Sensibilização aos alérgenos de borracha entre 1.162 pacientes testados com a bateria padrão brasileira

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Existem outros produtos como inseticidas, roupas, medicamentos e tintas, com aditivos químicos semelhantes. O látex causa principalmente alergia do tipo I, e vulcanizantes e antioxidantes da borracha são responsáveis pelas alergias do tipo IV.<a class="elsevierStyleCrossRefs" href="#bib0055">1,2</a>A bateria padrão brasileira (BPB) apresenta as misturas de borracha (carba, tiuram, mercapto, PPD) e outros alérgenos relacionados como hidroquinona, etilenodiamina e parafenilenodiamina (PPDA). A hidroquinona é um antioxidante raramente usado na indústria atualmente.<a class="elsevierStyleCrossRef" href="#bib0065">3</a> O dicloridrato de etilenodiamina estabiliza cremes esteroides e o látex, mas não é testado em outras séries‐padrão.<a class="elsevierStyleCrossRef" href="#bib0070">4</a> A PPDA pertence ao grupo dos benzenos e pode causar reações cruzadas com o PPD‐mix (N‐isopropil‐N‐fenil parafenilenodiamina [IPPD], N‐ciclohexil‐N‐fenil parafenilenodiamina, N, N‐difenil parafenilenodiamina).<a class="elsevierStyleCrossRef" href="#bib0075">5</a>Foram atendidos no Anexo de Dermatologia do Hospital das Clínicas ‐ UFMG, de outubro de 2009 a outubro de 2018, 1.162 pacientes com suspeita de dermatite de contato alérgica. Testados com a BPB (FDA‐allergenic, RJ, Brasil) utilizando Finn Chambers® (Oy, Finlândia) foram realizadas leituras de 48 horas e 96 horas, seguindo os critérios do ICDRG (International Contact Dermatitis Research Group).<a class="elsevierStyleCrossRef" href="#bib0080">6</a> Dados sobre idade, ocupação, locais afetados, história de atopia e positividade aos alérgenos foram coletados no software Excel ao longo desses anos. Neste estudo retrospectivo, foram consultados os dados da referida planilha e, quando necessários, os prontuários, para complemento das informações necessárias.Testaram positivo para alérgenos da borracha 120 pacientes (10,3%); desses, 98 (81,7%) apresentaram relevância clínica com base na história e exposição aos alérgenos. As características demográficas foram descritas de acordo com o índice MOAHLFA (<a class="elsevierStyleCrossRefs" href="#tbl0005">tabelas 1 e 2</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>A prevalência de positividade para as misturas de borracha foi: carba 41,7%; tiuram 30%; mercapto 15%; e PPD 5% (<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>).Associação entre os alérgenos da borracha (reações cruzadas) foi observada em 35,8% dos casos: carbamatos com tiurams em 16,6% e mercaptobenzotiazol com carbamatos em 1,7%. Além disso, a associação entre carba, mercapto e tiuram foi observada em 8,3% dos pacientes (<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Conde‐Salazar et al. relataram 14,7% de sensibilização aos aditivos de borracha em 4.680 pacientes testados.<a class="elsevierStyleCrossRef" href="#bib0055">1</a> Holness e Nethercott testaram 1.670 pacientes com positividade de 8,9% a pelo menos um alérgeno de borracha, semelhante ao que encontramos (10,2%).<a class="elsevierStyleCrossRef" href="#bib0085">7</a> O ESSCA (European Surveillance System on Contact Allergies), ao testar baterias padrão e específica para borracha, encontrou 8,8% de positividade. Outros autores encontraram entre 3,8% e 15% de reações positivas aos componentes de borracha utilizando baterias‐padrão<a class="elsevierStyleCrossRef" href="#bib0090">8</a> (<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Segundo o índice MOHALFA, a localização mais acometida é a das mãos, tanto neste como em outros relatos.<a class="elsevierStyleCrossRefs" href="#bib0055">1,2,7,9</a> A atopia esteve presente em 25% dos nossos pacientes, contrastando com 4,2% de Conde‐Salazar et al.<a class="elsevierStyleCrossRef" href="#bib0055">1</a>A principal população afetada pela sensibilização à borracha são os trabalhadores da saúde e de laboratórios, seguidos dos trabalhadores da limpeza e da construção civil, principalmente pelo uso de luvas e botas de borracha. Detectamos alta frequência de trabalhadores da construção civil (40,8%), fato relatado também por Conde‐Salazar et al. (47%).<a class="elsevierStyleCrossRef" href="#bib0055">1</a> Esses autores demonstraram maior positividade ao tiuram (83%) contrastando com outros que mostraram uma diminuição de tiuram e aumento de carba ao longo dos anos. Nossos resultados confirmaram essa tendência. Além disso, os dissulfetos de tiuram raramente aparecem na borracha final, embora possam ser usados como aditivos.<a class="elsevierStyleCrossRefs" href="#bib0055">1,7,10</a>Profissionais da área de saúde apresentaram risco estatisticamente aumentado de sensibilização aos carbamatos e tiurans presentes em luvas de borracha. A alergia ao tiuram está, também, relacionada a trabalhadores domésticos, de restaurantes, da construção civil e cabeleireiros.<a class="elsevierStyleCrossRefs" href="#bib0080">6,10</a> Em contraste, nossa série mostrou maior prevalência de sensibilização aos carbamatos principalmente nos trabalhadores da construção civil.Apesar de os carbamatos serem irritantes e causarem reações falso‐positivas, alguns estudos indicaram um verdadeiro aumento em sua sensibilização.<a class="elsevierStyleCrossRefs" href="#bib0090">8,9</a>A BPB testa apenas a mistura de mercapto, enquanto em outras há também mercaptobenzotiazol, que é provavelmente o verdadeiro hapteno presente nessa mistura. Nossos dados mostraram sua taxa de sensibilização semelhante a outros estudos.<a class="elsevierStyleCrossRefs" href="#bib0055">1,7,8</a>Algumas baterias não usam PPD‐mix, preferindo IPPD, que é um dos componentes da mistura. No entanto, alguns relatos indicam um subdiagnóstico de sensibilização a essa classe de alérgenos.<a class="elsevierStyleCrossRef" href="#bib0090">8</a> Sua frequência foi menor do que as outras substâncias em nosso estudo, tendência observada por outros autores.