Asma alérgica e não alérgica apresentam diferentes características fenotípicas e genotípicas
Allergic and non-allergic asthma have different phenotypic and genotypic characteristics
Priscila Takejima; Rosana Câmara Agondi; Helcio Rodrigues; Marcelo Vivolo Aun; Jorge Kalil; Pedro Giavina-Bianchi
Resumo
Objetivo: A identificação dos fenótipos da asma permite uma melhor compreensão e abordagem desta doença heterogênea. Muitos estudos têm demonstrado associação entre os antígenos leucocitários humanos (HLA) e asma em diversas populações, porém os resultados são inconclusivos e raramente consideram uma doença com diferentes fenótipos. O objetivo deste estudo foi caracterizar os fenótipos alérgico e não alérgico da asma e avaliar possíveis associações com o sistema HLA. Métodos: Um total de 190 pacientes com asma foram prospectivamente acompanhados durante dois anos. Foram divididos em dois grupos, asma alérgica e não alérgica, de acordo com a história clínica e os resultados do teste cutâneo de puntura e da pesquisa da IgE sérica específica. O grupo controle foi composto por 297 doadores falecidos de órgãos sólidos. As características de cada grupo e a tipificação dos HLA classe I e II foram avaliadas e comparadas. Resultados: O estudo mostrou diferentes características entre os fenótipos estudados. Os pacientes com asma não alérgica relataram uma idade mais tardia de início dos sintomas da doença e maior frequência de história sugestiva de intolerância aos anti-inflamatórios não esteroidais. O grupo asma alérgica apresentaram IgE sérica total elevada, presença de dermatite atópica e rinoconjuntivite mais frequente e, inesperadamente, maior gravidade da doença. Novas associações entre os genótipos HLA e os fenótipos alérgico e não alérgico da asma foram identificados. Os genótipos HLA-B*42, HLA-C*17, HLA-DPA1*03 e HLA-DPB1*105 foram associados com a asma alérgica, e o HLA-B*48 com o fenótipo não alérgico. A presença do haplótipo HLA-DPA1*03 DQA*05 foi associado com asma alérgica, e a presença do HLA-DPA1*03 e ausência do HLA-DQA*05 com a asma não alérgica. Conclusões: A asma alérgica e não alérgica apresentaram diferentes características fenotípicas e genotípicas. Novas associações entre os fenótipos e o sistema HLA classe I e II foram identificadas.
Palavras-chave
Abstract
Objective: The identification of asthma phenotypes allows a better understanding and management of this heterogeneous disease. Studies have reported associations between human leukocyte antigens (HLA) and asthma in different populations, but results have been inconclusive and rarely take into consideration the distinct disease phenotypes. The objectives of this study were to characterize allergic and non-allergic asthma phenotypes and to evaluate possible associations with the HLA system. Methods: A total of 190 patients with asthma were prospectively followed during two years. They were divided into two groups, allergic and non-allergic asthma, according to clinical history and the results of skin prick testing and serum-specific IgE measurement. The control group comprised 297 deceased donors of solid organs. The characteristics of each group and HLA class I and II genotypes were assessed and compared. Results: The study revealed different characteristics between the phenotypes studied. Nonallergic patients were older at the onset of asthma symptoms and had a higher rate of history of intolerance to non-steroidal antiinflammatory drugs. Allergic patients showed higher total serum IgE levels, reported atopic dermatitis and rhinoconjunctivitis more frequently, and, unexpectedly, showed greater disease severity. New associations between HLA genotypes and the allergic/non-allergic asthma phenotypes were identified. HLA-B*42, HLA-C*17, HLADPA1*03, and HLA-DPB1*105 genotypes were associated with allergic asthma, and HLA-B*48, with the non-allergic phenotype. The presence of haplotype HLA-DPA1*03 DQA*05 was associated with allergic asthma, and the presence of HLA-DPA1*03 and absence of HLA-DQA*05, with non-allergic asthma. Conclusion: Allergic and non-allergic asthma have distinct phenotypic and genotypic characteristics. New associations between asthma phenotypes and HLA class I and II were identified.
Keywords
Referências
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Submetido em:
10/01/2017
Aceito em:
15/02/2017
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