RESUMO
OBJECTIVE: To evaluate the risk of IgE sensitization and symptoms to shrimp in a population that has received AIT with polymerized mite extract. METHODS: Patients with allergic rhinitis sensitized to dust mites (Dermatophogides spp) with an indication for mite AIT were included. Those patients who had not yet received AIT or had received less than 6 doses were included as controls and those who had received more than 24 doses of AIT were included as cases. Sensitization to shrimp was assessed by skin prick test with complete shrimp extract and/or shrimp-specific IgE. RESULTS: A total of 68 patients were included; 47 cases and 21 controls. When calculating the odds ratio of sensitization according to time with immunotherapy we observed that there were no differences between the group of cases and controls (OR 0.76 95% CI 0.26 to 2.22 p 0.7 by MacNemar technique). Factors such as consumption or not of shrimp and frequency of consumption do not seem to be related to the outcome. CONCLUSION: In contrast to what was reported with aqueous extracts, we observed that AIT with polymerized extracts is not a risk factor for shrimp sensitization. It is necessary to reproduce these results with a larger sample size to explore other factors.
OBJETIVO: Evaluar el riesgo de sensibilización IgE y síntomas a camarón en una población que ha recibido AIT con extracto polimerizado para ácaros. MÉTODOS: Se incluyeron pacientes con rinitis alérgica sensibilizados a ácaros del polvo (Dermatophogides spp) con indicación de AIT para ácaros. Aquellos pacientes que no habían aún recibido AIT o llevaban menos de seis dosis, fueron incluidos como controles, y aquellos que llevaban más de 24 dosis de AIT, fueron incluidos como casos. Se evaluó la sensibilización a camarón mediante prueba cutánea con extracto completo de camarón y/o IgE específica a camarón. RESULTADOS: En total, 68 pacientes fueron incluidos; 47 casos y 21 controles. Al calcular el odds ratio de la sensibilización de acuerdo al tiempo con la inmunoterapia, observamos que no había diferencias entre el grupo de casos y controles (OR 0,76 95% IC 0,26 a 2,22 p 0,7 por técnica de MacNemar). Factores como el consumo o no de camarón y la frecuencia de consumo, no parecen estar relacionados con el desenlace. CONCLUSIÓN: A diferencia de lo reportado con extractos acuosos, observamos de AIT con extractos polimerizados para no es un factor de riesgo para la sensibilización a camarón. Es necesario reproducir estos resultados con un mayor tamaño de muestra que permita explorar otros factores.
Assuntos
Dessensibilização Imunológica , Penaeidae , Pyroglyphidae , Humanos , Animais , Masculino , Feminino , Pyroglyphidae/imunologia , Adulto , Penaeidae/imunologia , Adolescente , Adulto Jovem , Criança , Pessoa de Meia-Idade , Polimerização , Rinite Alérgica/terapia , Antígenos de Dermatophagoides/imunologia , Imunoglobulina E/imunologiaRESUMO
INTRODUCTION: Cross-reactivity between shrimp and house dust mite (HDM) proteins has been widely documented. In tropical region, shrimp (5-15%) and mite sensitization (80-95%) is prevalent in allergic patients. However, the clinical relevance of shrimp sensitization in patients with allergic rhinitis (AR) has been poorly studied. The aim of this study was to determine the prevalence and the clinical relevance shrimp IgE sensitization in AR patients sensitized to Dermatophagoides pteronyssinus. METHODS: The study was conducted in Medellin (Colombia). A cross-sectional study in patients with AR sensitized to HDM was performed in 3 steps: (i) assessment of IgE sensitization frequency to shrimp Penaeus azteca, Litopenaeus vannamei, and tropomyosin homologous allergens rDer p 10, rPen a 1, and rLit v 1, (ii) evaluation of the clinical relevance of shrimp sensitization using oral challenge test (OCT) and (iii) identification of possible risk factors for positive-OCT results. Ethical committee approval was obtained. RESULTS: From 443 patients with AR, 86 (19.4%) were sensitized to shrimp and 23 of them (26.7%) had shrimp allergy diagnosis. Thirty-six of the patients sensitized to shrimp (41.2%) reported not previously consumed this food and eleven of them had a positive-OCT (30.5%). There was not statistically significant difference in total IgE or sIgE (D. pteronyssinus, P. azteca, L. vannamei, rPen a 1, and rLit v 1) between OCT groups (positive vs. negative results). Anti-Der p 10 IgE was associated with risk for a positive-OCT in different multivariable scenarios. DISCUSSION/CONCLUSION: Our results suggest that in patients with HDM-associated AR and shrimp IgE sensitization is necessary to evaluate the clinical relevance of shrimp IgE even if the patient has never consumed shrimp because of cross-reactivity. Anti-Der p 10 could be a possible biomarker of clinical relevance to shrimp sensitization and could reduce the need for OCTs.
