Alérgenos recombinantes: papel no diagnóstico e na imunoterapia alérgeno-específica
Recombinant allergens: role in diagnosis and in allergen-specific immunotherapy
L. Karla Arruda; Michelle C. R. Barbosa; Gil Bardini; Ariana Campos Yang; Isabel Ruguê Genov; Adriana Santos Moreno
Resumo
Nos últimos 30 anos tem havido um avanço notável na identificação, purificação e expressão recombinante de alérgenos relevantes das mais variadas fontes, incluindo ácaros, insetos, ma‑ míferos, polens, alimentos, fungos, látex e outras fontes. Estes avanços resultaram na utilização crescente de alérgenos purificados, naturais ou recombinantes, para melhorar o diagnóstico de alergia pelos métodos que dispomos, incluindo os testes cutâneos de hipersensibilidade imediata, e os métodos in vitro para medida de anticorpos IgE específicos, como ImmunoCAP, ImmunoCAPISAC, ELISA e MARIA. Mais recentemente, o uso de alérgenos recombinantes de pólen de bétula (rBet v 1) e de gramas (coquetel de 5 alérgenos) em imunoterapia foi relatado como seguro e eficaz, com resultados comparáveis aos obtidos usando extratos naturais, em pacientes com rinoconjuntivite alérgicos a polens. No presente artigo, apresentamos revisão atualizada do uso de alérgenos recombinantes em diagnóstico de alergia e em imunoterapia alérgeno-específica, incluindo novas estratégias de imunoterapia. Focalizamos na avaliação crítica de estudos que investigaram sensibilidade, especificidade, reatividade cruzada e valor prognóstico de métodos diagnósticos com uso de alérgenos recombinantes versus extratos naturais; nas recomendações atuais para o uso destes novos métodos na prática clínica; e na revisão de estudos clínicos com imunoterapia usando alérgenos recombinantes realizados até o momento.
Palavras-chave
Abstract
Over the past 30 years, a great deal of progress has been made in the identification, purification, and recombinant expression of relevant allergens from various sources, including mites, insects, mammals, pollens, foods, fungi, latex, and other sources. These new developments have resulted in an increasing use of purified allergens, either natural or recombinant, to improve the diagnosis of allergy via the methods currently available, including skin tests and in vitro tests for measuring specific IgE antibodies, e.g., ImmunoCAP, ImmunoCAP-ISAC, ELISA, and MARIA. More recently, the use of recombinant allergens from birch pollen (rBet v 1) and from grass pollen (a cocktail of five allergens) in immunotherapy has been reported to be safe and effective, with results comparable to those obtained with natural extracts in patients with rhino-conjunctivitis due to pollen allergy. In the present article, we present an up-to-date review on the use of recombinant allergens in the diagnosis of allergy and in allergen-specific immunotherapy, including new strategies for immunotherapy. We focus on the critical analysis of studies that have investigated sensitivity, specificity, cross-reactivity, and the prognostic value of diagnostic methods that include recombinant allergens versus natural extracts; on current recommendations for the use of these new methods in clinical practice; and on the review of clinical studies using immunotherapy with recombinant allergens performed to date.
Keywords
References
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Submitted date:
11/07/2013
Accepted date:
11/26/2013
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