Top

Alergia

Alergia

 

     Tulburările alergice precum febra fânului, eczemele şi astmul afectează aproximativ 25% din populaţia lumii. La subiecţii alergici, expunerea persistentă sau repetitivă la alergeni (care sunt consideraţi substanţe comune inofensive) are ca rezultat inflamaţiile cronice.

     Dar hai să o luăm cu începutul.
CE ESTE ALERGIA?

     

O reacţie alergică apare atunci când sistemul imunitar al unei persoane devine hipersensibil la anumiţi factori declanşatori (alergeni) precum anumite alimente, polen, medicamente, venin de albine sau animale.

 

      Alergenii declanşează producerea de imunoglobulină E (IgE), un anticorp pe care îl avem cu toţii în cantităţi mici şi care, în mod normal ne protejează de paraziţi şi nu de alergeni. Pe perioada expunerii la alergeni, IgE este supraprodus de organism şi astfel se eliberează histamina, cea care cauzează de fapt simptomele alergiei.

 

      Termenul de “alergie” a fost inventat de Clemens von Pirquet în anul 1906 ca o explicaţie a unor reacţii neobişnuite la anumite substanţe, pe care le aveau unii indivizi testaţi de acesta.

 

      Deşi alergiile se pot dezvolta la orice vârstă, unii cercetători susţin că acest lucru este determinat genetic. Dacă nici unul dintre părinţi nu este alergic atunci şansele de a dezvolta o alergie de către copii este de 15 %, iar procentul poate creşte până la 30%, în cazul în care doar unul dintre ei are o alergie şi la 60%,  când ambii părinţi sunt hipersensibili.

 

SIMPTOME

     O reacţie alergică poate provoca inflamaţii şi iritaţii pe piele sau în interiorul corpului însă, cu toate acestea, simptomele specifice vor depinde de tipul de alergen şi de timpul la care persoană este expusă.

 

     Iată câteva exemple de alergeni şi simptomele specifice acestora:
TIPURI DE ALERGII

 

Administrația pentru alimente și medicamente (FDA) recomandă ca persoanele cu risc de şoc anafilactic să poarte în permanență două auto-injectoare de epinefrină. Dacă o doză nu este eficientă, persoana va avea nevoie de a doua.

 

     EpiPen este doar un tip de injector recomandat. Utilizarea sa implică o doză măsurată de adrenalină cu efect în câteva minute de la apariția oricărui simptom sever. Toți injectorii au același efect, dar modalitățile de utilizare a acestora pot diferi. 

 

     Este recomandat să apeleze totuşi și serviciile de urgență.

 

TRATAMENT

Cel mai bun mod de a controla o alergie este evitarea alergenului pe cât de mult se poate, însă, acest lucru nu este intodeauna posibil.

 

Medicamentele nu vindecă alergia dar pot ajuta la ameliorarea simptomelor care devin uneori greu de suportat.

 

Înainte de administrarea oricărui produs, fie că este Rx (se eliberează pe baza unei prescripţii medicale), fie că este OTC (over the counter), este recomandat să se discute cu un medic sau farmacist.

 

  

   Sunt investigați mulți agenți farmacologici sau biologici noi care vizează diferitele etape ale căilor celulare și ale mediatorului implicate în inflamația alergică. Sunt luate în considerare, de asemenea, strategii pentru reducerea sensibilizării și promovarea toleranței la alergenii obișnuiți.

 

     Antagoniștii receptorilor de leucotriene (antileucotriene) pot de asemenea  ajuta în tratarea unor alergii pentru care alte tratamente nu au funcționat.  Acestea blochează substanţele chimice apărute în mod natural în plămâni, denumite leucotriene, care determină îngustarea şi inflamaţia căilor aeriene pulmonare, responsabile de apariţia simptomelor astmului bronşic. Un astfel de medicamente este Montelakastul.

