibilizantes&#44; a preval&#234;ncia de dermatite de contato al&#233;rgica e o perfil epidemiol&#243;gico e cl&#237;nico de crian&#231;as e adolescentes com dermatite at&#243;pica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal&#44; prospectivo&#44; em pacientes entre 4 e 18 anos de idade&#44; com dermatite at&#243;pica recalcitrante&#44; atendidos no Ambulat&#243;rio de Dermatologia Sanit&#225;ria &#40;RS&#41;&#46; Todos foram submetidos a testes de contato com uma bateria com al&#233;rgenos de s&#233;rie pedi&#225;trica&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As preval&#234;ncias de sensibiliza&#231;&#227;o e de dermatite al&#233;rgica de contato nos pacientes avaliados foram de 37&#44;07&#37; &#40;20&#47;54&#41; e 27&#44;7&#37; &#40;15&#47;54&#41;&#44; respectivamente&#46; Os al&#233;rgenos mais frequentes foram&#58; sulfato de n&#237;quel &#40;16&#44;7&#37;&#41;&#44; azul disperse &#40;5&#44;6&#37;&#41; e fragr&#226;ncia mix I &#40;5&#44;6&#37;&#41;&#46; O n&#237;quel foi associado ao sexo feminino &#40;p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;019&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Tamanho e sele&#231;&#227;o amostral&#44; aus&#234;ncia de grupo controle&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Uma parcela dos pacientes com dermatite at&#243;pica recalcitrante pode estar sensibilizada a diferentes al&#233;rgenos e mesmo ter desenvolvido dermatite al&#233;rgica de contato&#46; Reconhecer esse contexto &#233; importante na estrat&#233;gia de preven&#231;&#227;o e no manejo da doen&#231;a&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Fundamentos"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivos"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Limita&#231;&#245;es do estudo"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Como citar este artigo&#58; Cattani CAS&#44; Oppermann K&#44; Perazzoli S&#44; Guarda NH&#44; Bar&#233;a P&#44; Bonamigo RR&#46; Sensitizing agents found in children and adolescents with recalcitrant atopic dermatitis&#58; a cross&#8208;sectional study with a pediatric battery&#46; An Bras Dermatol&#46; 2022&#59;97&#58;307&#8211;14&#46;</p>"
      ]
    ]
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        "detalles" => array:1 [
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            "identificador" => "at1"
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        "tabla" => array:2 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Subst&#226;ncia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Concent<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ve&#237;culo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#8208; Acetato de hidrocortisona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8208; Lanolina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8208; Azul disperse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#8208; Bicromato de pot&#225;ssio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#8208; Budesonida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#8208; P&#8208;terc&#8208;butilfenol formalde&#237;do resina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#8208; Colof&#244;nia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#8208; <span class="elsevierStyleItalic">Compositae</span> mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#8208; Fragr&#226;ncia mix II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8208; Mercaptobenzotiazol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#8208; Lyral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#8208; Mercapto mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#8208; Metilcloroisotiazolinona&#47;Metilisotiazolinona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#193;gua&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#8208; Metildibromo glutaronitrilo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">15&#8208; Neomicina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">17&#8208; Fragr&#226;ncia mix I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">20&#8208; Tiuram mix&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;10&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;37&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;123&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;077&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;35&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">10&#8211;18 a &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;347&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fototipo</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;26&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;361&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VI &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atopia pessoal<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim &#40;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;28&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fisher&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;22&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atopia familiar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;34&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;279&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;258&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;15&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escore EASI</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leve &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;26&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderado &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;544&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;901&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grave &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muito grave &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Local da dermatite</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Face&#47;Pesco&#231;o &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;23&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;826&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;363&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MsSs &#40;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fisher&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tronco &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;32&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fisher&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;338&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MsIs &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fisher&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dura&#231;&#227;o da DA &#40;anos&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MW&#8208;U<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mediana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idade inicial da DA &#40;anos&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MW&#8208;U<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>274&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;720&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mediana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Dermatite at&#243;pica e testes de contato&#58; caracter&#237;sticas da amostra &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>54&#41; e associa&#231;&#245;es</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">TCP&#44; n&#250;mero de testes de contato positivos&#59; a&#44; anos de idade&#59; FM I&#44; fragr&#226;ncia mix I&#59; FM II&#44; fragr&#226;ncia mix II&#59; MCI&#47;MI&#44; metilcloroisotiazolinona&#47;metilisotiazolinona&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">OBS&#58; Demais alergenos da bateria&#44; todos com resultados negativos&#58; tiuram mix&#44; colof&#244;nia&#44; mercaptobenzotiazol&#44; sesquiterpene lactone mix&#44; lyral&#44; p&#8208;terc&#8208;butilfenol formaldeido resina&#44; bicromato de pot&#225;ssio&#44; &#225;lcool lanolina&#44; p&#8208;fenilenodiamina&#44; <span class="elsevierStyleItalic">Compositae</span> mix&#44; acetato de hidrocortisona&#44; budesonida&#44; metildibromoglutaronitrilo&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">4&#8211;9an<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">10&#8211;18&#170;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p<span class="elsevierStyleItalic">&#8208;</span>valor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Relev&#226;ncia cl&#237;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Sulfato n&#237;quel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;25&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;019&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;22&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;273&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Azul disperso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;10&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;280&nbsp;\t\t\t\t\t\t\n
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Artigo original
Sensibilizantes encontrados em crianças e adolescentes com dermatite atópica recalcitrante: estudo transversal com bateria pediátrica
Cristiane Almeida Soares Cattania,b,
Corresponding author
crisalmeidacattani@gmail.com

Autor para correspondência.