Assuntos
Antígenos de Dermatophagoides/imunologia , Proteínas de Artrópodes/imunologia , Hipersensibilidade Alimentar/imunologia , Imunoglobulina E/sangue , Penaeidae/imunologia , Rinite Alérgica/imunologia , Tropomiosina/imunologia , Adulto , Alérgenos/imunologia , Animais , Reações Cruzadas , Estudos Transversais , Feminino , Hipersensibilidade Alimentar/sangue , Humanos , Imunoglobulina E/imunologia , Testes Imunológicos , Masculino , Pessoa de Meia-Idade , Rinite Alérgica/sangue , Método Simples-Cego , Adulto JovemRESUMO
BACKGROUND: Much is known about the frequency of sensitization to Blomia tropicalis, Dermatophagoides pteronyssinus and Dermatophagoides farinae, although less is known about sensitization to other species and their possible interactions. OBJECTIVE: In patients with allergic manifestations, to evaluate the frequency of sensitization to 10 species of mites in a tropical area and their possible interactions. METHODS: Cross-sectional study. Sensitization was evaluated by skin tests. A generalized linear Poisson regression model with robust variance was used. Based on the sensitization probability reasons and social networking analysis, explorations of relationship for 10 mites were performed. RESULTS: 147 patients were included. The highest sensitization was found to mites' family Pyroglyphidae (> 70 %) and less frequently was the Glycyphagidae family (< 50 %). Sensitization to any mites significantly increased the likelihood of sensitization to others. Sensitization to Der f or Der p increased, more than 20 times the likelihood of sensitization to other mites of the Pyroglyphidae family and more than 10 times to mites from other families. Sensitization to mites from Glycyphagidae, Chortoglyphidae or Acaridae family also increased the risk of sensitization to other mites but less than 5 times. CONCLUSION: Sensitization to mites is frequent in tropical area. Pyroglyphidae sensitization is the main risk factor for polysensitization with other mites from Glycyphagidae, Chortoglyphidae or Acaridae. These results must be considered at diagnosis and treatment of allergy diseases.
Assuntos
Hipersensibilidade Imediata/etiologia , Ácaros/imunologia , Adolescente , Adulto , Idoso , Animais , Antígenos de Dermatophagoides/efeitos adversos , Antígenos de Dermatophagoides/imunologia , Proteínas de Artrópodes/efeitos adversos , Proteínas de Artrópodes/imunologia , Criança , Pré-Escolar , Colômbia , Estudos Transversais , Cisteína Endopeptidases/efeitos adversos , Cisteína Endopeptidases/imunologia , Feminino , Humanos , Hipersensibilidade Imediata/epidemiologia , Masculino , Pessoa de Meia-Idade , Ácaros/classificação , Fatores de Risco , Serina Endopeptidases/efeitos adversos , Serina Endopeptidases/imunologia , Testes Cutâneos , Especificidade da Espécie , Clima Tropical , Adulto JovemRESUMO
Allergies comprise a set of highly prevalent diseases. When allergic processes are not controlled, they can endanger patients' health and lives, and have an important economic and social impact. The aim of this paper is to present a practical consensus of the scientific evidence on the use of immunotherapy in allergic diseases. A collaborative review made by various institutes and universities in Colombia was carried out upon request of the Asociación Colombiana de Alergia, Asma e Imunología, led by general practitioners, allergists, immunologists, internists and paediatricians with experience in the field of allergies. As a result, based on current national and international scientific evidence, we describe in detail what immunotherapy is about, its indications, contraindications and its economic and health benefits. Conclusions show immunotherapy as a clinically effective and safe treatment, which can substantially reduce the cost of the overall treatment of allergic patients.