 

REFERINŢE ŞTIINŢIFICE
  1. von Pirquet C. Allergie. Münch Med Wochenschr. 1906;53:1457–1458. 
  2. Silverstein AM. Clemens Freiherr von Pirquet: explaining immune complex disease in 1906. Nature Immunol. 2000;1:453–455. 
  3. Holgate ST. The epidemic of allergy and asthma. Nature. 1999;402:B2–B4. 
  4. Kay AB. Allergy and allergic diseases. First of two parts. N Engl J Med. 2001;344:30–37. 
  5. Eder W, Ege MJ, von Mutius E. The asthma epidemic. N Engl J Med. 2006;355:2226–2235. 
  6. Sampson HA, et al. Symposium on the definition and management of anaphylaxis: summary report. J Allergy Clin Immunol. 2005;115:584–591. 
  7. Barnes PJ. New therapies for asthma. Trends Mol Med. 2006;12:515–520. 
  8. Kraft S, Kinet JP. New developments in FcεRI regulation, function and inhibition. Nature Rev Immunol. 2007;7:365–378. This review of FcεRI-dependent signalling in mast cells and basophils considers how the biology and functional properties of FcεRI might be exploited for the development of new therapeutics.
  9. Holgate ST, Polosa R. Treatment strategies for allergy and asthma. Nature Rev Immunol. 2008;8:218–230. 
  10. Larché M, Akdis CA, Valenta R. Immunological mechanisms of allergen-specific immunotherapy. Nature Rev Immunol. 2006;6:761–771. This review discusses the history, immunological mechanisms and future prospects of improving allergen-specific immunotherapy.
  11. Akdis M, Akdis CA. Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol. 2007;119:780–791. 
  12. Kukkonen K, et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. 2007;119:192–198. 
  13. Yazdanbakhsh M, Kremsner PG, van Ree R. Allergy, parasites, and the hygiene hypothesis. Science. 2002;296:490–494. 
  14. Galli SJ, Askenase PW. The Reticuloendothelial System: A Comprehensive Treatise. In: Abramoff P, Phillips SM, Escobar MR, editors. Hypersensitivity.IX. Plenum; 1986. pp. 321–369. 
  15. Fallon PG, Mangan NE. Suppression of TH2-type allergic reactions by helminth infection. Nature Rev Immunol. 2007;7:220–230. 
  16. Hawrylowicz CM, O’Garra A. Potential role of interleukin-10-secreting regulatory T cells in allergy and asthma. Nature Rev Immunol. 2005;5:271–283. This review provides an introduction to the mechanisms by which regulatory T cells that produce the anti-inflammatory and immunosuppressive cytokine IL-10 might limit the pathology associated with allergy and allergic inflammation of the airways in asthma.
  17. Romagnani S. Coming back to a missing immune deviation as the main explanatory mechanism for the hygiene hypothesis. J Allergy Clin Immunol. 2007;119:1511–1513. 
  18. Cookson W. The immunogenetics of asthma and eczema: a new focus on the epithelium. Nature Rev Immunol. 2004;4:978–988. 
  19. Vercelli D. Discovering susceptibility genes for asthma and allergy. Nature Rev Immunol. 2008;8:169–182. This review presents the current understanding of the many genes that have been implicated in asthma and allergy, including evidence that exposure to the same microbial products may have opposite effects on susceptibility to developing allergic disorders, depending on an individual’s genotype.
  20. Geha RS, Jabara HH, Brodeur SR. The regulation of immunoglobulin E class-switch recombination. Nature Rev Immunol. 2003;3:721–732.
  21. Gould HJ, Sutton BJ. IgE in allergy and asthma today. Nature Rev Immunol. 2008;8:205–217. This review describes the complex role of IgE and its receptors in allergy and asthma, including evidence that IgE and its receptors may contribute to epitope spreading in, and therefore exacerbation of, allergic disorders.
