Anafilaxia e os alérgenos ocultos
Anaphylaxis and hidden allergens
Albertina Varandas Capelo, Alexandra Sayuri Watanabe, Nathalia Portobello, Jane da Silva, Mario Gueller, Ana Carolina D'Onofrio-Silva, Fabiana Andrade Oliveira, Alex Eustáquio de Lacerda, Elaine Gagete Miranda-da-Silva, Marisa Rosimeire Ribeiro
Resumo
As reações de hipersensibilidade imediata alérgicas podem ser desencadeadas por agentes de alto peso molecular, como pro‑ teínas alimentares, sementes, grãos, especiarias e insetos, ou por agentes de baixo peso molecular, como produtos químicos e aditivos industriais. Esses alérgenos são capazes de induzir manifestações respiratórias, cutâneas e até quadros sistêmicos graves, como anafilaxia. Quando não estão devidamente identi‑ ficados nos rótulos de produtos, são contaminantes inesperados ou representam novos ingredientes adicionados a itens previa‑ mente seguros, recebem a denominação de alérgenos ocultos. Esses componentes podem passar despercebidos durante a investigação clínica, contribuindo para diagnósticos equivocados, especialmente nos casos classificados como anafilaxia idiopática. Esta revisão tem como objetivo a compreensão ampla das causas raras de anafilaxia provocadas por alérgenos ocultos, reforçando a importância de reconhecê-los como possíveis gatilhos, essencial para o diagnóstico correto e orientação de medidas preventivas eficazes. Os métodos empregados incluíram uma revisão narrativa nas bases MEDLINE, LILACS e SciELO, no período de abril de 2024 a abril de 2025. Foram selecionados estudos originais, de acesso aberto, nos idiomas inglês ou português, sem restrições de data. Excluíram-se artigos incompletos, anais de congressos, opiniões, resenhas e trabalhos que não abordassem diretamente o tema. Os achados reforçam que a identificação de alérgenos ocultos permanece um desafio significativo na prática clínica. Embora não esgote o tema, esta revisão destaca a necessidade de considerar rotineiramente esses agentes na investigação etio‑ lógica de reações alérgicas, sobretudo nos quadros de anafilaxia idiopática, além de criar algoritmos e diretrizes de investigação, visando facilitar o diagnóstico.
Palavras-chave
Abstract
Allergic immediate hypersensitivity reactions may be triggered by high-molecular-weight agents, such as food proteins, seeds, grains, spices, and insects, or by low-molecular-weight agents, such as chemicals and industrial additives. These allergens can induce respiratory and cutaneous manifestations, and may cause severe systemic reactions such as anaphylaxis. When not properly identified on product labels, when present as unexpected contaminants, or when introduced as novel ingredients in previously safe products, they are known as hidden allergens. These components may go unnoticed during clinical investigation, contributing to misdiagnosis, particularly in cases classified as idiopathic anaphylaxis. The goal of this review is to provide a comprehensive understanding of rare causes of anaphylaxis triggered by hidden allergens, emphasizing the importance of recognizing them as potential triggers for accurate diagnosis and appropriate preventive measures. The methods employed included a narrative review of the MEDLINE, LILACS, and SciELO databases covering the period from April 2024 to April 2025. Original open-access studies published in English or Portuguese were selected without date restrictions. Incomplete articles, conference proceedings, opinion papers, review articles, and studies not directly addressing the topic were excluded. The findings reinforce that the identification of hidden allergens remains a significant challenge in clinical practice. Although not intended to be exhaustive, this review highlights the need to routinely consider these agents in the etiological investigation of allergic reactions, especially in cases of idiopathic anaphylaxis, as well as the importance of developing investigation guidelines and algorithms to facilitate diagnosis.
Keywords
Referências
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Submetido em:
03/01/2025
Aceito em:
26/11/2025
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