, Kenselyn Oppermanna, Simone Perazzolia, Nathalia Hoffmann Guardaa, Paula Baréaa, Renan Rangel Bonamigob,c
a Ambulatório de Dermatologia Sanitária, Secretaria da Saúde do Estado do Rio Grande do Sul, Porto Alegre, RS, Brasil
b Programa de Pós‐Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
c Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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com relatos inclusive em crian&#231;as de idades mais precoces&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4&#44;5</span></a> Estudos recentes t&#234;m mostrado uma eleva&#231;&#227;o na preval&#234;ncia da DAC nas crian&#231;as sintom&#225;ticas variando de 27&#37; a 95&#37;&#44; 6&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#8211;8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Dada &#224; disfun&#231;&#227;o da barreira cut&#226;nea que diminui a prote&#231;&#227;o contra agentes ambientais&#44; a dermatite de contato irritativa &#40;DCI&#41; e a dermatite al&#233;rgica de contato &#40;DAC&#41; s&#227;o problemas significativos entre os indiv&#237;duos com DA&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Clinicamente&#44; a DA e a DAC podem ser indistingu&#237;veis&#59; as rea&#231;&#245;es al&#233;rgicas concomitantes foram descritas como poss&#237;veis causas de dermatite at&#243;pica recalcitrante ou resistente &#224; terapia&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;10&#44;11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Embora n&#227;o haja diretrizes consensuais baseadas em evid&#234;ncias para o teste de contato &#40;TC&#41; em crian&#231;as&#44; essa &#233; uma ferramenta segura e &#250;til para identificar a sensibiliza&#231;&#227;o cut&#226;nea&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;12</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A maioria dos estudos sobre preval&#234;ncia e caracter&#237;sticas cl&#237;nicas e epidemiol&#243;gicas da DAC em crian&#231;as e adolescentes com DA s&#227;o retrospectivos e provenientes de centros norte&#8208;americanos e europeus&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2&#44;5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">No Brasil&#44; h&#225; poucos trabalhos sobre DAC na popula&#231;&#227;o pedi&#225;trica e todos realizaram TC utilizando a s&#233;rie padr&#227;o brasileira utilizada em adultos ou s&#233;ries de cosm&#233;ticos&#44; at&#233; o momento n&#227;o h&#225; registros de estudo que tenha utilizado s&#233;rie pedi&#225;trica no Brasil&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;13&#8211;15</span></a> Cabe ressaltar a import&#226;ncia do conhecimento dos sensibilizantes em cada pa&#237;s&#44; face &#224; variabilidade de exposi&#231;&#245;es e diferen&#231;as entre regi&#245;es do mundo&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O presente estudo tem como objetivo verificar os sensibilizantes e a presen&#231;a da DAC em crian&#231;as e adolescentes com DA recalcitrante&#44; al&#233;m do perfil epidemiol&#243;gico e cl&#237;nico dos mesmos&#44; provindos de uma amostra sul Brasileira que foi submetida aos testes de contato com uma s&#233;rie pedi&#225;trica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiais e m&#233;todos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Trata&#8208;se de um estudo transversal&#44; prospectivo&#44; com testes de contato em pacientes com dermatite at&#243;pica recalcitrantes&#44; entre 4 a 18 anos&#44; atendidas no Ambulat&#243;rio de Dermatologia Sanit&#225;ria&#44; Porto Alegre&#44; RS &#40;Brasil&#41;&#44; entre fevereiro de 2019 e mar&#231;o de 2020&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Esse estudo foi aprovado pelos Comit&#234;s de &#201;tica em Pesquisa da Secretaria da Sa&#250;de do Estado do Rio Grande do Sul e da Universidade Federal de Ci&#234;ncias da Sa&#250;de de Porto Alegre &#40;pareceres de n&#250;meros 3&#46;091&#46;016 e 3&#46;084&#46;699&#44; respectivamente&#41;&#46; Foram avaliados apenas os pacientes cujos respons&#225;veis legais assinaram os termos de consentimento&#46; A anamnese e o exame f&#237;sico foram realizados na primeira consulta&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Os pacientes selecionados foram aqueles diagnosticados com dermatite at&#243;pica&#44; seguindo os crit&#233;rios de Hanifin e Radjka modificados<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> e que apresentavam hist&#243;ria de dermatite recalcitrante &#40;ou que recorria logo ap&#243;s a suspens&#227;o do tratamento t&#243;pico&#41; e&#44; portanto&#44; com suspeita cl&#237;nica de dermatite al&#233;rgica de contato&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">10&#8211;12</span></a> Foram exclu&#237;dos os pacientes em uso de corticosteroides ou imunomoduladores t&#243;picos nos &#250;ltimos sete dias&#44; imunossupressores sist&#234;micos ou corticosteroides dentro de 30 dias&#44; exposi&#231;&#227;o &#224; radia&#231;&#227;o ultravioleta 15 dias antes do teste&#44; dermatite no local do teste&#44; hist&#243;ria de anafilaxia&#44; dist&#250;rbios psiqui&#225;tricos ou gravidez&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As vari&#225;veis coletadas foram&#58; idade&#44; sexo&#44; idade de in&#237;cio e dura&#231;&#227;o da dermatite&#44; presen&#231;a de outras doen&#231;as at&#243;picas associadas e hist&#243;ria familiar de doen&#231;as at&#243;picas&#46; Al&#233;m dessas&#44; foram avaliados&#58; o fototipo da pele&#44; a topografia da dermatite e a gravidade da DA por meio do &#205;ndice de &#193;rea e Gravidade do Eczema&#44; o EASI&#58; extens&#227;o por regi&#227;o corporal &#40;face e pesco&#231;o&#44; membros superiores&#44; membros inferiores e tronco&#41; que pode variar de 0 a 100&#37;&#59; intensidade de cada les&#227;o &#40;eritema&#44; edema ou p&#225;pulas&#44; escoria&#231;&#227;o e liquenifica&#231;&#227;o&#41;&#44; em uma escala de 0&#8211;3&#46; A soma dos pontos classifica a doen&#231;a em muito leve &#40;0&#44;1 a 1&#41;&#59; leve &#40;1&#44;1 a 7&#41;&#59; moderada &#40;7&#44;1 a 20&#41;&#59; grave &#40;21&#44;1 a 50&#41;&#59; ou muito grave 50&#44;1 a 72&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Os TC foram realizados com uma bateria pedi&#225;trica modificada&#44; baseada no consenso da