IgE, IgG4 e IgA específicas na alergia ao látex
Specific IgE, IgG4, and IgA in latex allergy
Laila S. Garro; Marcelo V. Aun; Antônio A. Motta; Jorge Kalil; Pedro Giavina-Bianchi
Resumo
Objetivo: A alergia ao látex é considerada um problema mundial de saúde por estar associada a reações potencialmente fatais. O objetivo principal deste estudo é identificar fatores clínico-laboratoriais associados à sensibilização e alergia ao látex, avaliando as concentrações de IgE, IgG4 e IgA específicas nestas condições. Métodos: Estudo observacional transversal em uma coorte de 400 crianças e adolescentes com defeito do fechamento do tubo neural. Os pacientes realizaram entrevista clínica e foram submetidos a coleta de sangue periférico para a detecção dos níveis séricos de IgE, IgG4 e IgA específicas para látex. As prevalências de sensibilização e alergia ao látex foram calculadas e as variáveis clínico-laboratoriais coletadas foram analisadas. Resultados: A prevalência de sensibilização e de alergia ao látex em pacientes com defeito de fechamento do tubo neural foi de 33,2% e 12,2%, respectivamente. As manifestações clínicas de alergia ao látex mais frequentes foram as cutâneas (79,6%), mas anafilaxia foi observada em 4,75% dos pacientes. Os fatores clínico-cirúrgicos associados à alergia ao látex foram identificados e um escore de sintomas para rastrear os pacientes foi desenvolvido. A concentração de IgE sérica específica para látex ≥ 0,77 kUA/L tem boa acurácia para diferenciar os pacientes sensibilizados assintomáticos dos alérgicos. As dosagens de IgE sérica específica para alérgenos recombinantes também apresentaram boa acurácia no diagnóstico da alergia. Conclusões: Maior concentração de IgE específica para látex e Hevb5, menor concentração de IgG4 específica para látex e escore de sintomas ≥ 40% estiveram associados com alergia ao látex.
Palavras-chave
Abstract
Objective: Latex allergy is considered a global health problem because it is associated with life-threatening reactions. The main objective of this study was to identify clinical and laboratory factors associated with sensitization and allergy to latex, assessing the concentrations of latex-specific IgE, IgG4, and IgA. Methods: This was an observational study of a cohort of 400 children and adolescents with neural tube closure defect. Patients underwent a clinical interview and had their blood drawn for the measurement of serum levels of latex-specific IgE, IgG4, and IgA. The prevalence rates of sensitization and allergy to latex were calculated, and clinical and laboratory variables were analyzed. Results: The prevalence rates of sensitization and allergy to latex in patients with neural tube closure defects were 33.2 and 12.2%, respectively. Cutaneous manifestations of latex allergy were the most common ones (79.6%), but anaphylaxis was observed in 4.75% of the patients. Clinical and surgical factors associated with latex allergy were identified, and a symptom scoring system was developed as a screening tool. A latex-specific IgE concentration ≥ 0.77 kUA/L showed good accuracy to differentiate between asymptomatic sensitization and allergy. The measurement of specific IgE to recombinant allergens also showed good accuracy in the diagnosis of allergy. Conclusions: Higher concentrations of latex-specific IgE and Hevb5, lower concentrations of latex-specific IgG4, and a symptom score ≥ 40% were associated with latex allergy.
Keywords
Referências
1. Mertes PM, Alla F, Tréchot P, Auroy Y, Jougla E. Anaphylaxis during anesthesia in France: an 8-year national survey. J Allergy Clin Immunol. 2011;128(2):366-73.
2. Fernandes AC, Bitu SOB, Violante Júnior FH. Alergia ao látex em pacientes portadores de mielomeningocele. Rev Bras Ortop. 2006;41(6):217-20.
3. Bueno de Sa A, Camilo Araujo RF, Cavalheiro S, Carvalho Mallozi M, Sole D. Profile of latex sensitization and allergies in children and adolescents with myelomeningocele in Sao Paulo, Brazil. Journal of Investigational Allergology and Clinical Immunology. 2013;23(1):43-9.
4. Cremer R, Hoppe A, Korsch E, Kleine-Diepenbruck U, Blaker F. Natural rubber latex allergy: prevalence and risk factors in patients with spina bifida compared with atopic children and controls. Eur J Pediatr. 1998;157(1):13-6.
5. Ausili E, Tabacco F, Focarelli B, Nucera E, Patriarca G, Rendeli C. Prevalence of latex allergy in spina bifida: genetic and environmental risk factors. Eur Rev Med Pharmacol Sci. 2007;11(3):149-53.
6. Yeh WSC, Kiohara PR, Soares ISC, Carmona MJC, Rocha FT, Galvao CES. Prevalence of sensitivity signals to latex in meningomyelocele patients undergoing multiple surgical procedures. Rev Bras Anestesiol. 2012;62(1):56-62.