<a class="elsevierStyleCrossRefs" href="#bib0055">1,6,7</a> A sensibilização ao PPD‐mix é significativamente maior em trabalhadores da indústria e cabeleireiros/barbeiros em decorrência do contato com agentes para‐amino presentes em tinturas permanentes de cabelo.<a class="elsevierStyleCrossRef" href="#bib0100">10</a> Em nosso estudo, a PPDA mostrou 40,8% de sensibilização, sendo 27,5% relacionados a tinturas de cabelo em mulheres.Conde‐Salazar encontrou sensibilidade ao cromato em 47% dos trabalhadores da construção civil alérgicos à borracha, e nosso estudo 40,8%, e propuseram que o cromato atuaria como um forte sensibilizante e irritante, facilitando maior sensibilização às luvas.<a class="elsevierStyleCrossRef" href="#bib0055">1</a>São conhecidas as associações de positividade entre os aditivos de borracha.<a class="elsevierStyleCrossRef" href="#bib0055">1</a> Nosso estudo apontou 35,8% dessas – carba‐tiuram foi a mais frequente (16,6%), seguida da carba‐mercapto‐tiuram (8,3%). Durante a vulcanização, novos compostos podem ser formados por reações entre carba, tiuram e/ou mercaptobenzotiazóis. Os componentes recém‐formados também podem causar sensibilização, por isso é recomendado testar amostras das luvas ou botas, para aumentar a sensibilidade dos testes de contato.<a class="elsevierStyleCrossRef" href="#bib0095">9</a>O éter monobenzílico da hidroquinona pode causar leucodermia, mas seu uso atual na indústria é raro. Sua prevalência em bateria específica para borracha foi de 0,82% entre pacientes europeus. O dicloridrato de etilenodiamina mostrou menores positividades em 2.027 pacientes relatados (0,69%).<a class="elsevierStyleCrossRef" href="#bib0095">9</a> Removidos de outras séries, estão presentes na BPB e tiveram uma baixa prevalência neste estudo (3,3% etilenodiamina e 5% hidroquinona).Atualmente há aumento na sensibilização aos carbamatos a nível global. Além disso, eles são os aceleradores mais usados na indústria, já que a utilização de tiurans e mercaptos vem sendo diminuída pelos fabricantes. A BPB pode ser considerada etapa inicial para se estudar alergia à borracha, mas não parece ser suficiente, de acordo com os dados do presente trabalho. Adoção de uma série suplementar especifica, além do teste com fragmentos de botas e luvas, são recomendados para melhor acurácia diagnóstica.<a class="elsevierStyleCrossRefs" href="#bib0060">2,8,9</a>Suporte financeiroNenhum.Contribuição dos autoresVanessa Barreto Rocha: Concepção e desenho do estudo; Levantamento dos dados; Redação do artigo ou revisão crítica do conteúdo intelectual importante; Obtenção, análise e interpretação dos dados; Participação intelectual em conduta propedêutica e/ou terapêutica de casos estudados; Aprovação final da versão final do manuscrito.Erica Possa de Abreu: Concepção e desenho do estudo; Levantamento dos dados, ou análise e interpretação dos dados; Redação do artigo ou revisão crítica do conteúdo intelectual importante; Obtenção, análise e interpretação dos dados; Revisão crítica da literatura; Aprovação final da versão final do manuscrito.Maria Antonieta Rios Scherrer: Concepção e desenho do estudo; levantamento dos dados, ou análise e interpretação dos dados; Análise estatística; Redação do artigo ou revisão crítica do conteúdo intelectual importante; Obtenção, análise e interpretação dos dados; Participação efetiva na orientação da pesquisa; Participação intelectual em conduta propedêutica e/ou terapêutica de casos estudados; Revisão crítica da literatura; Aprovação final da versão final do manuscrito.Conflito de interessesNenhum." 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An Bras Dermatol. 2023;98:105–7." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Trabalho realizado no Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Tabela 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Tabela " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "M, sexo masculino; O, dermatite ocupacional; A, antecedente de atopia; H, dermatite das mãos; L, dermatite das pernas; F, dermatite da face; A, idade 40 anos ou mais.*Uter W, Schnuch A, Gefeller O, ESCD working group: Euro‐pean Surveillance System on Contact Allergies. Guidelines forthe descriptive presentation and statistical analysis of contactallergy data. Contact Dermatitis. 2004;51:47‐56." "tablatextoimagen" => array:1 [ 0 => array:1 [ "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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \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">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">M \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">59 (49,2) \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">O \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">61 (50,8) (40,8% ‐ trabalhadores da construção civil) \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">A \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 (25) \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">H \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">70 (50,8) \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">L \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">48 (40) \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">F \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">43 (34,2) \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">A \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">82 (68,3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "pt" => "Índice MOAHLFA* dos pacientes com positividade aos alérgenos da borracha" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Tabela 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Tabela " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "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 " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Número total de casos</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \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">n \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">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">PPD‐mix \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 \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 \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">Hidroquinona \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 \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 \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">Mercapto‐mix \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 \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">15 \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">Thiuram‐mix \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">36 \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 \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">Etilenodiamina \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 \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">3,3 \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">PPDA \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">49 \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">40,8 (33 – 27,5% relacionado a tintura capilar) \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">polissensibilização> 3 alérgenos \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 \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">32,5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "pt" => "Frequência de sensibilização às substâncias testadas" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Tabela 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Tabela " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "PPDA, parafenilenodiamina; PPD (mistura de N‐isopropil‐N‐fenil parafenilenodiamina, N‐ciclohexil‐N‐fenil parafenilenodiamina, N, N‐difenil parafenilenodiamina)." "tablatextoimagen" => array:1 [ 0 => array:1 [ "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">Mistura \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">Tiuram \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">Mercapto \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">PPD \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">PPDA \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">Mercapto+tiuram \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">Carba \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 / 120 \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">2/120 \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">5/120 \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 \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">10 / 120 \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 " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">16,6% \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">1,70% \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">4,20% \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 \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">8,30% \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 " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Carba \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">Mercapto \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">PPD \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">PPDA \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"> \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">Thiuram \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 \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 \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 \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">3/120 \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"> \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 " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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 \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 \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 \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">2,50% \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"> \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 " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Mercapto \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">Tiuram \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">Carba \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">PPDA \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"> \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">PPD \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"> \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"> \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"> \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">5/120 \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"> \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 " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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"> \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"> \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"> \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">4,20% \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"> \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 " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Tiuram \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">Carba \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">PPD \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">PPDA \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"> \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">Mercapto \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 \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 \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 \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">1/120 \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"> \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 " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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 \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 \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 \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">0,80% \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"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "pt" => "Associações