For&#231;a&#8208;Tarefa da Dermatite Al&#233;rgica de Contato em Crian&#231;as da Academia Europeia de Alergologia e Imunologia Cl&#237;nica &#40;EAACI&#41; sobre recomenda&#231;&#245;es para o teste de contato com uma s&#233;rie dos principais al&#233;rgenos no grupo pedi&#225;trico&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> A bateria foi elaborada pela empresa IPI &#8208;ASAC Brasil&#174; e adaptada conforme a disponibilidade dos produtos no Brasil&#46; Essa &#233; composta por 20 subst&#226;ncias&#44; incluindo al&#233;rgenos e misturas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> Algumas subst&#226;ncias est&#227;o presentes na bateria padr&#227;o brasileira&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> mas outras n&#227;o existem regionalmente&#44; como o bufexamac &#40;anti&#8208;inflamat&#243;rio&#41; e o pivolato de tixocortol &#40;corticosteroide do grupo A&#41;&#44; que foram removidos&#46; Esse foi substitu&#237;do pela hidrocortisona &#40;mesmo grupo A&#41;&#46; Um componente da mistura de <span class="elsevierStyleItalic">Compositae</span> tamb&#233;m foi exclu&#237;do por falta de mat&#233;ria&#8208;prima&#46; Os al&#233;rgenos foram inseridos nas c&#226;maras de 8<span class="elsevierStyleHsp" style=""></span>mm em contensores Alergo Chamber &#40;Neoflex&#174;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Os procedimentos foram realizados de acordo com as recomenda&#231;&#245;es do Grupo Internacional de Dermatite de Contato &#40;ICDRG&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> Os contensores foram aplicados no dorso dos pacientes e removidos em 48 horas&#46; As leituras foram realizadas em 48<span class="elsevierStyleHsp" style=""></span>h e em 96 horas&#44; ambas pelos mesmos dermatologistas&#46; Os testes com rea&#231;&#245;es classificadas como &#43;&#44; &#43;&#43; ou &#43;&#43;&#43; foram considerados positivos&#46; Somente os resultados das leituras de 96<span class="elsevierStyleHsp" style=""></span>h foram inclu&#237;dos na an&#225;lise estat&#237;stica&#46; Foram considerados pacientes com DAC aqueles que apresentavam os testes positivos em 96 horas com al&#233;rgenos relevantes na atualidade &#40;exposi&#231;&#227;o aos al&#233;rgenos que explicasse o quadro cl&#237;nico do momento&#41;&#46; Os que n&#227;o apresentavam relev&#226;ncia atual foram classificados como sensibilizados&#44; mas n&#227;o portadores de DAC&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A an&#225;lise dos dados foi realizada por meio de software estat&#237;stico para ci&#234;ncias sociais &#40;SPSS&#41; vers&#227;o 25&#46; O teste do Qui&#8208;Quadrado ou o teste de Fisher foram usados para vari&#225;veis categ&#243;ricas&#46; Para as vari&#225;veis cont&#237;nuas&#44; utilizou&#8208;se o teste de Mann Whitney&#46; Valores de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foram considerados estatisticamente significativos&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Foram avaliados 54 pacientes com DA&#46; Utilizando a classifica&#231;&#227;o da Organiza&#231;&#227;o Mundial da Sa&#250;de&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> a amostra foi dividida em dois grupos et&#225;rios&#58; crian&#231;as &#40;4 a 9 anos&#41; e adolescentes &#40;10 a 18 anos&#41;&#59; 31 &#40;57&#44;4&#37;&#41; eram crian&#231;as e 23 &#40;42&#44;6&#37;&#41; eram adolescentes &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; O sexo feminino predominou com 35 pacientes &#40;64&#44;8&#37;&#41;&#44; assim como os fototipos III e IV&#44; com 15 &#40;27&#44;8&#37;&#41; e 21 &#40;38&#44;9&#37;&#41; dos pacientes&#44; respectivamente&#46; A m&#233;dia de idade de in&#237;cio da DA foi de 2&#44;63 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;7&#41;&#44; com mediana de 1&#44;5 anos&#46; A dura&#231;&#227;o m&#233;dia da DA foi de 6&#44;57 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;2&#41; com a mediana de 5 anos&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Outras doen&#231;as at&#243;picas estavam presentes em 45 pacientes &#40;83&#44;3&#37;&#41; e havia hist&#243;ria familiar de atopia em 35 pacientes &#40;64&#44;8&#37;&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; gravidade da DA&#44; a maioria dos pacientes apresentava EASI leve e moderado &#40;35&#44;2&#37; e 46&#44;3&#37;&#44; respectivamente&#41;&#46; Nove &#40;16&#44;7&#37;&#41; tinham doen&#231;a grave e havia apenas um com DA muito grave&#46; As &#225;reas corporais mais acometidas foram&#58; membros inferiores &#40;96&#44;3&#37;&#41;&#44; membros superiores &#40;85&#44;2&#37;&#41;&#44; tronco &#40;68&#44;5&#37;&#41; face e pesco&#231;o &#40;63&#37;&#41;&#46; A dermatite afetava tr&#234;s ou mais &#225;reas em 42 pacientes &#40;78&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Vinte rea&#231;&#245;es positivas em 96 horas foram registradas nos 54 pacientes testados&#44; ou seja&#44; encontramos uma taxa de sensibiliza&#231;&#227;o de 37&#44;07&#37; &#40;20&#47;54&#41;&#46; O &#237;ndice de relev&#226;ncia foi de 75&#37;&#44; ou seja&#44; em 15 pacientes a exposi&#231;&#227;o atual ao sensibilizante respondia pelo quadro cl&#237;nico atual&#46; Dessa forma&#44; a preval&#234;ncia de DAC na nossa amostra foi de 27&#44;7&#37; &#40;15&#47;54&#41; &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tabelas 2 e 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Foi constatado que 11 das 31 crian&#231;as &#40;35&#44;5&#37;&#41; e quatro dos 23 adolescentes &#40;17&#44;4&#37;&#41; apresentaram testes positivos&#44; por&#233;m essa diferen&#231;a n&#227;o alcan&#231;ou signific&#226;ncia estat&#237;stica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;107&#41;&#46; Do mesmo modo&#44; os testes estat&#237;sticos n&#227;o mostraram maior sensibiliza&#231;&#227;o associada &#224;s seguintes vari&#225;veis&#58; fototipo&#44; hist&#243;rico pessoal ou familiar de atopia&#44; idade de in&#237;cio da DA&#44; localiza&#231;&#227;o e gravidade da doen&#231;a&#46; O sexo feminino apresentou uma tend&#234;ncia estat&#237;stica a mais testes positivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;077&#41;&#46; Um per&#237;odo menor de dura&#231;&#227;o da DA &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;5 