Sensibilização a aeroalérgenos em pacientes com suspeita de alergia respiratória atendidos na rede pública e privada no município de Aracaju
Sensitization to inhalant allergens in patients with suspected respiratory allergy treated at public and private health care clinics in the city of Aracaju
Allisson M. Oliveira; Enaldo V. Melo; Glauber A. Nunes; Jackeline M. Franco; Mario A. dos Santos; Silvia de M. Simões
Resumo
Objetivo: Identificar e comparar os padrões de sensibilização a alérgenos inalantes entre pacientes com suspeita de alergias respiratórias atendidos em ambulatórios públicos e privados do município de Aracaju. Métodos: Foram analisados 1.514 resultados de testes cutâneos (TC) de punctura, realizados de abril de 2006 a setembro de 2009. Destes, 872 TC foram realizados em consultório de setor privado, e 642 nos ambulatórios do setor público. Os extratos alergênicos utilizados em TC foram: Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, Periplaneta americana, Blattella germanica, penas, mistura de fungos e epitélios de cão e de gato. Resultados: A sensibilização a pelo menos um alérgeno foi de 55% (58,4% no setor privado vs 50,3% no setor público; p < 0,05). Houve predomínio de TC positivos para ácaros domiciliares (total 53%; 57,3% vs. 47,2%; p < 0,0001), seguido de baratas (total 19,9%; 22,1% vs. 16,8%; p < 0,05) e animais domésticos (total 18,4%; 24,4% vs. 10,3%; p < 0,0001). Foram encontradas frequências significativamente maiores de TC positivos no setor privado quando comparado ao setor público para D. farinae (50,1% vs. 37,5%; p < 0,0001), D. pteronyssinus (47,7% vs. 35,7%; p < 0,0001), B. tropicalis (50,8% vs. 35,5%; p < 0,0001), epitélio de gato (18,1% vs. 6,2%; p < 0,0001), epitélio de cão (12,0% vs. 4,2%; p < 0,0001), penas (4,8% vs. 2,6%; p = 0,03) e B. germanica (16,1% vs. 11,5%; p = 0,01). Não se observou diferença significante quanto à sensibilização a fungos do ar e a P. americana. Conclusão: Ácaros domiciliares, baratas e animais domésticos foram as principais fontes de sensibilização alérgica na população estudada. Indivíduos atendidos no setor público apresentaram menor frequência de sensibilização a alérgenos inalantes quando comparados àqueles atendidos em clínica privada na cidade de Aracaju.
Palavras-chave
Abstract
Objective: To identify and compare sensitization profiles to inhalant allergens in patients with suspected respiratory allergy treated at public and private clinics in the city of Aracaju. Methods: A total of 1,514 results of skin prick tests (SPTs) performed between April 2006 and September 2009 were analyzed. Of these, 872 were carried out in a private office and 642 at public health care clinics. The following allergenic extracts were used for SPT: Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, Periplaneta americana, Blattella germanica, feather, mold mix, dog and cat epithelia. Results: Sensitization to at least one allergen was observed in 55% of the patients (private office 58.4% vs. public clinics 50.3%; p < 0.05). There was a predominance of positive SPTs to house dust mites (total 53%; 57.3% vs. 47.2%; p < 0.0001), followed by cockroaches (total 19.9%; 22.1% vs. 16.8%; p < 0.05), and pets (total 18.4%; 24.4% vs. 10.3%; p < 0.0001). Positive SPTs were significantly more frequent in the private office as compared to public clinics for D. farinae (50.1% vs. 37.5%; p < 0.0001), D. pteronyssinus (47.7% vs. 35.7%; p < 0.0001), B. tropicalis (50.8% vs. 35.5%; p < 0.0001), cat epithelium (18.1% vs. 6.2%; p < 0.0001), dog epithelium (12.0% vs. 4.2%; p < 0.0001), feather (4.8% vs. 2.6%; p = 0.03), and B. germanica (16.1% vs. 11.5%; p = 0.01). There were no significantly differences in the rates of sensitization to molds or P. americana. Conclusion: House dust mites, cockroaches, and pets were the main sources of allergic sensitization in the studied population. Individuals treated at public health care clinics showed a lower frequency of sensitization to inhalant allergens when compared to those seen in a private office in the city of Aracaju.
Keywords
Referências
1. Keller MB, Lowenstein SR. Epidemiology of asthma. Semin Respir Crit Care Med. 2002;23:317-29.
2. Bousquet J, Burney PG, Zuberbier T, Cauwenberge PV, Akdis CA, Bindslev-Jensen C, et al. GA2LEN (Global Allergy and Asthma European Network) addresses the allergy and asthma ‘epidemic’. Allergy. 2009;64:969-77.
3. Cooper PJ, Chico ME, Rodrigues LC, Strachan DP, Anderson HR, Rodriguez EA, et al. Risk factors for atopy among school children in a rural area of Latin America. Clin Exp Allergy. 2004;34:845-52.
4. Bloomfield SF, Stanwell-Smith R, Crevel RW, Pickup J. Too clean, or not too clean: the hygiene hypothesis and home hygiene. Clin Exp Allergy. 2006;36:402-25.