entre as misturas de borracha com positividade ao teste para cada tipo testado" ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Tabela 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Tabela " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "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">Estudo \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">Número de pacientes \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">≥ alérgeno da borracha (%) \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">Série padrão \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">Série suplementar específica para borracha \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">Conde‐Salazar<a class="elsevierStyleCrossRef" href="#bib0055">1</a> \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">4,68 \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">14,7% \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 \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 \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">Holness and Nethercott<a class="elsevierStyleCrossRef" href="#bib0085">7</a> \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">1,67 \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">8,9% \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 \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 \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">Bendewald<a class="elsevierStyleCrossRef" href="#bib0060">2</a> \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">773 \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">31,7% \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 \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 \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">Este estudo \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">1.162 \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">10,3% \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 \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">Não \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "pt" => "Comparação com outros estudos de positividade aos alérgenos da borracha" ] ] ] "bibliografia" => array:2 [ "titulo" => "Referências" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type IV allergy to rubber additives: A 10‐year study of 686 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Conde-Salazar" 1 => "E. del-Río" 2 => "D. Guimaraens" 3 => "A.G. Domingo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1993" "volumen" => "29" "paginaInicial" => "176" "paginaFinal" => "180" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An 8‐Year Retrospective Review of Patch Testing with Rubber Allergens: The Mayo Clinic Experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.J. Bendewald" 1 => "S.A. Farmer" 2 => "M.D.P. Davis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatitis" "fecha" => "2010" "volumen" => "21" "paginaInicial" => "33" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20137737" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pigmented contact dermatitis and chemical depigmentation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Nakayma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "editores" => "J.D.Johansen, P.J.Frosch, J.P.Lepoittevin" "titulo" => "Contact dermatitis. 5. ed." "paginaInicial" => "389" "serieFecha" => "2011" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allergens from the European baseline series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.E. Andersen" 1 => "I.R. White" 2 => "A. Goossens" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "editores" => "J.D.Johansen, P.J.Frosch, J.P.Lepoittevin" "titulo" => "Contact dermatitis. 5. ed." "paginaInicial" => "576" "serieFecha" => "2011" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "McFadden et al. Hair dyes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Basketter" 1 => "J.D. 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"fecha" => "2020" "volumen" => "31" "paginaInicial" => "202" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32209868" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Results of patch testing with a special series of rubber allergens" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.L. Holness" 1 => "J.R. Nethercott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0536.1997.tb00271.x" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis." "fecha" => "1997" "volumen" => "36" "paginaInicial" => "207" "paginaFinal" => "211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9165204" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patch test results with rubber series in the European Surveillance System on Contact Allergies (ESSCA), 2013/14" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Uter" 1 => "K. Warburton" 2 => "E. Weisshaar" 3 => "D. Simon" 4 => "B. Ballmer-Weber" 5 => "V. Mahler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cod.12651" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis." 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"fecha" => "2016" "volumen" => "76" "paginaInicial" => "195" "paginaFinal" => "203" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28032352" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sensitization to Rubber Accelerators in Northeastern Italy: The Triveneto Patch Test Database" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Buttazzo" 1 => "A. Prodi" 2 => "A.B. Fortina" 3 => "M.T. Corradin" 4 => "F.L. Filon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DER.0000000000000205" "Revista" => array:6 [ "tituloSerie" => "Dermatitis." 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Carta ‐ Investigação

Sensibilização aos alérgenos de borracha entre 1.162 pacientes testados com a bateria padrão brasileira

Maria Antonieta Rios Scherrera, Erica Possa de Abreua, Vanessa Barreto Rochab,

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abreuerica20@gmail.com

Autor para correspondência.