Assuntos
Alérgenos , Dessensibilização Imunológica , Colômbia , Consenso , Humanos , HipersensibilidadeRESUMO
Las alergias constituyen un conjunto de enfermedades de gran prevalencia. Cuando los procesos alérgicos no se controlan, pueden poner en peligro la salud e, incluso, la vida de los pacientes y, además, su efecto económico y social es considerable. El objetivo de esta revisión es presentar un consenso práctico de la información científica disponible sobre el empleo de la inmunoterapia en las enfermedades alérgicas con la colaboración de varios institutos y universidades de Colombia, por solicitud de la Asociación Colombiana de Alergia, Asma e Inmunología. La revisión incluyó aspectos prácticos presentados desde el punto de vista de médicos generales, alergólogos, inmunólogos, internistas y pediatras con experiencia en el campo de las alergias. Con base en la evidencia científica actual a nivel nacional e internacional, se describió de forma detallada en qué consiste la inmunoterapia, sus indicaciones, contraindicaciones y sus beneficios para la salud, así como en el ámbito socioeconómico. Se concluyó que la inmunoterapia es efectiva y segura, y que, además, puede reducir sustancialmente el costo del tratamiento global de los pacientes alérgicos.
Allergies comprise a set of highly prevalent diseases. When allergic processes are not controlled, they can endanger patients´ health and lives, and have an important economic and social impact. The aim of this paper is to present a practical consensus of the scientific evidence on the use of immunotherapy in allergic diseases. A collaborative review made by various institutes and universities in Colombia was carried out upon request of the Asociación Colombiana de Alergia, Asma e Imunología , led by general practitioners, allergists, immunologists, internists and paediatricians with experience in the field of allergies. As a result, based on current national and international scientific evidence, we describe in detail what immunotherapy is about, its indications, contraindications and its economic and health benefits. Conclusions show immunotherapy as a clinically effective and safe treatment, which can substantially reduce the cost of the overall treatment of allergic patients.
Assuntos
Alérgenos , Anafilaxia , Asma , Conjuntivite , Consenso , Dermatite , Himenópteros , Imunoterapia , RiniteRESUMO
Introduction: Among allergic patients, pet avoidance is commonly recommended. It is difficult for patients to accomplish this because of their emotional attachment to the pets, and its effectiveness is controversial. Objective: To explore the applicability and effectiveness of pet avoidance measures among sensitized patients. Materials and methods: We evaluated 288 patients with asthma, rhinitis, conjunctivitis and/or dermatitis using skin prick test to measure their sensitization to cats, dogs and other animals to which they were exposed. Exposure to animals was evaluated in each patient (pets at home, frequent indirect exposure or no exposure). In those patients sensitized to animals some avoidance measures, such as removing pets from home and preventing indirect exposure, were recommended. On the following two appointments, we evaluated patients' fulfillment of these recommendations. Results: Sensitization to cats, dogs and birds was high (9%, 48%, 14%, respectively), as well as direct and indirect exposure (30%, 46%, 24%, respectively). Most patients denied contact with other animals (horses, hamsters, rabbits or cows), and sensitization to them was low. During the follow-up of patients sensitized to their pets at home (n=50), most of them refused to remove them from their house due to emotional attachment, and only two followed this recommendation. Conclusions: High exposure to animals could explain the frequency of sensitization to pets in this population. However, emotional attachment and prevalent indirect exposure to animals among sensitized patients make avoidance recommendations impractical or impossible to achieve.