5. von Mutius E, Le Souef PN. Early gene-environment interactions: can they inform primary preventive strategies for asthma? Semin Respir Crit Care Med. 2007;28:255-63.
6. Prescott S, Allen KJ. Food allergy: riding the second wave of the allergy epidemic. Pediatr Allergy Immunol. 2011;22:155-60.
7. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299:1259-60.
8. Anderson GP. The immunobiology of early asthma. Med J Aust. 2002;177:S47-9.
9. Martino DJ, Prescott SL. Silent mysteries: epigenetic paradigms could hold the key to conquering the epidemic of allergy and immune disease. Allergy. 2010;65:7-15.
10. Renz H, Blumer N, Virna S, Sel S, Garn H. The immunological basis of the hygiene hypothesis. Chem Immunol Allergy. 2006;91:30-48.
11. Fishbein AB, Fuleihan RL. The hygiene hypothesis revisited: does exposure to infectious agents protect us from allergy? Curr Opin Pediatr. 2012;24:98-102.
12. Brooks C, Pearce N, Douwes J. The hygiene hypothesis in allergy and asthma: an update. Curr Opin Allergy Clin Immunol. 2013;13:70-7.
13. Zeyrek CD, Zeyrek F, Sevinc E, Demir E. Prevalence of asthma and allergic diseases in Sanliurfa, Turkey, and the relation to environmental and socioeconomic factors: is the hygiene hypothesis enough? J Investig Allergol Clin Immunol. 2006;16:290-5.
14. Fernandes JKS, Pachoal Jr. FM, Sales LHM, Medeiros Jr. M, Bellesi N, Guimarães KS. Teste cutâneo de pucntura e identificação de ácaros em amostra de poeira domiciliar - diferenças em populações economicamente distintas. Rev Bras Alerg Imunopatol. 2005;28:304-8.
15. Santos MA, Morato-Castro FF. Imunoterapia. Rev Bras Alerg Imunopatol. 1996;19:86-91.
16. Vercelli D. Genetic polymorphism in allergy and asthma. Curr Opin Immunol. 2003;15:609-13.
17. Prasarnphanich T, Sindhurat S. Sensitization to common indoor allergens and its association with allergic diseases in Thai female high-school students. Pediatr Allergy Immunol. 2005;16:402-7.
18. Pastorino AC, Kuschnir FC, Arruda LK, Casagrande RR, de Souza RG, Dias GA, et al. Sensitisation to aeroallergens in Brazilian adolescents living at the periphery of large subtropical urban centres. Allergol Immunopathol (Madr). 2008;36:9-16.
19. Sarinho EC, Mariano J, Sarinho SW, Medeiros D, Rizzo JA, Almerinda RS, et al. Sensitisation to aeroallergens among asthmatic and nonasthmatic adolescents living in a poor region in the Northeast of Brazil. Allergol Immunopathol (Madr). 2009;37:239-43.
20. Soares FA, Segundo GR, Alves R, Ynoue LH, Resende RO, Sopelete MC, et al. [Indoor allergen sensitization profile in allergic patients of the allergy clinic in the University Hospital in Uberlandia, Brazil]. Rev Assoc Med Bras. 2007;53:25-8.
21. Rizzo MC, Sole D, Rizzo A, Holanda MA, Rios JB, Wandalsen NF, et al. Etiologia da doença atópica em crianças brasileiras - Estudo multicêntrico. J Pediatr (Rio J). 1995;71:31-5.
22. Godinho R, Lanza M, Godinho A, Rodrigues A, Assis TM. Frequência de positividade em teste cutâneo para aeroalérgenos. Rev Bras Otorrinolaringol. 2003;69:824-8.
22. Godinho R, Lanza M, Godinho A, Rodrigues A, Assis TM. Frequência de positividade em teste cutâneo para aeroalérgenos. Rev Bras Otorrinolaringol. 2003;69:824-8. Sensibilização a aeroalérgenos – Oliveira AM et al. 50 Braz J Allergy Immunol. – Vol. 1. N° 1, 2013
23. Mezzari A, Perin C, Santos Junior SA, Bernd LA, Di Gesu G. Os fungos anemófilos e sensibilização em indivíduos atópicos em Porto Alegre, RS. Rev Assoc Med Bras. 2003;49:270-3.
24. Strachan DP. Family size, infection and atopy: the first decade of the “hygiene hypothesis”. Thorax. 2000;55:S2-10.
25. Schaub B, Lauener R, von Mutius E. The many faces of the hygiene hypothesis. J Allergy Clin Immunol. 2006;117:969-77.
26. Braun-Fahrlander C, Gassner M, Grize L, Neu U, Sennhauser FH, Varonier HS, et al. Prevalence of hay fever and allergic sensitization in farmer’s children and their peers living in the same rural community. SCARPOL team. Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution. Clin Exp Allergy. 1999;29:28‑34.
27. Porto SM, Ugá MAD, Moreira RS. Uma análise da utilização de serviços de saúde por sistema de financiamento: Brasil 1998 -2008. Cien Saude Colet. 2011;16:3795-806.
Submetido em:
24/09/2012
Aceito em:
08/04/2013
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