a Serviço de Dermatologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil

b Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil

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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A ampla sensibiliza&#231;&#227;o aos componentes da borracha &#233; bem conhecida&#44; e pode ocorrer pelo l&#225;tex ou por aditivos das borrachas sint&#233;ticas&#46; Existem outros produtos como inseticidas&#44; roupas&#44; medicamentos e tintas&#44; com aditivos qu&#237;micos semelhantes&#46; O l&#225;tex causa principalmente alergia do tipo I&#44; e vulcanizantes e antioxidantes da borracha s&#227;o respons&#225;veis pelas alergias do tipo IV&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A bateria padr&#227;o brasileira &#40;BPB&#41; apresenta as misturas de borracha &#40;carba&#44; tiuram&#44; mercapto&#44; PPD&#41; e outros al&#233;rgenos relacionados como hidroquinona&#44; etilenodiamina e parafenilenodiamina &#40;PPDA&#41;&#46; A hidroquinona &#233; um antioxidante raramente usado na ind&#250;stria atualmente&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> O dicloridrato de etilenodiamina estabiliza cremes esteroides e o l&#225;tex&#44; mas n&#227;o &#233; testado em outras s&#233;ries&#8208;padr&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> A PPDA pertence ao grupo dos benzenos e pode causar rea&#231;&#245;es cruzadas com o PPD&#8208;mix &#40;N&#8208;isopropil&#8208;N&#8208;fenil parafenilenodiamina &#91;IPPD&#93;&#44; N&#8208;ciclohexil&#8208;N&#8208;fenil parafenilenodiamina&#44; N&#44; N&#8208;difenil parafenilenodiamina&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Foram atendidos no Anexo de Dermatologia do Hospital das Cl&#237;nicas &#8208; UFMG&#44; de outubro de 2009 a outubro de 2018&#44; 1&#46;162 pacientes com suspeita de dermatite de contato al&#233;rgica&#46; Testados com a BPB &#40;FDA&#8208;allergenic&#44; RJ&#44; Brasil&#41; utilizando Finn Chambers&#174; &#40;Oy&#44; Finl&#226;ndia&#41; foram realizadas leituras de 48 horas e 96 horas&#44; seguindo os crit&#233;rios do ICDRG <span class="elsevierStyleItalic">&#40;International Contact Dermatitis Research Group&#41;&#46;</span><a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Dados sobre idade&#44; ocupa&#231;&#227;o&#44; locais afetados&#44; hist&#243;ria de atopia e positividade aos al&#233;rgenos foram coletados no <span class="elsevierStyleItalic">software</span> Excel ao longo desses anos&#46; Neste estudo retrospectivo&#44; foram consultados os dados da referida planilha e&#44; quando necess&#225;rios&#44; os prontu&#225;rios&#44; para complemento das informa&#231;&#245;es necess&#225;rias&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Testaram positivo para al&#233;rgenos da borracha 120 pacientes &#40;10&#44;3&#37;&#41;&#59; desses&#44; 98 &#40;81&#44;7&#37;&#41; apresentaram relev&#226;ncia cl&#237;nica com base na hist&#243;ria e exposi&#231;&#227;o aos al&#233;rgenos&#46; As caracter&#237;sticas demogr&#225;ficas foram descritas de acordo com o &#237;ndice MOAHLFA &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tabelas 1 e 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A preval&#234;ncia de positividade para as misturas de borracha foi&#58; carba 41&#44;7&#37;&#59; tiuram 30&#37;&#59; mercapto 15&#37;&#59; e PPD 5&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Associa&#231;&#227;o entre os al&#233;rgenos da borracha &#40;rea&#231;&#245;es cruzadas&#41; foi observada em 35&#44;8&#37; dos casos&#58; carbamatos com tiurams em 16&#44;6&#37; e mercaptobenzotiazol com carbamatos em 1&#44;7&#37;&#46; Al&#233;m disso&#44; a associa&#231;&#227;o entre carba&#44; mercapto e tiuram foi observada em 8&#44;3&#37; dos pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Conde&#8208;Salazar et al&#46; relataram 14&#44;7&#37; de sensibiliza&#231;&#227;o aos aditivos de borracha em 4&#46;680 pacientes testados&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Holness e Nethercott testaram 1&#46;670 pacientes com positividade de 8&#44;9&#37; a pelo menos um al&#233;rgeno de borracha&#44; semelhante ao que encontramos &#40;10&#44;2&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> O ESSCA <span class="elsevierStyleItalic">&#40;European Surveillance System on Contact Allergies&#41;&#44;</span> ao testar baterias padr&#227;o e espec&#237;fica para borracha&#44; encontrou 8&#44;8&#37; de