  22. Herrick CA, Bottomly K. To respond or not to respond: T cells in allergic asthma. Nature Rev Immunol. 2003;3:405–412. 
  23. Dickey BF. Exoskeletons and exhalation. N Engl J Med. 2007;357:2082–2084. 
  24. Saxon A, Diaz-Sanchez D. Air pollution and allergy: you are what you breathe. Nature Immunol. 2005;6:223–226. 
  25. Hammad H, Lambrecht BN. Dendritic cells and epithelial cells: linking innate and adaptive immunity in asthma. Nature Rev Immunol. 2008;8:193–204. 
  26. Platts-Mills TA, Woodfolk JA, Erwin EA, Aalberse R. Mechanisms of tolerance to inhalant allergens: the relevance of a modified TH2 response to allergens from domestic animals. Springer Semin Immunopathol. 2004;25:271–279. 
  27. Sandilands A, Smith FJ, Irvine AD, McLean WH. Filaggrin’s fuller figure: a glimpse into the genetic architecture of atopic dermatitis. J Invest Dermatol. 2007;127:1282–1284. 
  28. Schleimer RP, Kato A, Kern R, Kuperman D, Avila PC. Epithelium: at the interface of innate and adaptive immune responses. J Allergy Clin Immunol. 2007;120:1279–1284
  29. Ying S, Meng Q, Corrigan CJ, Lee TH. Lack of filaggrin expression in the human bronchial mucosa. J Allergy Clin Immunol. 2006;118:1386–1388. 
  30. Jeong SK, et al. Mite and cockroach allergens activate protease-activated receptor 2 and delay epidermal permeability barrier recovery. J Invest Dermatol. 2008;128:1930–1939. 
  31. McKerrow JH, Caffrey C, Kelly B, Loke P, Sajid M. Proteases in parasitic diseases. Annu Rev Pathol. 2006;1:497–536. 
  32. Min B, Paul WE. Basophils: in the spotlight at last. Nature Immunol. 2008;9:223–225. 
  33. Sokol CL, Barton GM, Farr AG, Medzhitov R. A mechanism for the initiation of allergen-induced T helper type 2 responses. Nature Immunol. 2008;9:310–318. This paper identifies a key role for basophils in the initiation of TH2-cell responses to exogenous proteases. 
  34. Marshall JS. Mast-cell responses to pathogens. Nature Rev Immunol
  35. Galli SJ, et al. Mast cells as ‘tunable’ effector and immunoregulatory cells: recent advances. Annu Rev Immunol. 2005;23:749–786. This review discusses many aspects of mast-cell biology, including mast-cell phenotypic heterogeneity and function, and the roles of mast cells as effector and potential immunoregulatory cells in innate and adaptive immune responses.
  36. Gilfillan AM, Tkaczyk C. Integrated signalling pathways for mast-cell activation. Nature Rev Immunol. 2006;6:218–230. 
  37. Rivera J, Gilfillan AM. Molecular regulation of mast cell activation. J Allergy Clin Immunol. 2006;117:1214–1225. 
  38. Dvorak AM. Ultrastructural studies of human basophils and mast cells. J Histochem Cytochem. 2005;53:1043–1070. 
  39. Caughey GH. Mast cell tryptases and chymases in inflammation and host defense. Immunol Rev. 2007;217:141–154. 
  40. Pejler G, Abrink M, Ringvall M, Wernersson S. Mast cell proteases. Adv Immunol. 2007;95:167–255. 
  41. Stevens RL, Adachi R. Protease-proteoglycan complexes of mouse and human mast cells and importance of their beta-tryptase-heparin complexes in inflammation and innate immunity. Immunol Rev. 2007;217:155–167. 
  42. Bradding P, Holgate ST. The mast cell as a source of cytokines in asthma. Ann NY Acad Sci. 1996;796:272–281. 
  43. Saito H, Nakajima T, Matsumoto K. Human mast cell transcriptome project. Int Arch Allergy Immunol. 2001;125:1–8. 
  44. Boyce JA. Mast cells and eicosanoid mediators: a system of reciprocal paracrine and autocrine regulation. Immunol Rev. 2007;217:168–185.
  45. Finkelman FD. Anaphylaxis: lessons from mouse models. J Allergy Clin Immunol. 2007;120:506–515. 