anos&#59; DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;60 &#91;mediana 3&#44;2 anos&#93;&#41; foi associado a maior frequ&#234;ncia de testes positivos quando comparada com uma dura&#231;&#227;o mais longa da DA &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#44;3 anos&#44; DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;25 &#91;mediana 6 anos&#93;&#41;&#44; com p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Os al&#233;rgenos com maior frequ&#234;ncia de sensibiliza&#231;&#227;o foram&#58; sulfato de n&#237;quel &#40;16&#44;7&#37;&#41;&#44; azul disperso &#40;5&#44;6&#37;&#41; e a mistura de fragr&#226;ncias I &#40;5&#44;6&#37;&#41;&#46; O perfil geral dos al&#233;rgenos &#233; exibido na tabela &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Nenhum al&#233;rgeno foi associado a uma faixa et&#225;ria espec&#237;fica&#59; por&#233;m&#44; foi demonstrada associa&#231;&#227;o entre a sensibiliza&#231;&#227;o ao n&#237;quel e o sexo feminino &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;19&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A s&#237;ndrome da pele excitada &#40;&#8220;<span class="elsevierStyleItalic">angry back syndrome</span>&#8221;&#41; foi detectada em uma crian&#231;a&#46; Rea&#231;&#245;es irritativas apareceram em 11 pacientes &#40;20&#44;4&#37;&#41;&#44; sendo que 10 eram crian&#231;as &#40;entre 4 e 9 anos&#41;&#46; Fragr&#226;ncias e n&#237;quel foram as subst&#226;ncias irritativas mais comuns nas crian&#231;as&#46; N&#227;o havia adolescentes com exposi&#231;&#227;o ocupacional e apenas um com 16 anos apresentou uma rea&#231;&#227;o irritativa &#40;&#224; fragr&#226;ncia mix II&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0115" class="elsevierStylePara elsevierViewall">A rela&#231;&#227;o entre a DA e a DAC ainda n&#227;o &#233; totalmente compreendida&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;5&#44;20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">O Registro de Dermatite de Contato Pedi&#225;trica &#40;PCDR&#41; que cont&#233;m os dados da maior quantidade de TC pedi&#225;trico nos EUA relatou que dentre 49&#37; das crian&#231;as encaminhadas com DA&#44; 42&#37; tamb&#233;m apresentaram DCA&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">No geral&#44; a maioria dos autores n&#227;o encontrou diferen&#231;as significativas na preval&#234;ncia de DAC entre crian&#231;as e adolescentes at&#243;picos e n&#227;o at&#243;picos&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;4&#44;8&#44;13&#44;15&#44;21&#8211;23</span></a> No entanto&#44; muitos dos trabalhos publicados mostraram resultados controversos com rela&#231;&#227;o ao assunto&#46; As taxas de sensibiliza&#231;&#227;o variaram consideravelmente&#44; assim como o delineamento dos estudos em rela&#231;&#227;o ao tamanho e caracter&#237;sticas da amostra&#44; crit&#233;rios diagn&#243;sticos para DA&#44; metodologia de TC e al&#233;rgenos usados&#46; Al&#233;m disso&#44; um vi&#233;s de sele&#231;&#227;o pode ter ocorrido na maioria dos estudos porque as crian&#231;as sem DA foram mais encaminhadas para os testes devido a suspeita de DAC&#44; enquanto aquelas com DA podem ter sido encaminhadas em virtude de reca&#237;da da DA&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Poucos autores publicaram os resultados do TC e o perfil de crian&#231;as e adolescentes com DA&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;3&#44;6&#44;14&#44;24&#8211;35</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Independentemente das crian&#231;as com DA terem um risco aumentado de sensibiliza&#231;&#227;o em compara&#231;&#227;o &#224;s outras&#44; a DAC pode coexistir em at&#233; 30&#37; das crian&#231;as com DA&#44; de acordo com publica&#231;&#245;es recentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2&#44;11</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">As s&#233;ries utilizadas nos TC dos estudos pedi&#225;tricos apresentam varia&#231;&#245;es geogr&#225;ficas na sele&#231;&#227;o de al&#233;rgenos&#44; mas a maioria &#233; da Am&#233;rica do Norte e da Europa&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;5&#44;7</span></a> Este &#233; o primeiro estudo brasileiro a avaliar a preval&#234;ncia e o perfil da DAC em crian&#231;as e adolescentes com DA por meio dos TC com bateria pedi&#225;trica&#46; Nessa amostra&#44; a preval&#234;ncia de DAC foi de 27&#44;7&#37;&#44; coincidindo com as &#250;ltimas revis&#245;es da literatura internacional&#44; em que a preval&#234;ncia variou de 20 a 44&#37; nesse grupo&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;5&#44;7</span></a> Outros autores brasileiros encontraram preval&#234;ncia semelhante &#224; nossa&#44; em amostras n&#227;o extensas&#44; regionalizadas&#44; mas utilizando os testes da bateria padr&#227;o brasileira &#40;30 subst&#226;ncias&#41;&#44; n&#227;o com uma s&#233;rie pedi&#225;trica&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#8211;15</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Alguns estudos encontraram uma alta taxa de testes com rea&#231;&#245;es irritativas &#40;falso&#8208;positivas&#41; nos pacientes com DA&#44; provavelmente devido a um menor limiar de irritabilidade numa barreira cut&#226;nea defeituosa&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;9&#44;14&#44;36</span></a> Em nosso estudo tamb&#233;m apareceram rea&#231;&#245;es irritativas em 20&#44;4&#37; das crian&#231;as&#44; principalmente ao n&#237;quel e a fragr&#226;ncias&#44; na faixa et&#225;ria menor&#46; No entanto&#44; apesar de rea&#231;&#245;es falso&#8208;positivas serem frequentes nos pacientes com DA&#44; rea&#231;&#245;es positivas fracas podem ocorrer e devem ser consideradas positivas verdadeiras&#44; especialmente em pacientes com exacerba&#231;&#227;o da DA&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> Ademais&#44; muitos pacientes tamb&#233;m apresentaram rea&#231;&#245;es positivas fracas relevantes&#44; tal como um estudo pedi&#225;trico brasileiro que relatou 84&#44;2&#37; de TC positivos relevantes com rea&#231;&#245;es de intensidade 1&#43;&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Em nosso estudo&#44; 57&#44;4&#37; da amostra eram crian&#231;as entre 4 a 9 anos de idade e&#44; embora n&#227;o seja significativo&#44; foram