positividade&#46; Outros autores encontraram entre 3&#44;8&#37; e 15&#37; de rea&#231;&#245;es positivas aos componentes de borracha utilizando baterias&#8208;padr&#227;o<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Segundo o &#237;ndice MOHALFA&#44; a localiza&#231;&#227;o mais acometida &#233; a das m&#227;os&#44; tanto neste como em outros relatos&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2&#44;7&#44;9</span></a> A atopia esteve presente em 25&#37; dos nossos pacientes&#44; contrastando com 4&#44;2&#37; de Conde&#8208;Salazar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A principal popula&#231;&#227;o afetada pela sensibiliza&#231;&#227;o &#224; borracha s&#227;o os trabalhadores da sa&#250;de e de laborat&#243;rios&#44; seguidos dos trabalhadores da limpeza e da constru&#231;&#227;o civil&#44; principalmente pelo uso de luvas e botas de borracha&#46; Detectamos alta frequ&#234;ncia de trabalhadores da constru&#231;&#227;o civil &#40;40&#44;8&#37;&#41;&#44; fato relatado tamb&#233;m por Conde&#8208;Salazar et al&#46; <span class="elsevierStyleItalic">&#40;</span>47&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Esses autores demonstraram maior positividade ao tiuram &#40;83&#37;&#41; contrastando com outros que mostraram uma diminui&#231;&#227;o de tiuram e aumento de carba ao longo dos anos&#46; Nossos resultados confirmaram essa tend&#234;ncia&#46; Al&#233;m disso&#44; os dissulfetos de tiuram raramente aparecem na borracha final&#44; embora possam ser usados como aditivos&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;7&#44;10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Profissionais da &#225;rea de sa&#250;de apresentaram risco estatisticamente aumentado de sensibiliza&#231;&#227;o aos carbamatos e tiurans presentes em luvas de borracha&#46; A alergia ao tiuram est&#225;&#44; tamb&#233;m&#44; relacionada a trabalhadores dom&#233;sticos&#44; de restaurantes&#44; da constru&#231;&#227;o civil e cabeleireiros&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;10</span></a> Em contraste&#44; nossa s&#233;rie mostrou maior preval&#234;ncia de sensibiliza&#231;&#227;o aos carbamatos principalmente nos trabalhadores da constru&#231;&#227;o civil&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Apesar de os carbamatos serem irritantes e causarem rea&#231;&#245;es falso&#8208;positivas&#44; alguns estudos indicaram um verdadeiro aumento em sua sensibiliza&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A BPB testa apenas a mistura de mercapto&#44; enquanto em outras h&#225; tamb&#233;m mercaptobenzotiazol&#44; que &#233; provavelmente o verdadeiro hapteno presente nessa mistura&#46; Nossos dados mostraram sua taxa de sensibiliza&#231;&#227;o semelhante a outros estudos&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;7&#44;8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Algumas baterias n&#227;o usam PPD&#8208;mix&#44; preferindo IPPD&#44; que &#233; um dos componentes da mistura&#46; No entanto&#44; alguns relatos indicam um subdiagn&#243;stico de sensibiliza&#231;&#227;o a essa classe de al&#233;rgenos&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Sua frequ&#234;ncia foi menor do que as outras subst&#226;ncias em nosso estudo&#44; tend&#234;ncia observada por outros autores&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;6&#44;7</span></a> A sensibiliza&#231;&#227;o ao PPD&#8208;mix &#233; significativamente maior em trabalhadores da ind&#250;stria e cabeleireiros&#47;barbeiros em decorr&#234;ncia do contato com agentes para&#8208;amino presentes em tinturas permanentes de cabelo&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Em nosso estudo&#44; a PPDA mostrou 40&#44;8&#37; de sensibiliza&#231;&#227;o&#44; sendo 27&#44;5&#37; relacionados a tinturas de cabelo em mulheres&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Conde&#8208;Salazar encontrou sensibilidade ao cromato em 47&#37; dos trabalhadores da constru&#231;&#227;o civil al&#233;rgicos &#224; borracha&#44; e nosso estudo 40&#44;8&#37;&#44; e propuseram que o cromato atuaria como um forte sensibilizante e irritante&#44; facilitando maior sensibiliza&#231;&#227;o &#224;s luvas&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">S&#227;o conhecidas as associa&#231;&#245;es de positividade entre os aditivos de borracha&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Nosso estudo apontou 35&#44;8&#37; dessas &#8211; carba&#8208;tiuram foi a mais frequente &#40;16&#44;6&#37;&#41;&#44; seguida da carba&#8208;mercapto&#8208;tiuram &#40;8&#44;3&#37;&#41;&#46; Durante a vulcaniza&#231;&#227;o&#44; novos compostos podem ser formados por rea&#231;&#245;es entre carba&#44; tiuram e&#47;ou mercaptobenzotiaz&#243;is&#46; Os componentes rec&#233;m&#8208;formados tamb&#233;m podem causar sensibiliza&#231;&#227;o&#44; por isso &#233; recomendado testar amostras das luvas ou botas&#44; para aumentar a sensibilidade dos testes de contato&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">O &#233;ter monobenz&#237;lico da hidroquinona pode causar leucodermia&#44; mas seu uso atual na ind&#250;stria &#233; raro&#46; Sua preval&#234;ncia em bateria espec&#237;fica para borracha foi de 0&#44;82&#37; entre pacientes europeus&#46; O dicloridrato de etilenodiamina mostrou menores positividades em 2&#46;027 pacientes relatados &#40;0&#44;69&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Removidos de outras s&#233;ries&#44; est&#227;o presentes na BPB e tiveram uma baixa preval&#234;ncia neste estudo &#40;3&#44;3&#37; etilenodiamina e 5&#37; hidroquinona&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Atualmente h&#225; aumento na sensibiliza&#231;&#227;o aos carbamatos a n&#237;vel global&#46; Al&#233;m disso&#44; eles s&#227;o os aceleradores mais usados na ind&#250;stria&#44; j&#225; que a utiliza&#231;&#227;o de tiurans e mercaptos vem sendo diminu&#237;da pelos fabricantes&#46; A BPB pode ser considerada etapa inicial para se estudar alergia &#224; borracha&#44; mas n&#227;o parece ser suficiente&#44; de acordo com os dados do presente trabalho&#46; Ado&#231;&#227;o de uma s&#233;rie suplementar especifica&#44; al&#233;m do teste com fragmentos de botas e luvas&#44; s&#227;o recomendados para melhor acur&#225;cia diagn&#243;stica&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;8&#44;9</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0090" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0095" class="elsevierStylePara elsevierViewall">Vanessa Barreto Rocha&#58; Concep&#231;&#227;o e desenho do estudo&#59; Levantamento dos dados&#59; Reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#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; Aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Erica Possa de Abreu&#58; Concep&#231;&#227;o e desenho do estudo&#59; Levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; Reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#59; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; Revis&#227;o cr&#237;tica da literatura&#59; Aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Maria Antonieta Rios Scherrer&#58; Concep&#231;&#227;o e desenho do estudo&#59; levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; An&#225;lise estat&#237;stica&#59; Reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#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; Aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0110" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Scherrer MAR&#44; Abreu EP&#44; Rocha VB&#46; Sensitization to rubber allergens among 1&#44;162 patients tested with the Brazilian standard battery&#46; An Bras Dermatol&#46; 2023&#59;98&#58;105&#8211;7&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPD&#8208;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
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                  \t\t\t\t">6&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">5&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">Hidroquinona&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></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mercapto&#8208;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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thiuram&#8208;mix&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Etilenodiamina&nbsp;\t\t\t\t\t\t\n
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                  \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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;8 &#40;33 &#8211; 27&#44;5&#37; relacionado a tintura capilar&#41;&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">polissensibiliza&#231;&#227;o<span class="elsevierStyleHsp" style=""></span>&#62; 3 al&#233;rgenos&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