  46. Wills-Karp M. Immunologic basis of antigen-induced airway hyperresponsiveness. Annu Rev Immunol. 1999;17:255–281. 
  47. Sarin S, Undem B, Sanico A, Togias A. The role of the nervous system in rhinitis. J Allergy Clin Immunol. 2006;118:999–1016. 
  48. Cevikbas F, Steinhoff A, Homey B, Steinhoff M. Neuroimmune interactions in allergic skin diseases. Curr Opin Allergy Clin Immunol. 2007;7:365–373. 
  49. Lalloo UG, Barnes PJ, Chung KF. Pathophysiology and clinical presentations of cough. J Allergy Clin Immunol. 1996;98:S91–S96. discussion S96–S97.
  50. MacGlashan D, Jr, Gauvreau G, Schroeder JT. Basophils in airway disease. Curr Allergy Asthma Rep. 2002;2:126–132. 
  51. Marone G, Triggiani M, de Paulis A. Mast cells and basophils: friends as well as foes in bronchial asthma? Trends Immunol. 2005;26:25–31. 
  52. Galli SJ, Grimbaldeston MA, Tsai M. Immunomodulatory mast cells: negative, as well as positive, regulators of immunity. Nature Rev Immunol. 2008;8:478–486. 
  53. Sayed BA, Christy A, Quirion MR, Brown MA. The master switch: the role of mast cells in autoimmunity and tolerance. Annu Rev Immunol. 2008;26:705–739
  54. Bradding P, Walls AF, Holgate ST. The role of the mast cell in the pathophysiology of asthma. J Allergy Clin Immunol. 2006;117:1277–1284
  55. Brown JM, Wilson TM, Metcalfe DD. The mast cell and allergic diseases: role in pathogenesis and implications for therapy. Clin Exp Allergy. 2008;38:4–18. 
  56. Larché M, Robinson DS, Kay AB. The role of T lymphocytes in the pathogenesis of asthma. J Allergy Clin Immunol. 2003;111:450–463. 
  57. Kay AB, et al. Airway expression of calcitonin gene-related peptide in T-cell peptide-induced late asthmatic reactions in atopics. Allergy. 2007;62:495–503. 
  58. Bonness S, Bieber T. Molecular basis of atopic dermatitis. Curr Opin Allergy Clin Immunol. 2007;7:382–386. 
  59. Doherty T, Broide D. Cytokines and growth factors in airway remodeling in asthma. Curr Opin Immunol. 2007;19:676–680.
  60. Holgate ST. Epithelium dysfunction in asthma. J Allergy Clin Immunol. 2007;120:1233–1244. This review discusses the role of the airway epithelium and its function (and dysfunction) in the development and pathology of asthma.
  61. Mauad T, Bel EH, Sterk PJ. Asthma therapy and airway remodeling. J Allergy Clin Immunol. 2007;120:997–1009. 
  62. Ollerenshaw SL, Jarvis D, Sullivan CE, Woolcock AJ. Substance P immunoreactive nerves in airways from asthmatics and nonasthmatics. Eur Respir J. 1991;4:673–682. 
  63. Chanez P, et al. Bronchial mucosal immunoreactivity of sensory neuropeptides in severe airway diseases. Am J Respir Crit Care Med. 1998;158:985–990. 
  64. Joos GF, De Swert KO, Schelfhout V, Pauwels RA. The role of neural inflammation in asthma and chronic obstructive pulmonary disease. Ann NY Acad Sci. 2003;992:218–230. 
  65. Lewis MJ, Short AL, Lewis KE. Autonomic nervous system control of the cardiovascular and respiratory systems in asthma. Respir Med. 2006;100:1688–1705. 
  66. Brightling CE, et al. Mast-cell infiltration of airway smooth muscle in asthma. N Engl J Med. 2002;346:1699–1705. 
  67. Cohn L, Elias JA, Chupp GL. Asthma: mechanisms of disease persistence and progression. Annu Rev Immunol. 2004;22:789–815.
  68. Gern JE, Busse WW. Relationship of viral infections to wheezing illnesses and asthma. Nature Rev Immunol. 2002;2:132–138. 
  69. Leung DY, Boguniewicz M, Howell MD, Nomura I, Hamid QA. New insights into atopic dermatitis. J Clin Invest. 2004;113:651–657. 
  70. Pawankar R, Nonaka M, Yamagishi S, Yagi T. Pathophysiologic mechanisms of chronic rhinosinusitis. Immunol Allergy Clin North Am. 2004;24:75–85. 
Please follow and like us: