Teste de contato atópico com aeroalérgenos: uma ferramenta promissora no diagnóstico da dermatite atópica
Atopy patch test with aeroallergens: a promising tool in the diagnosis of atopic dermatitis
Sérgio Duarte Dortas Junior; Soloni Afra Pires Levy; Andrea Huguenim Silva Pires; Augusto Tiaqui Abe; Solange Oliveira Rodrigues Valle; Vilma Perez Coelho; Ludwig Ruppert Hahnstadt; Alfeu Tavares França
Resumo
Objetivos: Avaliar a padronização do método com relação à concentração do aeroalérgeno, tempo de oclusão, de interpretação; e determinar a especificidade e a sensibilidade do teste de contato alérgico (TCA) em relação ao teste por puntura e a dosagem de IgE específica, na verificação da sensibilização a ácaros em crianças com dermatite atópica (DA). Métodos: Foram selecionadas 72 crianças com idade entre 2 e 12 anos, acompanhadas no ambulatório de alergia do Hospital São Zacharias. Estas foram submetidas a teste de puntura, dosagem de IgEs específicas e TCA para ácaros (Dermatophagoides pteronyssinus, Dermatophagoides farinae e Blomia tropicalis). Os testes foram realizados em 3 grupos: (1) DA com ou sem rinite e asma, (2) Rinite e/ou asma sem DA, (3) Saudáveis (controle). Resultados: No grupo 1, 40% dos pacientes apresentaram reação positiva. A sensibilidade foi maior nos pacientes com maior tempo de exposição (48 h e 72 h). No grupo 2, o TCA foi mais específico que sensível para todos os extratos, com aumento da sensibilidade quanto maior o tempo de exposição (72 h). No grupo 3, apenas 8,3% apresentaram positividade a algum aeroalérgeno do TCA. Conclusão: O TCA mostrou ter valor diagnóstico em relação às reações de fase tardia a ácaros (D. pteronyssinus, D. farinae e B. tropicalis), com elevada especificidade. Ele demonstrou ser um teste confiável quando comparado aos resultados do grupo controle.
Palavras-chave
Abstract
Objectives: To evaluate the standardization of the atopy patch test (APT) with regard to concentration of aeroallergens, occlusion time, and interpretation, and to determine the specificity and sensitivity of the method in relation to prick test and serum specific IgE determination in the investigation of dust mite sensitization in children with atopic dermatitis (AD). Methods: Seventytwo children, ranging from 2 to 12 years of age, were selected among those receiving care at the allergy outpatient clinic of São Zacharias Hospital. Children underwent skin prick testing, specific IgE measurements, and APT for mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis). Tests were performed in three groups: (1) AD with or without rhinitis and asthma; (2) rhinitis and/or asthma without AD; (3) healthy individuals (controls). Results: In group 1, 40% of the patients presented positive reactions. Sensitivity was higher in patients with longer exposure times (48 h and 72 h). In group 2, APT was more specific than sensitive for all extracts, with increasing sensitivity associated with longer times of exposure (72 h). In group 3, only 8.3% of the individuals were positive to any aeroallergen on APT. Conclusion: APT seems to have diagnostic value in identifying late phase reactions to mites (D. pteronyssinus, D. farinae, and B. tropicalis), with high specificity, and proved to be a reliable test when compared with the results obtained for controls.
Keywords
References
1. National Collaborating Centre for Women’s and Children’s Health (UK). Atopic Eczema in Children: Management of atopic eczema in children from birth up to the age of 12 years [Internet]. London: RCOG Press; 2007 Dec. Disponível em: http://www.ncbi.nlm.nih.gov/books/NBK49365/
2. Mitchell EB, Crow J, Chapman MD, Jouhal SS, Pope FM, Platts-Mills TA. Basophils in allergen-induced patch test sites in atopic dermatitis. Lancet. 1982;1:127-30.
3. Hanifin JM, Rajka G. Diagnostis features of atopic dermatitis. Acta Dennatovener. 1980:(Suppl 92):44-7.
4. Sociedade Brasileira de Alergia e Imunopatologia, Sociedade Brasileira de Pediatria, Sociedade Brasileira de Pneumologia e Tisiologia. IV Diretrizes Brasileiras para o Manejo da Asma. J Bras Pneumol. 2006;32(Suppl 7):S447-74.
5. Solé D & Daher S. IgE: da Síntese à pratica clínica. São Paulo: Ed. Rosconi; 2008.
6. Holm L, Matuseviciene G, Scheynius A, Tengyvall LM. Atopy patch test with house dust mite allergen an IgE-mediated reaction? Allergy. 2004;59:874-82.
7. Darsow U, Vieluf D, Ring J. Atopy patch test with different vehicles and allergen concentrations: An approach to standardization. J Allergy Clin Immunol. 1995;95:677-84.
8. Chung BY, Kim HO, Park CW, Lee CH. Diagnostic Usefulness of the Serum-Specific IgE, the Skin Prick Test and the Atopy Patch Test Compared with That of the Oral food Challenge Test. Ann Dermatol. 2010;22:404-11.
9. Sporik R, Hill DJ, Hosking CS. Specificity of allergen skin testing in predicting positive open food challenges to milk, eggs, and peanut in children. Clin Exp Allergy. 2000;30:1540-6.
10. Niggemann B, Reibel S, Wahn U. The atopy patch test (APT) - a useful tool for the diagnosis of food allergy in children with atopic dermatitis. Allergy. 2000;55:281-5.
11. Langeveld-Wildschut EG, van Marion AM, Thepen T, Mudde GC, Bruijnzeel PL, Bruijnzeel-Koomen CA. Evaluation of variables influencing the outcome of the atopy patch test. J Allergy Clin Immunol. 1995;96:66-73.
12. Mudde GC, Van Reisen FC, Boland GJ, De Gast GC, Bruunzeel PLB, Bruunzeel-Koomen CAFM. Allergen presentation by epidermal Langerhans cells from patients with atopic dermatites is mediated by IgE. Immunology. 1990;69:335-41.
13. Stingl G, Maurer D. IgE-mediated allergen presentation via Fc epsilon RI on antigen-presenting cells. Int Arch Allergy Immunol. 1997;113:24-9.
14. Bruunzeel PLB, Kuuper PHM, Kapp A, Warringa RAJ, Betz S, Bruunzeel-Koomen CAFM. The involvement of eosinophil in the patch test reaction to aeroallergens in atopic dermatitis: its relevance for the pathogenesis of atopic dermatitis. Clin Exp Allergy. 1993;32:97‑109.
15. Thepen T, Langeveld-Wildshut EG, Bihari IC, van Wichen DF, van Reijsen FC, Mudde GC. Biphasic response against aeroallergen in atopic dermatitis showing a swith from initial Th2 response to a Th1 response in situ: an immunocytochemical study. J Allergy Clin Immunol. 1996;97:828-37.
16. Niggemann B, Ziegert M, Reibel S. Importance of chamber size for the outcome of atopy patch test in children with atopic dermatitis and food allergy. J Allergy Clin Immunol. 2002;110:515-6.
17. Johansson C, Sandström MH, Bartosik J, Sarnhult T, Christiansen J, Zargari A, et al. Atopy path test reactions to Mallassezia allergens differentiate subgroups of atopic dermatitis patients. Br J Dermatol. 2003;148:479-88.
18. Heinemann C, Schliemann-Willers S, Kelterer D, Metzner U, Kluge K, Wigger-Alberti W, et al. The atopy path test-reproducibility and comparison of different evaluation methods. Allergy. 2002;57:641‑5.
Submitted date:
02/15/2012
Accepted date:
09/23/2012
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