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90 (
5
); 688-689
doi:
10.25259/IJDVL_1226_2024

Author’s reply

Department of Morphology, Universidade Federal de Sergipe, Av. Marechal Rondon, São Cristóvão, Brazil

Corresponding author: Prof. Marcio Bezerra-Santos, Department of Morphology, Universidade Federal de Sergipe, São Cristóvão, Brazil. marciobezerra.ufs@outlook.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Bezerra-Santos M. Author’s reply. Indian J Dermatol Venereol Leprol. 2024;90:688-9. doi: 10.25259/IJDVL_1226_2024

Dear Editor,

We appreciate the opportunity to respond to the letter to the editor1 regarding some critical observations about the methodology and the inferences drawn from our results.2

First, the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire is an accepted and validated instrument worldwide and the scientific literature has shown high sensitivity, specificity and positive predictive value for the epidemiological diagnosis of allergic diseases, and it is known for its good reproducibility and validity in previous studies and its reliability in telephone interviews.3,4 The great advantage of ISAAC is that it allows the comparison of data between studies from around the world. Although initially designed for children and adolescents, it is possible to use ISAAC for adults as well.35 Nevertheless, we know that this questionnaire evaluates symptoms related to allergic diseases and that it is not possible to be certain that all patients are truly atopic (allergic), and classifying allergic diseases based solely on questionnaire responses may not fully capture the complexity and heterogeneity of these conditions that are known to have various genotypes and phenotypes. To accurately characterise the atopic state, it would be necessary to confirm it with laboratory data, such as immunoglobulin E (IgE) levels. Therefore, we acknowledge the limitation of our study regarding the confirmation of the atopic status of the patients, since it is epidemiological in nature. We encourage new studies on the association between atopic diseases and leprosy that include laboratory data.

Regarding the sample size, it is important to note that we worked with a convenience sample of patients treated at the University Hospital of the Federal University of Sergipe. The number of leprosy patients is limited, even in an endemic area. Regardless, we obtained a significant and substantial sample that allowed us to make inferences based on our findings. About the relationship between the number of cases and controls, we acknowledged this as a limitation of our study and justified it due to the difficulty in recruiting household contacts who have prolonged contact with the cases (leprosy patients) and are not genetically related to them. Recognising that this is one of the strengths of this study in comparison with other studies in the literature, it is important to remember that leprosy is a disease that carries a significant negative stigma throughout history, and many patients and their families do not want to disclose that they have this disease, affecting the recruitment of controls.

Finally, we recognise the complexity of the immune response present in leprosy in its various clinical forms and the evolution in identifying new types of immune responses involved in the disease (Th9, Th17, Th22 and Treg). However, the cited study itself states that despite the new types of immune responses involved, the classical immunological paradigm of the interaction between Th1 and Th2 lymphocytes exists and an immunoregulation between them is still recognised.6

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The author confirms that there was no use of AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

References

  1. , , , . Letter to the editor regarding Association between asthma, rhinitis and atopic dermatitis with leprosy: A case-control study. Indian J Dermatol Venereol Leprol.. 2024;90:687-8.
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  2. , , , , , , et al. Association between asthma, rhinitis and atopic dermatitis with leprosy: A case-control study. Indian J Dermatol Venereol Leprol. 2023;89:834-41.
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  3. , , , , . Prevalence of asthma, allergic rhinitis and pollinosis in a city of Brazil: A monitoring study. Allergol Immunopathol (Madr). 2020;48:537-44.
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  4. , , , , , , et al. Prevalence of asthma symptoms and associated factors in adolescents and adults in southern Brazil: A Global Asthma Network Phase I study. World Allergy Organ J. 2021;14:100529.
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  5. , , , , , . Validity and reproducibility of the asthma core International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire obtained by telephone survey. J Asthma. 2012;49:390-4.
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  6. , , . Leprosy as a complex infection: Breakdown of the Th1 and Th2 immune paradigm in the immunopathogenesis of the disease. Front Immunol. 2017;8:1635.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]

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