encontrados mais resultados positivos nesse grupo mais jovem&#46; Esse achado acompanha os relatos de outros autores sobre altas taxas de sensibiliza&#231;&#227;o em crian&#231;as de faixas et&#225;rias menores&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;4&#44;31</span></a> Por outo lado&#44; como a exposi&#231;&#227;o a al&#233;rgenos aumenta com a idade&#44; mais DAC foi relatada no grupo de adolescentes em diversos estudos&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;13&#44;15</span></a> Ainda em rela&#231;&#227;o &#224; faixa et&#225;ria&#44; s&#227;o descritas diferen&#231;as significativas com alguns al&#233;rgenos&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> Um amplo estudo norte&#8208;americano relatou que crian&#231;as menores foram mais sensibilizadas a ingredientes dos produtos de higiene pessoal&#44; enquanto a sensibiliza&#231;&#227;o ao azul disperso e ao ouro foi mais comum em crian&#231;as maiores&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Em nossa amostra&#44; a idade de in&#237;cio da DA nas crian&#231;as com TC positivos n&#227;o diferiu estatisticamente daquelas com TC negativos&#44; coincidindo com os achados de Labadie et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> Da mesma maneira&#44; n&#227;o encontramos associa&#231;&#227;o entre o fototipo e mais TC positivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;361&#41;&#46; Poucos estudos inclu&#237;ram essa vari&#225;vel e um sugeriu que as tend&#234;ncias &#233;tnicas e culturais&#44; como <span class="elsevierStyleItalic">body piercing</span>&#44; poderiam influenciar na incid&#234;ncia de DAC&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Como v&#225;rios estudos&#44; tamb&#233;m observamos maior n&#250;mero de pacientes do sexo feminino encaminhados &#40;64&#44;8&#37;&#41; e com maior tend&#234;ncia a TC positivos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;077&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;13&#44;15&#44;21&#44;26</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Em nosso estudo&#44; uma menor dura&#231;&#227;o da DA &#40;mediana de 3&#44;2 anos&#41; foi associada a mais testes positivos do que uma dura&#231;&#227;o mais longa&#46; Isso pode ser decorrente do predom&#237;nio de crian&#231;as menores referidas &#40;57&#44;4&#37; com idades entre 4 a 9 anos&#41;&#46; O maior estudo pedi&#225;trico norte&#8208;americano tamb&#233;m encontrou mais TC positivos naquelas com dermatite de menor dura&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">A associa&#231;&#227;o entre a presen&#231;a de outras doen&#231;as at&#243;picas ou hist&#243;rico familiar e maior sensibiliza&#231;&#227;o n&#227;o foi encontrada na nossa amostra&#46; Outros trabalhos tamb&#233;m n&#227;o relataram diferen&#231;as significativas entre atopia e os grupos et&#225;rios com TC positivos&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;8&#44;25</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">A maioria dos nossos pacientes apresentava les&#245;es de DA em mais de duas regi&#245;es corporais&#44; como no estudo de Rodrigues et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> Outros autores tamb&#233;m relataram dermatite mais difusa &#40;espalhada&#41; dentre aquelas crian&#231;as testadas&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;7</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Associa&#231;&#245;es significativas foram descritas entre DA&#44; DAC e eczema de m&#227;os em adolescentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;9&#44;35</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">No presente trabalho&#44; como havia mais pacientes com DA leve a moderada&#44; nenhuma correla&#231;&#227;o foi poss&#237;vel entre maior gravidade da doen&#231;a e maior sensibiliza&#231;&#227;o al&#233;rgica&#46; Da mesma maneira&#44; Ozceker et al&#46; n&#227;o encontraram mais DAC nas crian&#231;as com DA grave&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> No entanto&#44; outros autores relataram associa&#231;&#227;o entre mais TC positivos e doen&#231;a mais grave&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;32&#44;34</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">De fato&#44; alguns trabalhos sugeriram que o limiar de sensibiliza&#231;&#227;o estaria inversamente relacionado &#224; gravidade da DA&#46; Uma menor positividade nas rea&#231;&#245;es dos TC em pacientes com DA grave poderia ser explicada pelo aumento da c&#233;lula T helper 2 &#40;Th2&#41; em oposi&#231;&#227;o ao desvio da c&#233;lula T helper 1 &#40;Th1&#41; do sistema imune&#44; tradicionalmente observado na DAC&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;10&#44;30</span></a></p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Perfil de sensibiliza&#231;&#227;o aos al&#233;rgenos</span><p id="par0190" class="elsevierStylePara elsevierViewall">Os resultados dos trabalhos sobre a preval&#234;ncia de DAC e a frequ&#234;ncia dos al&#233;rgenos sensibilizantes em crian&#231;as e adolescentes com DA apresentaram varia&#231;&#245;es de acordo com a amostra selecionada&#44; o tempo de exposi&#231;&#227;o&#44; o tipo e a quantidade de subst&#226;ncias testadas&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;7&#44;37</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Importante ressaltar que h&#225; diferen&#231;as na sele&#231;&#227;o de al&#233;rgenos das baterias de TC utilizadas nos estudos pedi&#225;tricos mundiais&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> por&#233;m as mais aplicadas s&#227;o as do grupo norte&#8208;americano de dermatite de contato &#40;NACDG&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> e do Registro de Dermatite de Contato Pedi&#225;trica &#40;PCDR&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> Muitos estudos na Europa usaram s&#233;ries padr&#227;o ou regionais de acordo com o Sistema Europeu de Vigil&#226;ncia em Alergias de Contato &#40;ESSCA&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">38&#44;39</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Recentemente&#44; baseada em uma pesquisa de consenso&#44; a Sociedade Americana de Dermatite de Contato prop&#244;s uma s&#233;rie pedi&#225;trica para crian&#231;as de 6 a 18 