RESUMO
In this review, the Hymenoptera Allergy Committee of the SEAIC analyzes the most recent scientific literature addressing problems related to the diagnosis of hymenoptera allergy and to management of venom immunotherapy. Molecular diagnosis and molecular risk profiles are the key areas addressed. The appearance of new species of hymenoptera that are potentially allergenic in Spain and the associated diagnostic and therapeutic problems are also described. Finally, we analyze the issue of mast cell activation syndrome closely related to hymenoptera allergy, which has become a new diagnostic challenge for allergists given its high prevalence in patients with venom anaphylaxis.
Assuntos
Venenos de Artrópodes/imunologia , Himenópteros/imunologia , Hipersensibilidade/imunologia , Mordeduras e Picadas de Insetos/imunologia , Animais , Venenos de Artrópodes/uso terapêutico , Hipersensibilidade/diagnóstico , Hipersensibilidade/epidemiologia , Hipersensibilidade/terapia , Testes Imunológicos , Imunoterapia/métodos , Mordeduras e Picadas de Insetos/diagnóstico , Mordeduras e Picadas de Insetos/epidemiologia , Mordeduras e Picadas de Insetos/terapia , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia , Resultado do TratamentoRESUMO
INTRODUCTION: Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk, as both local and systemic adverse reactions may occur, especially in the initial phases. We compared the tolerance to 3 VIT buildup protocols and analyzed risk factors associated with adverse reactions during this phase. MATERIALS AND METHODS: We enrolled 165 patients divided into 3 groups based on the buildup protocol used (3, 4, and 9 weeks). The severity of systemic reactions was evaluated according to the World Allergy Organization model. Results were analyzed using exploratory descriptive statistics, and variables were compared using analysis of variance. RESULTS: Adverse reactions were recorded in 53 patients (32%) (43 local and 10 systemic). Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). The severity of the local reaction was slight/moderate in 15 patients and severe in 13. Systemic reactions were grade 1-2. No significant association was found between the treatment modality and the onset of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association between severity of the local reaction and female gender. As for the risk factors associated with systemic reactions during the buildup phase, we found no significant differences in values depending on the protocol used or the insect responsible. CONCLUSIONS: The buildup protocols compared proved to be safe and did not differ significantly from one another. In the population studied, patients undergoing the 9-week schedule presented no systemic reactions. Therefore, this protocol can be considered the safest approach.
Assuntos
Venenos de Artrópodes/administração & dosagem , Dessensibilização Imunológica/métodos , Himenópteros/imunologia , Hipersensibilidade/terapia , Mordeduras e Picadas de Insetos/terapia , Adolescente , Adulto , Idoso , Animais , Venenos de Artrópodes/efeitos adversos , Venenos de Artrópodes/imunologia , Criança , Dessensibilização Imunológica/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Tolerância Imunológica , Mordeduras e Picadas de Insetos/diagnóstico , Mordeduras e Picadas de Insetos/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Espanha , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
A 33 years-old female with a diagnosis of Kartagener's syndrome was studied. She had a clinical history of chronic sinusitis with nasal obstruction and rhinorrea, and a chronic cough with mucopurulent sputum. A paranasal sinus CT showed hypertrophyc mucosa. A thoracic CT showed a situs inversus and chronic bronchitis with bronchiectasis. The saccharin test lasted 55 minutes. The electron microscopy study showed in a a cross-sectional axoneme a total absence of the outer and inner arm of the 9th outer doublet in over a 100 cilias studied. No others ultrastructure anormalities were observed.