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