anos&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">39&#44;40</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">No entanto&#44; essas baterias propostas n&#227;o s&#227;o direcionadas especificamente &#224;s crian&#231;as com DA&#46; O perfil de sensibiliza&#231;&#227;o aos al&#233;rgenos parece ser diferente nessa popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;5&#44;11&#44;23</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">Em nosso estudo&#44; todos os pacientes com DA foram testados com uma bateria pedi&#225;trica&#44; seguindo as recomenda&#231;&#245;es do EAACI&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> mas adaptada &#224; realidade brasileira &#40;substitui&#231;&#227;o de tr&#234;s subst&#226;ncias&#41;&#46; Os al&#233;rgenos com maiores taxas de sensibiliza&#231;&#227;o&#44; em ordem de frequ&#234;ncia&#44; foram&#58; sulfato de n&#237;quel&#44; azul disperso&#44; mistura de fragr&#226;ncias I e neomicina&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Uma recente publica&#231;&#227;o nos EUA sobre DCA em crian&#231;as ressaltou os principais al&#233;rgenos naquelas com DA&#58; n&#237;quel&#44; mistura de fragr&#226;ncias I&#44; b&#225;lsamo do Peru&#44; bacitracina&#44; lanolina&#44; formalde&#237;do e neomicina&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Teo et al&#46;&#44; numa extensa revis&#227;o de estudos comparando DAC em indiv&#237;duos sem DA e com DA&#44; destacaram nesses &#250;ltimos os 10 al&#233;rgenos mais comuns&#58; n&#237;quel&#44; fragr&#226;ncia mix I&#44; metilisotiazolinona &#40;MI&#41;&#44; cobalto&#44; colof&#244;nia&#44; neomicina&#44; p&#8208;fenilenodiamina &#40;PPD&#41;&#44; tiuram mix&#44; b&#225;lsamo do Peru e metabissulfito de s&#243;dio&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> Tr&#234;s desses &#40;n&#237;quel&#44; fragr&#226;ncias e neomicina&#41; tamb&#233;m foram os mais frequentes em nosso estudo&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Os pacientes com DA podem ter maior risco de sensibiliza&#231;&#227;o devido a uma barreira defeituosa e ao uso frequente de produtos t&#243;picos &#40;cuidados com a pele e medicamentos&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;2&#44;9&#44;37</span></a> Al&#233;m disso&#44; um grande estudo multic&#234;ntrico &#40;11 pa&#237;ses europeus&#41; sugeriu que as crian&#231;as com DA recalcitrante tamb&#233;m deveriam ser testadas para metais&#44; corantes dispersos e C<span class="elsevierStyleItalic">ompositae&#46;</span><a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Como constatado em v&#225;rias publica&#231;&#245;es&#44; no presente estudo&#44; o n&#237;quel foi tamb&#233;m o al&#233;rgeno mais sensibilizante<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;14&#44;26&#44;28&#44;29&#44;31</span></a> e o mais associado ao sexo feminino &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;11&#44;13&#44;31&#44;33</span></a> A sensibiliza&#231;&#227;o ao n&#237;quel tem sido relacionada ao h&#225;bito de furar orelhas &#40;<span class="elsevierStyleItalic">ear piercing&#41;&#46;</span> Brinquedos&#44; roupas &#40;z&#237;peres&#44; bot&#245;es etc&#46;&#41; e equipamentos eletr&#244;nicos &#40;<span class="elsevierStyleItalic">tablets</span> e telefones celulares&#41; s&#227;o fontes cont&#237;nuas de libera&#231;&#227;o de n&#237;quel&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;11</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">O corante azul disperso foi o segundo al&#233;rgeno frequente em nosso estudo&#46; Os corantes dispersos &#40;<span class="elsevierStyleItalic">disperse dyes</span>&#41;&#44; presentes em roupas de cores intensas ou brilhantes e em alguns cosm&#233;ticos infantis&#44; s&#227;o potenciais al&#233;rgenos em crian&#231;as&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;12</span></a> Embora tais subst&#226;ncias n&#227;o fa&#231;am parte da bateria padr&#227;o brasileira&#44; sua import&#226;ncia em crian&#231;as com DA vem sendo mencionada em estudos recentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">22&#44;25&#44;26</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Os emolientes s&#227;o os principais produtos de cuidados com a pele usados no tratamento da DA&#46; Dermatites de contato a fragr&#226;ncias e conservantes contidos nesses emolientes podem desempenhar um papel no agravamento da doen&#231;a&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;3&#44;11&#44;12</span></a> As fragr&#226;ncias mix I e II foram encontradas&#44; em ordem de frequ&#234;ncia&#44; como o terceiro e o quinto al&#233;rgeno&#44; respectivamente&#44; em nosso estudo&#46; As fragr&#226;ncias est&#227;o entre as principais subst&#226;ncias presentes em brinquedos e outros produtos perfumados voltados para crian&#231;as&#44; mesmo naqueles rotulados como &#8220;sem fragr&#226;ncia&#8221; que podem conter ingredientes relacionados&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">A neomicina&#44; o quarto al&#233;rgeno frequente em nosso estudo&#44; &#233; um antibi&#243;tico amplamente presente em prepara&#231;&#245;es e medicamentos t&#243;picos e h&#225; muito tempo figura entre os principais al&#233;rgenos em crian&#231;as&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;21&#44;25</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">Indiv&#237;duos com DA podem ter mais sensibiliza&#231;&#227;o aos conservantes&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> Sensibiliza&#231;&#227;o &#224; metilcloroisotiazolinona&#44; &#224; metilisotiazolinona e &#224; associa&#231;&#227;o MCI&#47;MI presentes em cosm&#233;ticos&#44; produtos de limpeza e de higiene vem aumentando em estudos recentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;28</span></a> O formalde&#237;do e os liberadores de formalde&#237;do tamb&#233;m s&#227;o conservantes comuns em produtos de uso di&#225;rio<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a> e est&#227;o entre os cinco principais al&#233;rgenos em um grande estudo pedi&#225;trico em DA&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> No entanto&#44; em nosso estudo&#44; somente um paciente apresentou sensibiliza&#231;&#227;o ao formalde&#237;do e outro &#224; associa&#231;&#227;o