Introducción. Entre los pacientes alérgicos se recomienda comúnmente la evitación de mascotas; sin embargo, es difícil que los pacientes cumplan con esta recomendación debido al apego emocional y, además, su efecto clínico no es claro. Objetivo. Explorar la aplicabilidad de las medidas de evitación entre pacientes sensibilizados a mascotas . Materiales y métodos. En 284 pacientes con asma, rinitis, conjuntivitis y dermatitis, se evaluó la sensibilización a gatos, perros y otros animales mediante pruebas de punción epidérmica. Se evaluó, igualmente, el nivel de exposición a animales (mascotas en la casa y exposición indirecta frecuente). A aquellos pacientes sensibilizados a los animales, se les recomendaron medidas de evitación como retirar la mascota de la casa y evitar la exposición indirecta. En las dos citas médicas siguientes se evaluó el cumplimiento de estas recomendaciones. Resultados. La sensibilización a gatos, perros y aves fue alta (9, 48, y 14 %, respectivamente), al igual que la exposición directa o indirecta a estos animales (30, 46, 24 %, respectivamente). La mayoría de los pacientes negó el contacto frecuente con otros animales (caballos, hámsteres, conejos, vacas) y la sensibilización a estos fue baja. La mayoría de los pacientes sensibilizados a su propia mascota (n= 50) se rehusó a retirar la mascota de la casa y solo dos de ellos siguieron la recomendación de hacerlo. Conclusiones. La exposición frecuente a los animales podría explicar la gran frecuencia de sensibilización a las mascotas en esta población. Sin embargo, el apego emocional y la exposición indirecta frecuente, hacen que las recomendaciones de evitación sean imprácticas o casi imposibles de lograr.
Assuntos
Adolescente , Adulto , Idoso , Animais , Gatos , Criança , Pré-Escolar , Cães , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Cooperação do Paciente , Animais de Estimação , Hipersensibilidade/prevenção & controle , Asma/etiologia , Asma/prevenção & controle , Especificidade da Espécie , Aves/imunologia , Testes Cutâneos , Alérgenos/imunologia , Rinite/etiologia , Rinite/prevenção & controle , Estudos Prospectivos , Dermatite Atópica/etiologia , Dermatite Atópica/prevenção & controle , Emoções , Exposição Ambiental , Animais de Estimação/imunologia , Hipersensibilidade/etiologiaRESUMO
INTRODUCTION: Among allergic patients, pet avoidance is commonly recommended. It is difficult for patients to accomplish this because of their emotional attachment to the pets, and its effectiveness is controversial. OBJECTIVE: To explore the applicability and effectiveness of pet avoidance measures among sensitized patients. MATERIALS AND METHODS: We evaluated 288 patients with asthma, rhinitis, conjunctivitis and/or dermatitis using skin prick test to measure their sensitization to cats, dogs and other animals to which they were exposed. Exposure to animals was evaluated in each patient (pets at home, frequent indirect exposure or no exposure). In those patients sensitized to animals some avoidance measures, such as removing pets from home and preventing indirect exposure, were recommended. On the following two appointments, we evaluated patients' fulfillment of these recommendations. RESULTS: Sensitization to cats, dogs and birds was high (9%, 48%, 14%, respectively), as well as direct and indirect exposure (30%, 46%, 24%, respectively). Most patients denied contact with other animals (horses, hamsters, rabbits or cows), and sensitization to them was low. During the follow-up of patients sensitized to their pets at home (n=50), most of them refused to remove them from their house due to emotional attachment, and only two followed this recommendation. CONCLUSIONS: High exposure to animals could explain the frequency of sensitization to pets in this population. However, emotional attachment and prevalent indirect exposure to animals among sensitized patients make avoidance recommendations impractical or impossible to achieve.