7. Garpar A, Faria E. Alergia ao látex. Rev Portug Imunoalergol. 2012:20(3):173-92.
8. Cabanes N, Igea JM, la Hoz de B, Agustin P, Blanco C, Dominguez J, et al. Latex allergy: Position Paper. Journal of Investigational Allergology and Clinical Immunology. 2012;22(5):313-30.
9. Rendeli C, Nucera E, Ausili E, Tabacco F, Roncallo C, Pollastrini E, et al. Latex sensitisation and allergy in children with myelomeningocele. Childs Nerv Syst. 2006;22(1):28-32.
10. Mazon A, Nieto A, Estornell F, Nieto A, Reig C, Garcia-Ibarra F. Factors that influence the presence of symptoms caused by latex allergy in children with spina bifida. J Allergy Clin Immunol. 1997;99(5):600-4.
11. Nieto A, Estornell F, Mazon A, Reig C, Nieto A, Garcia-Ibarra F. Allergy to latex in spina bifida: a multivariate study of associated factors in 100 consecutive patients. J Allergy Clin Immunol.1996;98(3):501-7.
12. Konz KR, Chia JK, Kurup VP, Resnick A, Kelly KJ, Fink JN. Comparison of latex hypersensitivity among patients with neurologic defects. J Allergy Clin Immunol. 1995;95(5 Pt 1):950-4.
13. Ellsworth PI, Merguerian PA, Klein RB, Rozycki AA. Evaluation and risk factors of latex allergy in spina bifida patients: is it preventable? J Urol. 1993;150(2 Pt 2):691-3.
14. Pires G, Morais-Almeida M, Gaspar A, Godinho N, Calado E, AbreuNogueira J, et al. Risk factors for latex sensitization in children with spina bifida. Allergologia et Immunopathologia. 2002;30(1):5-13.
15. Wagner B, Buck D, Hafner C, Sowka S, Niggemann B, Scheiner O, et al. Hev b 7 is a Hevea brasiliensis protein associated with latex allergy in children with spina bifida. J Allergy Clin Immunol. 2001;108(4):621-7.
16. Peixinho CM, Tavares-Ratado P, Gabriel MF, Romeira AM, LozoyaIbanez C, Taborda-Barata L, et al. Different in vivo reactivity profile in health care workers and patients with spina bifida to internal and external latex glove surface-derived allergen extracts. Br J Dermatol. 2012;166(3):518-24.
17. Johansson SG, Yman L. In vitro assays for immunoglobulin E. Methodology, indications, and interpretation. Clin Rev Allergy. 1988;6(2):93-139.
18. Capriles-Hulett A, Sanchez-Borges M, Von-Scanzoni C, Medina JR. Very low frequency of latex and fruit allergy in patients with spina bifida from Venezuela: influence of socioeconomic factors. ANAI. 1995;75(1):62-4.
19. Buck D, Michael T, Wahn U, Niggemann B. Ventricular shunts and the prevalence of sensitization and clinically relevant allergy to latex in patients with spina bifida. Pediatr Allergy Immunol. 2000;11(2):111-5.
20. Soyer OU, Akdis M, Ring J, Behrendt H, Crameri R, Lauener R, et al. Mechanisms of peripheral tolerance to allergens. Allergy. 2012;68(2):161-70.
21. Michael T, Niggemann B, Moers A, Seidel U, Wahn U, Scheffner D. Risk factors for latex allergy in patients with spina bifida. Clin Exp Allergy. 1996;26(8):934-9.
22. Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immunol. 2007;120(6):1413-7.
23. Savage JH, Kaeding AJ, Matsui EC, Wood RA. The natural history of soy allergy. J Allergy Clin Immunol. 2010;125(3):683-6.
24. Ford LS, Bloom KA, Nowak-Wegtzyn AH, Shreffler WG, Masilami M, Sampson HA. Basophil reactivity, wheal size, and immunoglobulin levels distinguish degrees of cow's milk tolerance. J Allergy Clin Immunol. 2013;131(1):180-6.
25. Sampson HA. Update on food allergy. J Allergy Clin Immunol. 2004;113(5):805-19.
26. Akdis CA. Therapies for allergic inflammation: refining strategies to induce tolerance. Nat Med. 2012;18(5):736-49.
27. Vazquez-Ortiz M, Pascal M, Juan M, Alsina L, Martin-Mateos MA, Plaza AM. Serum allergen-specific IgA is not associated with natural or induced tolerance to egg in children. Allergy. 2013;in press.
28. Savilahti EM, Rantanen V, Lin JS, Karinen S, Saarinen KM, Goldis M, et al. Early recovery from cow's milk allergy is associated with decreasing IgE and increasing IgG4 binding to cow's milk epitopes. J Allergy Clin Immunol. 2010;125(6):1315-9.
29. van de Veen W, Stanic B, Yaman G, Wawrzyniak M, Sollner S, Akdis DG, et al. IgG4 production is confined to human IL-10-producing regulatory B cells that suppress antigen-specific immune responses. J Allergy Clin Immunol. 2013;131(4):1204-12.
Submetido em:
10/01/2017
Aceito em:
15/02/2017
Facebook
LinkedIn
Mendeley
StumbleUpon
Reddit
Email