MCI&#47;MI&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Apesar de v&#225;rios autores mencionarem alergia aos corticosteroides t&#243;picos principalmente em pacientes com DA resistente ao tratamento&#44; em nossa amostra n&#227;o encontramos testes positivos aos corticosteroides menos potentes &#40;grupo A&#41; presentes na bateria pedi&#225;trica&#46; Alguns estudos atribuem esse resultado negativo ao fato de aqueles pacientes com doen&#231;a recalcitrante utilizarem mais os corticosteroides de maior pot&#234;ncia &#40;grupos B e D&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">Considerando que determinados al&#233;rgenos parecem apresentar padr&#245;es espec&#237;ficos conforme a idade&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;21&#44;26</span></a> alguns autores sugerem TC com diferentes s&#233;ries direcionadas &#224;s crian&#231;as e aos adolescentes&#58;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> s&#233;ries reduzidas nas crian&#231;as &#40;pela menor superf&#237;cie corporal&#41;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4&#44;6&#44;25&#44;29</span></a> e s&#233;ries estendidas nos adolescentes &#40;maior exposi&#231;&#227;o&#44; inclusive ocupacional&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">28&#44;40</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">No entanto&#44; os autores concordam na dificuldade de designar uma s&#233;rie de subst&#226;ncias ideal para triagem na popula&#231;&#227;o pedi&#225;trica e recomendam o uso de baterias regionais e personalizadas com subst&#226;ncias dos produtos do paciente baseadas no hist&#243;rico de exposi&#231;&#227;o e na relev&#226;ncia cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;28&#44;39&#44;40</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">O ponto forte deste estudo &#233; ser o primeiro no Brasil &#40;de nosso conhecimento&#41; a realizar testes de contato em crian&#231;as com DA com empregando bateria pedi&#225;trica para avaliar a preval&#234;ncia&#44; o perfil dos sensibilizantes e da DAC nesse grupo vulner&#225;vel&#46; As principais limita&#231;&#245;es desta pesquisa poderiam ser o tamanho amostral&#44; a aus&#234;ncia de grupo controle a ser testado com a bateria padr&#227;o brasileira para comparar com outros estudos e o fato de nossos pacientes serem provenientes de um servi&#231;o de sa&#250;de p&#250;blica &#40;influ&#234;ncias socioecon&#244;micas na exposi&#231;&#227;o a determinados al&#233;rgenos&#41;&#46; Por ser um estudo que abre a discuss&#227;o sobre o uso da s&#233;rie pedi&#225;trica em dermatite at&#243;pica recalcitrante&#44; o delineamento transversal &#233; o delineamento correspondente aos objetivos&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclus&#245;es</span><p id="par0275" class="elsevierStylePara elsevierViewall">A DAC pode coexistir e desempenhar um papel no agravamento da DA&#46; Quase 1&#47;3 das crian&#231;as e dos adolescentes com DA de uma amostra do Sul do Brasil atendidas no sistema p&#250;blico de sa&#250;de foi diagnosticada com DAC&#44; por meio dos testes de contato com bateria pedi&#225;trica&#46; Os al&#233;rgenos mais importantes nessa popula&#231;&#227;o foram o sulfato de n&#237;quel&#44; o azul disperse&#44; as fragr&#226;ncias e a neomicina&#46; Futuros estudos multic&#234;ntricos&#44; com amostras maiores&#44; grupos de controle e metodologias padronizadas s&#227;o necess&#225;rios&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Nosso estudo contribui para acrescentar informa&#231;&#245;es sobre sensibilizantes em crian&#231;as e adolescentes com DA recalcitrante&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Suporte financeiro</span><p id="par0285" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Contribui&#231;&#227;o dos autores</span><p id="par0290" class="elsevierStylePara elsevierViewall">Cristiane Almeida Soares Cattani&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Renan Rangel Bonamigo&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Kenselyn Oppermann&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Simone Perazzoli&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Nathalia Hoffmann Guarda&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Paula Bar&#233;a&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflito de interesses</span><p id="par0320" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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            0 => "Adolescente"
            1 => "Crian&#231;a"
            2 => "Dermatite al&#233;rgica de contato"
            3 => "Dermatite at&#243;pica"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A dermatite at&#243;pica &#233; a doen&#231;a cut&#226;nea inflamat&#243;ria mais comum na inf&#226;ncia e ocasiona importante impacto na qualidade de vida &#8211; principalmente as graves&#44; ou recalcitrantes aos tratamentos&#46; A sensibiliza&#231;&#227;o a al&#233;rgenos com potencial para o surgimento de dermatite al&#233;rgica de contato &#233; um fator associado &#224; recalcitr&#226;ncia da dermatite at&#243;pica&#46; Compreender a rela&#231;&#227;o entre a dermatite at&#243;pica&#44; al&#233;rgenos e dermatite al&#233;rgica de contato &#233; essencial para o tratamento dos pacientes&#46; No Brasil&#44; n&#227;o h&#225; estudos sobre a sensibiliza&#231;&#227;o a al&#233;rgenos utilizando&#8208;se testes de contato em crian&#231;as com dermatite at&#243;pica&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Verificar os principais sensibilizantes&#44; a preval&#234;ncia de dermatite de contato al&#233;rgica e o perfil epidemiol&#243;gico e cl&#237;nico de crian&#231;as e adolescentes com dermatite at&#243;pica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal&#44; prospectivo&#44; em pacientes entre 4 e 18 anos de idade&#44; com dermatite at&#243;pica recalcitrante&#44; atendidos no Ambulat&#243;rio de Dermatologia Sanit&#225;ria &#40;RS&#41;&#46; Todos foram submetidos a testes de contato com uma bateria com al&#233;rgenos de s&#233;rie pedi&#225;trica&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As preval&#234;ncias de sensibiliza&#231;&#227;o e de dermatite al&#233;rgica de contato nos pacientes avaliados foram de 37&#44;07&#37; &#40;20&#47;54&#41; e 27&#44;7&#37; &#40;15&#47;54&#41;&#44; respectivamente&#46; Os