Assuntos
Hipersensibilidade/prevenção & controle , Cooperação do Paciente , Animais de Estimação , Adolescente , Adulto , Idoso , Alérgenos/imunologia , Animais , Asma/etiologia , Asma/prevenção & controle , Aves/imunologia , Gatos/imunologia , Criança , Pré-Escolar , Dermatite Atópica/etiologia , Dermatite Atópica/prevenção & controle , Cães/imunologia , Emoções , Exposição Ambiental , Feminino , Humanos , Hipersensibilidade/etiologia , Lactente , Masculino , Pessoa de Meia-Idade , Animais de Estimação/imunologia , Estudos Prospectivos , Rinite/etiologia , Rinite/prevenção & controle , Testes Cutâneos , Especificidade da Espécie , Adulto JovemRESUMO
BACKGROUND: Pet avoidance is commonly recommended to allergic patients, even if an IgE-mediated sensitization has not been demonstrated. This management is difficult to accomplish by patients with emotional attachment to their pets and the effectiveness is controversial. OBJECTIVE: To assess the sensitization to different animals among patients with asthma, rhinitis, conjunctivitis and/or dermatitis. To assess the sensitization to different animals among patients with asthma, rhinitis, conjunctivitis and/or dermatitis. PATIENTS AND METHOD: A retrospective study was performed with 300 previously reported patients with asthma, rhinitis, conjunctivitis and/or dermatitis; we organized two groups: Group 1 included patients who were tested skin sensitization to both dog and cat. Group 2 was comprised of all patients with skin testing droppings or feathers of birds (canary, parrot, pigeon or hen). RESULTS: Sensitization to cat and especially to dog was high (7% and 47%, respectively). The co-sensitization to dog was high among patients sensitized to cat (85%). Sensitization to other epithelia (horse, hamster, rabbit, cow) was low. About birds, there was a greater sensitization to proteins contained in the feces than in the feathers, pigeon sensitization was the most frequent. We observed no differences in the pattern of sensitization among patients according to age, gender or allergic symptoms. CONCLUSIONS: The frequency of co-sensitization with cat and dog was high, which may be explained by shared proteins between the two species as lipocalins. About birds, the proteins in pigeon droppings were the main cause of sensitization; however, it does not seem to share cross-reactivity with other birds and the frequency was relatively low compared with epithelia allergens.
ANTECEDENTES: comúnmente se recomienda a los pacientes alérgicos evitar las mascotas, aun si no se ha demostrado sensibilización IgE mediada. Esta medida, sin una sensibilización demostrada, no es necesaria; además, es difícil de cumplir por parte de los pacientes con apego afectivo a sus mascotas y su eficacia es controvertida. OBJETIVO: evaluar la sensibilización a diferentes animales en pacientes con asma, rinitis, conjuntivitis, dermatitis o todas. PACIENTES Y MÉTODO: estudio retrospectivo efectuado a partir de una población previamente reportada de 300 pacientes con asma, rinitis, conjuntivitis, dermatitis o con combinaciones de éstas; se formaron dos grupos: el grupo 1 estuvo conformado por los pacientes a quienes se realizaron pruebas cutáneas de sensibilización a gato y a perro. El grupo 2 estuvo conformado por todos los pacientes con pruebas cutáneas para excremento o plumas de aves (canario, perico, paloma o gallina). RESULTADOS: la sensibilización a gato y especialmente a perro fue alta (7 y 47%, respectivamente). La cosensibilización a perro fue alta entre los pacientes sensibilizados a gato (85%). La sensibilización a otros epitelios (caballo, hámster, conejo, vaca) fue baja. Con respecto a las aves, se observó mayor sensibilización a las proteínas contenidas en los excrementos, la sensibilización a paloma fue la más frecuente. No observamos diferencias en el patrón de sensibilización entre los pacientes de acuerdo con la edad, género o los síntomas alérgicos. CONCLUSIONES: la frecuencia de cosensibilización a gato y a perro fue alta, lo que puede explicarse por proteínas compartidas entre las dos especies, como las lipocalinas. Con respecto a las aves, las proteínas contenidas en el excremento de paloma fueron la principal causa de sensibilización; sin embargo, no parece compartir reactividad cruzada con otras aves y la frecuencia fue relativamente baja en comparación con los epitelios.