Anafilaxia a alfa-gal: um relato de caso paraibano
Alpha-gal anaphylaxis: a case report from Paraíba, Brazil
Renata de Cerqueira Paes Correa Lima; Constantino Giovanni Braga Cartaxo; Wanne Sabrini Silva de-Brito
Resumo
O presente relato apresenta um caso de anafilaxia tardia ao carboidrato alfa-gal em um adolescente da cidade de Belém, na Paraíba, Brasil. O paciente desenvolveu reação tardia à ingesta de carne e vísceras de animais. Ele mora em fazenda e tem contato próximo com animais potencialmente contaminados por carrapatos. Essa causa de reação alérgica é nova, e estudos começaram a atribuí-la a casos antes ditos idiopáticos. A anafilaxia é uma reação potencialmente fatal, que deve ser prontamente diagnosticada e tratada. Sendo assim, a descoberta de seu fator desencadeante é um dos principais itens que direcionam o tratamento. No Brasil, nenhum caso de anafilaxia por alfa-gal foi antes descrito na literatura local.
Palavras-chave
Abstract
This report presents a case of late anaphylaxis to alpha-gal carbohydrate in a teenager living in the city of Belém, Paraíba, Brazil. The patient developed a late reaction to eating meat and offal of animals; he lives on a farm and has close contact with animals potentially contaminated by ticks. This cause of allergic reaction is new, and studies have started to attribute it to cases previously said to be idiopathic. Anaphylaxis is a potentially fatal reaction that must be promptly diagnosed and treated. Thus, the discovery of its triggering factor is one of the main items that guide treatment. In Brazil, no case of alpha-gal anaphylaxis had been described in the local literature.
Keywords
Referências
1. Huang F, Chawla K, Järvinen KM, Nowak-Weegrzyn A. Anaphylaxis in a New York City pediatric emergency department: Triggers, treatments, and outcomes. Bone. 2012;23(1):1-7.
2. Simons FER, Ardusso LRF, Bilò MB, El-Gamal YM, Ledford DK, Ring J, et al. World allergy organization guidelines for the assessment and management of anaphylaxis. Japanese J Allergol. 2014;62(11):1464‑500.
3. Simons FER. Anaphylaxis. J Allergy Clin Immunol. J Allergy Clin Immunol. 2010;125(Suppl 2):S161-8.
4. Silva MTN. Alergia e Imunologia . In: Burns DAR, Campos Júnior D, Silva LR, Borges WG, Blank D; Sociedade Brasileira de Pediatria. Tratado de Pediatria. São Paulo: Manole; 2017. p. 445-6.
5. Domingues-Ferreira M, Paia Neto L, Ribeiro RG. Alergia a alfa-gal: uma revisão sistemática. Braz J Allergy Immunol. 2015;3(6):241‑50.
6. Steinke JW, Platts-Mills TAE, Commins SP. The alpha-gal story: Lessons learned from connecting the dots. J Allergy Clin Immunol [Internet]. 2015;135(3):589-96.
7. Platts-Mills TAE, Schuyler AJ, Hoyt AEW, Commins SP. Delayed anaphylaxis involving IgE to galactose-alpha-1,3-galactose. Curr Allergy Asthma Rep. 2015;15:12.
8. Commins SP, Jerath MR, Cox K, Erickson LD, Platts-Mills T. Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat. Allergol Int [Internet]. 2016;65(1):16-20.
9. Platts-Mills TA, Schuyler AJ, Tripathi A, Commins SP. Anaphylaxis to the carbohydrate side chain alpha-gal. Immunol Allergy Clin North Am. 2015 May;35(2):247-60.
10. Galili U, Rachmilewitz EA, Peleg A, Flechner I. A unique natural human IgG antibody with anti-alpha-galactosyl specificity. J Exp Med. 1984;160:1519-31.
11. van Nunen S. Tick-induced allergies: Mammalian meat allergy, tick anaphylaxis and their significance. Asia Pac Allergy. 2015;5(1):3‑16.
12. Fischer J, Biedermann T. Delayed immediate-type hypersensitivity to red meat and innards: current insights into a novel disease entity. J Dtsch Dermatol Ges. 2016 Jan;14(1):38-44.
13. Steinke JW, Platts-Mills TAE, Commins SP. The alpha-gal story: Lessons learned from connecting the dots. J Allergy Clin Immunol [Internet]. 2015;135(3):589-96.
14. Fischer J, Yazdi AS, Biedermann T. Clinical spectrum of a-Gal syndrome: from immediate-type to delayed immediate-type reactions to mammalian innards and meat. Allergo J Int. 2016;25:55-62.
15. Fischer J, Hebsaker J, Caponetto P, Platts-Mills TA, Biedermann T. Galactose-alpha-1,3-galactose sensitization is a prerequisite for pork-kidney allergy and cofactor-related mammalian meat anaphylaxis [Letter]. J Allergy Clin Immunol. 2014 Sep;134(3):755-9. e1. doi: 10.1016/j.jaci.2014.05.051.
16. Rispens T, Derksen NI, Commins SP, Platts-Mills TA, Aalberse RC. IgE production to α-gal is accompanied by elevated levels of specific IgG1 antibodies and low amounts of IgE to blood group B. PLoS One. 2013;8(2):e55566.
17. Pita J, Ciobanu A, Loureiro C, Bom AT. Alergia a galactose- a-1,3- galactose. Rev Port Imunoalergologia. 2018;26(1):11-19.
18. São Paulo, Brasil. Secretaria de Estado da Saúde. Superintendência de Controle de Endemias - SUCEN. Manual de vigilância acarológica. Camargo-Neves VLF (coord.). São Paulo: SES; 2004. p. 62.
19. Mabelane T, Basera W, Botha M, Thomas HF, Ramjith J, Levin ME. Predictive values of alpha-gal IgE levels and alpha-gal IgE: Total IgE ratio and oral food challenge-proven meat allergy in a population with a high prevalence of reported red meat allergy. Pediatr Allergy Immunol. 2018;29(8):841-9.
20. Stewart P, McMullan K, Le Blanc S. Delayed red meat allergy: clinical ramifications of galactose-α-1,3-galactose sensitization. Ann Allergy Asthma Immunol. 2015;115:260-4.
21. Ferreira MD, Piaia Neto L, Ribeiro RG. Alergia a alfa-gal: uma revisão sistemática. Braz J Allergy Immunol. 2015;3(6):241-50.
22. Cocco RR, Ensina LF, Aranda CS, Solé D. Galactose-α-1,3-galactose (alpha gal) allergy without anaphylaxis: a case report in Brazil. Clinical and Translational Allergy. 2017;7(Suppl 1):PP159.
Submetido em:
12/11/2020
Aceito em:
07/03/2021
