Biomarcadores na dermatite atópica
Biomarkers in atopic dermatitis
Messias E. Faria; Vanessa C. E. S. A. Orso; Isabela A. R. Lisciotto; Cybele C. Faria; Messias E. F. Filho; Bárbara T. G. Soares; Marina A. de Siqueira
Resumo
O objetivo deste estudo é descrever os achados de artigos recentemente publicados a respeito dos avanços diagnósticos, prognósticos e terapêuticos sobre o uso de biomarcadores na dermatite atópica. Foi realizada revisão bibliográfica de 19 artigos publicados no Journal of Allergy and Clinical Immunology e no The New England Journal of Medicine. Atualmente, mais de 1 bilhão de pessoas têm algum tipo de doença alérgica, entre as quais a dermatite atópica é altamente prevalente. Por mais que possa ser diagnosticada de forma clÃnica através dos critérios de Hanifin e Rajka, estes são avaliador-dependentes, havendo grande variação dos resultados. Da mesma forma, a dosagem de IgE não é especÃfica. Assim, tais métodos não são precisos para o diagnóstico, aumentando a importância da descoberta de novos marcadores mais fidedignos. Os biomarcadores são caracterÃsticas biológicas quantificáveis que fornecem medidas objetivas do estado de saúde ou doença. Eles têm potencial para estratificação de risco, detecção precoce, identificação do tratamento, monitorização de resposta e prevenção da progressão para marcha atópica. Os avanços tecnológicos permitem aos clÃnicos determinar um grande número de biomarcadores através de fluidos corporais, o que resultará em uma melhor caracterização e estratificação dos pacientes com dermatite atópica, bem como acarretará medidas objetivas da resposta terapêutica e melhores comparações entre tratamentos correntes e novas terapias.
Palavras-chave
Abstract
The objective of this study is to describe the findings of recently published articles on the diagnostic, prognostic and therapeutic advances in the use of biomarkers in atopic dermatitis. Nineteen articles published in the Journal of Allergy and Clinical Immunology and in The New England Journal of Medicine were reviewed. Currently, more than 1 billion people have some type of allergic disease; among such diseases, atopic dermatitis is highly prevalent. Even though atopic dermatitis can be diagnosed clinically using the Hanifin and Rajka criteria, diagnosis is examiner-dependent, leading to major variations in results. Likewise, IgE dosage is non-specific. Thus, these methods are not accurate for diagnosis, highlighting the importance of finding new, more reliable markers. Biomarkers are quantifiable biological characteristics that provide objective measures of health status or disease. They have a potential for risk stratification, early detection, treatment identification, response monitoring and prevention of progression to the atopic march. Technological advances allow clinicians to determine a large number of biomarkers through body fluids, which will result in a better characterization and stratification of patients with atopic dermatitis and lead to objective measures of treatment response and better comparisons between current and new therapies.
Keywords
References
1. Gupta J, Grube E, Ericksen MB, Stevenson MD, Lucky AW. Intrinsically defective skin barrier function in children with atopic dermatitis correlates with disease severity. J Allergy Clin Immunol. 2008 Mar;121(3):725-730.e2
2. Lebovidge JS, Elverson W, Timmons KG. Clinical reviews in allergy and immunology Multidisciplinary interventions in the management of atopic dermatitis. J Allergy Clin Immunol. 2017;138(2):325‑34.
3. Boyce JA, Finkelman F, Shearer WT, Skevaki C, Berg J Van Den, Jones N, et al. Mechanisms of allergic diseases Immune biomarkers in the spectrum of childhood noncommunicable diseases. J Allergy Clin Immunol. 2016;137(5):1302‑16.
4. Wawrzyniak P, Akdis CA, Finkelman FD, Rothenberg ME. Advances and highlights in mechanisms of allergic disease in 2015. J Allergy Clin Immunol. 2016;137(6):1681‑96.
5. Tintle S, Shemer A, Suárez-Fariñas M, Fujita H, Gilleaudeau P, Sullivan-Whalen M, et al. Reversal of atopic dermatitis with narrowband UVB phototherapy and biomarkers for therapeutic response. J Allergy Clin Immunol. 2011 Sep;128(3):583-93.
6. Leung DYM, Guttman-yassky E. Deciphering the complexities of atopic dermatitis : Shifting paradigms in treatment approaches. J Allergy Clin Immunol. 2015;134(4):769-79.
7. Egawa G, Kabashima K. Current perspectives multifactorial skin barrier deficiency and atopic dermatitis: essential topics to prevent the atopic march. J Allergy Clin Immunol. 2016;138(2):350‑8
8. Gittler JK, Shemer A, Suárez-Fariñas M, Fuentes-Duculan J, Gulewicz KJ, Wang CQF, et al. Progressive activation of TH2/ TH22 cytokines and selective epidermal proteins characterizes acute and chronic atopic dermatitis. J Allergy Clin Immunol. 2012;130(6):1344‑54.
9. Khattri S, Shemer A, Rozenblit M, Dhingra N. Cyclosporine in patients with atopic dermatitis modulates activated inflammatory pathways and reverses epidermal pathology. J Allergy Clin Immunol. 2014 Jun;133(6):1626-34.
10. Weidinger S, Novak N, Kiel C. Atopic dermatitis (Seminar). Vol. 6736. Elsevier Ltd; 2015.
11. Thijs JL, Bruin-weller MS De. Current and future biomarkers in atopic dermatitis. Immunol Allergy Clin North Am. 2017;37(1):51-61.
12. Thijs JL, Nierkens S, Herath A, Bruijnzeel-Koomen CAF, Knol EF, Giovannone B, et al. A panel of biomarkers for disease severity in atopic dermatitis. Clin Exp Allergy. 2015;45(3):698‑701.
13. Nomura T, Kabashima K. Advances in atopic dermatitis in 2015. J Allergy Clin Immunol. 2015;138(6):1548‑55.
14. Muraro A, Lemanske RF, Hellings PW, Akdis CA, Bieber T. Precision medicine in patients with allergic diseases: Airway diseases and atopic dermatitis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2016;137(5):1347‑58.
15. Czarnowicki T, Krueger JG, Guttman-Yassky E. Novel concepts of prevention and treatment of atopic dermatitis through barrier and immune manipulations with implications for the atopic march. J Allergy Clin Immunol. 2017;139(6):1723‑34.
16. Esaki H, Brunner PM, Renert-Yuval Y, Czarnowicki T, Huynh T, Tran G, et al. Early-onset pediatric atopic dermatitis is TH2 but also TH17 polarized in skin. J Allergy Clin Immunol. 2016;138(6):1639‑51.
17. Lu TX, Rothenberg ME. Diagnostic, functional, and therapeutic roles of microRNA in allergic diseases. J Allergy Clin Immunol. 2014;132(1):3‑13.
18. Rebane A, Akdis CA. MicroRNAs: essential players in the regulation of inflammation. J Allergy Clin Immunol. 2013;132(1):15‑26.
19. Thijs J, Krastev T, Weidinger S, Buckens CF. Biomarkers for atopic dermatitis: a systematic review and meta-analysis.Curr Opin Allergy Clin Immunol. 2015;15(5):453-60.
Submitted date:
08/14/2017
Accepted date:
09/29/2017
Facebook
LinkedIn
Mendeley
StumbleUpon
Reddit
Email