al&#233;rgenos mais frequentes foram&#58; sulfato de n&#237;quel &#40;16&#44;7&#37;&#41;&#44; azul disperse &#40;5&#44;6&#37;&#41; e fragr&#226;ncia mix I &#40;5&#44;6&#37;&#41;&#46; O n&#237;quel foi associado ao sexo feminino &#40;p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;019&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Tamanho e sele&#231;&#227;o amostral&#44; aus&#234;ncia de grupo controle&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Uma parcela dos pacientes com dermatite at&#243;pica recalcitrante pode estar sensibilizada a diferentes al&#233;rgenos e mesmo ter desenvolvido dermatite al&#233;rgica de contato&#46; Reconhecer esse contexto &#233; importante na estrat&#233;gia de preven&#231;&#227;o e no manejo da doen&#231;a&#46;</p></span>"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Como citar este artigo&#58; Cattani CAS&#44; Oppermann K&#44; Perazzoli S&#44; Guarda NH&#44; Bar&#233;a P&#44; Bonamigo RR&#46; Sensitizing agents found in children and adolescents with recalcitrant atopic dermatitis&#58; a cross&#8208;sectional study with a pediatric battery&#46; An Bras Dermatol&#46; 2022&#59;97&#58;307&#8211;14&#46;</p>"
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    ]
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        "detalles" => array:1 [
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        "tabla" => array:2 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Subst&#226;ncia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Concent<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ve&#237;culo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#8208; Acetato de hidrocortisona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8208; Lanolina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8208; Azul disperse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#8208; Bicromato de pot&#225;ssio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#8208; Budesonida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#8208; P&#8208;terc&#8208;butilfenol formalde&#237;do resina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#8208; Colof&#244;nia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#8208; <span class="elsevierStyleItalic">Compositae</span> mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#8208; Fragr&#226;ncia mix II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8208; Mercaptobenzotiazol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#8208; Lyral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#8208; Mercapto mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#8208; Metilcloroisotiazolinona&#47;Metilisotiazolinona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#193;gua&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#8208; Metildibromo glutaronitrilo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#8208; Neomicina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#8208; P&#8208;fenilenodiamina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">17&#8208; Fragr&#226;ncia mix I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">19&#8208; Sulfato de n&#237;quel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20&#8208; Tiuram mix&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Vaselina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;10&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;37&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;123&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;077&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo et&#225;rio</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#8211;9 a &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;35&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">10&#8211;18 a &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;347&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fototipo</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;26&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;361&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VI &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atopia pessoal<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim &#40;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;28&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fisher&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;22&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atopia familiar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;34&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;279&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;258&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;15&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escore EASI</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leve &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;26&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderado &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;544&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;901&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grave &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muito grave &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Local da dermatite</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Face&#47;Pesco&#231;o &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;23&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;826&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;363&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MsSs &#40;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fisher&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tronco &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;32&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fisher&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;338&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MsIs &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fisher&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dura&#231;&#227;o da DA &#40;anos&#41;</td><td class="td" title="\n
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Article information
ISSN: 26662752
Original language: Portuguese
DOI:10.1016/j.abdp.2022.02.006
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