Avaliação do fenótipo atópico nos pacientes com DREA
Evaluation of atopic phenotype in patients with DREA
Mayra Coutinho Andrade; Rosilane dos Reis Pacheco; Mila Almeida; Priscila Takejima; Marcelo Vivolo Aun; Jorge Kalil; Pedro Giavina-Bianchi; Rosana Câmara Agondi
Resumo
Introdução: A doença respiratória exacerbada por anti-inflamatórios (DREA) é uma síndrome bem caracterizada, composta por asma, polipose nasal e intolerância a aspirina e anti-inflamatórios não esteroidais (AINEs). Apesar de já bem definida, há uma heterogeneidade entre a população de pacientes com diagnóstico de DREA. O objetivo desse trabalho foi avaliar o fenótipo atópico nos pacientes com DREA. Métodos: Foi realizado um estudo retrospectivo com pacientes com DREA acompanhados em um serviço terciário. Esses pacientes foram classificados em dois grupos: atópicos e não atópicos. Foram avaliados também dados como gravidade da asma, AINEs envolvidos na reação, e IgE sérica total. Resultados: Foram analisados 70 pacientes, destes 55 (78,6%) eram mulheres. A média de idade era de 54 anos. Do total de pacientes, 32 (45,7%) eram atópicos. Os pacientes atópicos apresentavam média de início de asma mais precoce (22 anos) e maior tempo de doença (31 anos) do que os não atópicos. A média de IgE sérica total era maior nos atópicos (742,1 UI/mL). No grupo dos pacientes com DREA e atopia, a pesquisa de IgE sérica específica mostrou-se positiva para os ácaros em 90,6% dos pacientes. A maioria dos pacientes atópicos (71%) relatava reação a múltiplos AINEs. Os principais medicamentos relacionados às exacerbações respiratórias nos pacientes com DREA foram: AAS em 72,1% dos casos; dipirona em 61,8%; diclofenaco em 45,6%; e cetoprofeno e ibuprofeno em 27,9% dos casos cada um. Conclusões: Existem diferenças entre os pacientes com DREA conforme a presença ou não de atopia. Os atópicos apresentam início de sintomas mais precoce, maior tempo de duração de asma, necessitam de mais medicação para controle e apresentam hipersensibilidade a um número maior de AINEs, sendo que o principal medicamento causador de sintomas também varia entre os dois grupos.
Palavras-chave
Abstract
Introduction: Aspirin-exacerbated respiratory disease (AERD) is a well characterized syndrome in which asthma, nasal polyposis, and intolerance to aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) coexist. Even though it is well defined, the population of patients diagnosed with AERD is very heterogeneous. The aim of this study was to evaluate atopic phenotype in patients with AERD. Methods: A retrospective study was performed with patients with AERD followed at a tertiary hospital. These patients were classified into two groups: atopic and non-atopic. Clinical characteristics and data such as asthma severity, NSAIDs involved in the reaction and total serum IgE were also evaluated. Results: Seventy patients were analyzed, of which 55 (78.6%) were women. Mean age was 54 years. Of the total sample, 32 (45.7%) were atopic. Atopic patients had a lower mean age at the onset of asthma (22 years) and presented a longer mean disease duration (31 years) than non-atopic patients. Mean total serum IgE was higher in atopic patients (742.1 IU/ mL). In the group with AERD and atopy, the specific serum IgE test was positive for mites in 90.6% of the patients. Most atopic patients (71%) reported reaction to multiple NSAIDs. The main drugs related to respiratory exacerbations in patients with AERD were: aspirin in 72.1% of cases; dipyrone in 61.8%; diclofenac in 45.6%; ketoprofen and ibuprofen in 27.9% each. Conclusions: There are differences between patients with AERD according to the presence or absence of atopy. Atopic patients have an earlier onset of symptoms and a longer duration of asthma, they require more medication to control the condition and are hypersensitive to a greater number of NSAIDs; the drug that most commonly triggered symptoms also differed between the two groups.
Keywords
Referências
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Submetido em:
02/05/2018
Aceito em:
28/05/2018
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