As múltiplas faces da anafilaxia: anafilaxia induzida por exercício e anafilaxia idiopática
The multiple faces of anaphylaxis: exercise-induced anaphylaxis and idiopathic anaphylaxis
Mario Geller
Resumo
A anafilaxia é uma reação grave que pode ter fatores desencadeantes diversos. É frequentemente associada a mecanismos alérgicos e/ou imunológicos, e requer pronto tratamento, pois em geral é de instalação rápida, progressiva, sendo potencialmente fatal. Anafilaxia induzida por exercício e anafilaxia induzida por exercício dependente de alimento são condições raras, mas potencialmente ameaçadoras à vida, nas quais a associação com o exercício é essencial. Atividades desencadeantes podem ser atividades físicas leves, bem como exercícios vigorosos. Na anafilaxia induzida por exercício dependente de alimento, a combinação de ingestão do alimento sensibilizante e o exercício é necessária para induzir os sintomas. Alimentos sensibilizantes comuns são: trigo, frutos do mar (particularmente camarão), amendoim, leite de vaca, soja, e farinhas contaminadas com ácaros. Anafilaxia induzida por exercício dependente de medicamentos pode também ocorrer; anti-inflamatórios não-esteroidais e antibióticos são desencadeantes frequentes desta condição. Aspectos clínicos e manejo do episódio agudo de anafilaxia induzida por exercício não diferem de forma significante de outros tipos de anafilaxia. Anafilaxia idiopática é diagnosticada por exclusão de outros tipos de anafilaxia de etiologia conhecida. Na anafilaxia idiopática, degranulação de mastócitos foi documentada, com liberação de histamina e triptase. Este artigo de revisão descreve os aspectos clínicos, diagnóstico e manejo da anafilaxia induzida por exercício, anafilaxia induzida por exercício dependente de alimento, anafilaxia induzida por exercício dependente de medicamento, e anafilaxia idiopática.
Palavras-chave
Abstract
Anaphylaxis is a severe reaction with a number of potential triggering factors. It is often associated with allergic and/or immunological mechanisms and requires prompt treatment due to its rapid onset and progression and because of its potentially fatal nature. Exercise-induced anaphylaxis and food-dependent exercise-induced anaphylaxis are rare but potentially life-threatening conditions in which association with exercise is essential. Triggering activities could be mild physical activities as well as vigorous exercise. In food-dependent exercise-induced anaphylaxis, a combination of intake of sensitizing food plus exercise is necessary to induce symptoms. Common sensitizing foods include wheat, shellfish (shrimp in particular), peanut, cow’s milk, soy, and mitecontaminated flour. Drug-dependent exercise-induced anaphylaxis may also occur; non-steroidal anti-inflammatory drugs and antibiotics are frequent triggers of this condition. Clinical features and management of acute episodes of exercise-induced anaphylaxis do not differ significantly from other types of anaphylaxis. Idiopathic anaphylaxis is diagnosed by exclusion of other types of anaphylaxis with known etiology. Mast cell degranulation has been documented in idiopathic anaphylaxis, with histamine and tryptase release. This review describes the clinical aspects, diagnosis and management of exercise-induced anaphylaxis, food-dependent and drug-dependent exercise-induced anaphylaxis, and idiopathic anaphylaxis.
Keywords
Referências
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Submetido em:
11/02/2013
Aceito em:
21/03/2013
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