Alergia a alfa-gal: uma revisão sistemática
Allergy to alpha-gal: a systematic review
MaurÃcio Domingues Ferreira; Luiz Piaia Neto; Rodrigo Gil Ribeiro
Resumo
A alergia ao carboidrato galactose-α-1,3-galactose (alfa-gal) tem sido associada a duas formas distintas de apresentação de anafilaxia: anafilaxia de inÃcio imediato durante a primeira exposição ao anticorpo monoclonal cetuximab intravenoso, e anafilaxia de inÃcio tardio 3-6 horas após ingestão de carne de mamÃferos não-primatas (carne vermelha), em pacientes sensibilizados previamente por picada de carrapatos. Recentemente foi descrito este tipo de anafilaxia que ocorre em pacientes que possuem IgE especÃfica para alfa-gal, um carboidrato que é componente de glicoproteÃnas e glicolipÃdeos de mamÃferos não primatas. Tais pacientes desenvolvem sintomas tardios como urticária, angioedema, sintomas gastrointestinais e anafilaxia, que podem ser graves e até fatais, após comerem carne vermelha ou vÃsceras de mamÃferos não primatas. Reações mais rápidas, em cerca de 2 horas após a ingestão do alimento, em indivÃduos com anticorpos IgE para alfa-gal, foram descritas em pacientes europeus que consumiram rim de porco, e em pacientes que relataram ingestão de álcool concomitantemente à carne vermelha. Cetuximab é um anticorpo monoclonal humanizado IgG1 contendo alfa-gal, e reações alérgicas a este anticorpo ocorreram com a primeira administração deste medicamento. O conhecimento das manifestações clÃnicas desta sÃndrome tem aumentado, e o número de casos tem crescido nos Estados Unidos e em outros paÃses do mundo, de forma que a alergia a alfa-gal tornou-se mais prontamente compreendida e diagnosticada nos últimos anos.
Palavras-chave
Abstract
Allergy to the carbohydrate galactose-α-1,3-galactose (alpha-gal) has been associated with two different presentations of anaphylaxis: immediate onset anaphylaxis, following the first intravenous exposure to monoclonal antibody cetuximab, and delayed onset anaphylaxis, starting 3-6 hours after the ingestion of meat from non-primate mammals (red meat), in patients previously sensitized by tick bites. Recently, this kind of anaphylaxis has been described in patients who have specific IgE to alpha-gal, a carbohydrate that is a component of non-primate mammalian glycoproteins and glycolipids. These patients develop delayed symptoms, such as urticaria, angioedema, gastrointestinal manifestations, and anaphylaxis, which may be serious or even fatal, after eating red meat or organs from non-primate mammals. Faster reactions, approximately 2 hours after food ingestion, in individuals with IgE to alpha-gal, have been reported in European patients who ingested pork kidney and in patients who reported concomitant consumption of alcohol and red meat. Cetuximab is a humanized IgG1 monoclonal antibody containing alpha-gal, and allergic reactions to this antibody have been reported after the first use of this medication. Knowledge of the clinical manifestations of this syndrome has improved, and the number of cases has grown in the United States and in other countries, improving our understanding of allergy to alpha-gal and allowing it to be more readily diagnosed in recent years.
Keywords
Referências
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Submetido em:
14/12/2015
Aceito em:
28/10/2016
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