Revista de Medicina Desportiva (English) May 2018 - Page 6

allergy passengers, where the food involved in the allergy cannot be consumed. 18 In this case, the ventila- tion system may be responsible for the dispersion of peanut particles leading to a reaction by inhala- tion. 12.18 Although these measures cannot be considered infallible, they have been shown to be effec- tive 12.19 And as such, they must be the subject of constructive analysis and constant evaluation. Addition- ally, and despite the Federal Avia- tion Administration requires the inclusion of injectable adrenaline in the kits of emergency, this is not a world reality, since there are airlines that do not have it. 20.21 This unavailability of resources, as well as the lack of training of the crew to deal with situations of anaphylaxis, can lead to the undertreatment of reactions 12.18 and be life-threatening. The doctor thus has a central role in the management of anaphylaxis on board, particularly in the admin- istration of adrenaline when the patient is unable to do so or when it is only available in the emergency kits. At the same time, the doctor is also essential in the travel planning of the allergic patient, particularly with regard to preventive measures and the treatment plan in case of inadvertent exposure to the aller- gen. 22 Since the events of september 11, 2001, an allergic patient can theoretically be prevented from carrying and using the auto-injector of adrenaline on the plane, so it is highly recommended that all infor- mation on their health condition, as well as the therapeutic needs are duly attested by the doctor in a doc- ument that will be in the possession of the patient when traveling. 17, 23,24 Additionally, there is a clear oppor- tunity for airlines to work together with doctors in the construction and implementation of evidence-based recommendations that promote the safety of the passenger with food allergies. The lack of information to the passenger with food allergy in the communication channels of the airlines is also a recognized prob- lem 20.21 and that contributes to the risk associated with travel. In addi- tion to the scientific contribution, the doctor also has a significant role in disseminating the need to imple- ment measures that, because they 4 may 2018 www.revdesportiva.pt are difficult or costly to perform, can be received reluctantly by the airlines. 22 Bibliography 1. Sicherer, S.H. and H.A. Sampson, Food allergy: A review and update on epidemiology, pathoge- nesis, diagnosis, prevention, and management. J Allergy Clin Immunol, 2018; 141(1):41-58. 2. Prescott, S. and K.J. Allen, Food allergy: riding the second wave of the allergy epidemic. Pediatr Allergy Immunol, 2011; 22(2):155-60. 3. Beyer, K., et al., Anaphylaxis in an emer- gency setting – elicitors, therapy and incidence of severe allergic reactions. Allergy, 2012; 67(11):1451-6. 4. Eigenmann, P.A. and S.A. Zamora, An internet-based survey on the circumstances of food-induced reactions following the diagnosis of IgE-mediated food allergy. Allergy, 2002; 57(5):449-53. Remainder Bibliography in: www.revdesportiva.pt (A Revista Online) Prof. Doctor Ovid Costa Cardiologist, Porto Comentário às 2018 ESC Guidelines for the diagnosis and management of syncope Comment to the 2018 ESC Guide- lines for the diagnosis and manage- ment of syncope The new Guidelines about syncopes introduce some new developments in relation to the previous ones, published in 2015. From the very first, the composition of the body of expert editors, a multidiscipli- nary team that included emergency physicians, internists, physiologists, neurologists, specialists on auto- nomic nervous system diseases, geriatric doctors and nurses and in which the cardiologists are in minor- ity. Another key point is the attempt to reduce the number of comple- mentary diagnostic exams and hospitalizations without the loss of safety or diagnostic accuracy. As the authors say: We have the knowledge, we have to apply it. As it is known, syncope is one of the most frequent causes to visit the Emergency Service (ES), where the urgent decision to treat or not treat, with or without hospitaliza- tion, is dependent of the immedi- ate and correct diagnosis. In this context, the Stratification of the risk in these situations is one of the news. It is a priority to imple- ment decision-making algorithms which, as we will see, do enable the classification of these patients in Low risk (can return home), High risk (Intensive evaluation in the ES versus admission) and Neither low nor high risk (Observation at the ES or at a Syncope unit as an alterna- tive to hospitalization). Let’s start with the definition of syncope, which is always good to remember: transient loss of conscious- ness due to cerebral hypoperfusion, char- acterized by rapid onset, short duration and spontaneous and complete recovery. It is a state of real or apparent loss of consciousness, characterized by a period of amnesia, abnormal and short-term motor control and in which the head trauma is excluded. The classifier criterion is the hypoperfusion, so the epilepsy (abnormal and excessive brain activity) and the psychogenic cause (conversion process) are excluded. The rare causes of syncope are often confused with the m