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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">32&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Frequ&#234;ncia de sensibiliza&#231;&#227;o &#224;s subst&#226;ncias testadas</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">PPDA&#44; parafenilenodiamina&#59; PPD &#40;mistura de N&#8208;isopropil&#8208;N&#8208;fenil parafenilenodiamina&#44; N&#8208;ciclohexil&#8208;N&#8208;fenil parafenilenodiamina&#44; N&#44; N&#8208;difenil parafenilenodiamina&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mistura&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" scope="col" style="border-bottom: 2px solid black">Mercapto&#43;tiuram&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;30&#37;&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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Carba&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">Mercapto&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">PPD&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">PPDA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thiuram&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">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;120&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</td></tr><tr title="table-row"><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="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">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
                  \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">2&#44;50&#37;&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  " 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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mercapto&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">Tiuram&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">Carba&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">PPDA&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">PPD&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
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          "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Associa&#231;&#245;es entre as misturas de borracha com positividade ao teste para cada tipo testado</p>"
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                  \t\t\t\t">4&#44;68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Bendewald<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">773&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">Sim&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
                  \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">Este estudo&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">1&#46;162&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o com outros estudos de positividade aos al&#233;rgenos da borracha</p>"
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                    0 => array:2 [
                      "titulo" => "Type IV allergy to rubber additives&#58; A 10&#8208;year study of 686 cases"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Conde-Salazar"
                            1 => "E&#46; del-R&#237;o"
                            2 => "D&#46; Guimaraens"
                            3 => "A&#46;G&#46; Domingo"
                          ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Acad Dermatol"
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                        "volumen" => "29"
                        "paginaInicial" => "176"
                        "paginaFinal" => "180"
                      ]
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                      "titulo" => "An 8&#8208;Year Retrospective Review of Patch Testing with Rubber Allergens&#58; The Mayo Clinic Experience"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "M&#46;J&#46; Bendewald"
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                      "titulo" => "Pigmented contact dermatitis and chemical depigmentation"
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                        "editores" => "J&#46;D&#46;Johansen, P&#46;J&#46;Frosch, J&#46;P&#46;Lepoittevin"
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                            0 => "K&#46;E&#46; Andersen"
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Article information

ISSN: 26662752
Original language: Portuguese

DOI:10.1016/j.abdp.2022.11.015

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