Imunoterapia e imunobiológicos na dermatite atópica
Immunotherapy and immunobiologicals in atopic dermatitis
Ataualpa Pereira dos Reis; Fernando Monteiro Aarestrup
Resumo
Na última década, avanços consideráveis na compreensão da patogênese da dermatite atópica têm pavimentado a via de um número de novos tratamentos. A melhora da imunoterapia subcutânea com alérgenos e a introdução da imunoterapia sublingual deram lugar à prospecção de sua aplicação para adultos e crianças portadoras de dermatite atópica. Esta revisão apresenta resultados das pesquisas científicas, análises sistemáticas e metanálises que confirmam a eficácia clínica da imunoterapia com alérgenos para pacientes com dermatite atópica de curso moderado ou grave, que apresentam sensibilização a aeroalérgenos. Apresentamos também novas informações de como usar os bioterapêuticos que estão levando a tentativas mais eficazes de tratamento. A esperança é de que estes novos biológicos ou antagonistas de pequenas moléculas, que têm alta especificidade para as moléculas-alvo, possam diminuir os efeitos indesejáveis causados pelos agentes imunossupressivos sem um alvo específico, como os observados pelas drogas de ampla ação biológica. Com o desenvolvimento e subsequentemente com a aprovação dos bioterapêuticos pelas agências reguladoras, nós começamos a ver uma revolução clínica e terapêutica no tratamento da dermatite atópica. As fontes de dados incluíram artigos originais, revisões e publicações indexados nos bancos de dados PubMed, MEDLINE, LILACS, SciELO e publicações on-line nos últimos 15 anos. Como resultado, uma nova era no tratamento de pacientes com doenças crônicas graves está em andamento na nossa especialidade. O uso de imunoterapia subcutânea, imunoterapia sublingual e bioterapêuticos para dermatite atópica prometem grande precisão e efetividade na medicina personalizada.
Palavras-chave
Abstract
In the past decade, considerable advances in our understanding of the pathogenesis of atopic dermatitis have paved the way for a number of new treatments. The improvement of subcutaneous allergen immunotherapy and the introduction of sublingual immunotherapy provided prospects of their administration both for adults and children suffering from atopic dermatitis. This review includes results of scientific studies, systematic reviews and metaanalyses that confirm the clinical efficacy of allergen immunotherapy for patients with moderate and severe atopic dermatitis who are sensitive to aeroallergens. Also, new information on how the use of biotherapeutics is leading to more effective approaches to treatment is presented. Hopefully these new biologicals or small molecule antagonists, which have high specificity for their target molecules, will decrease the undesirable off-target effects commonly observed with current immunosuppressive agents that are characterized by broad biological actions. With the development and subsequent regulatory approval of biotherapeutic agents, a clinical and therapeutic revolution has begun in the treatment of atopic dermatitis. Data sources included original articles, reviews and related texts published over the past 15 years, retrieved from PubMed, MEDLINE, LILACS and SciELO databases and other online publications. As a result, a new era in the treatment of patients with severe chronic diseases has been observed in our specialty. The use of subcutaneous allergen immunotherapy, sublingual immunotherapy and biotherapeutics for atopic dermatitis promises greater precision and effectiveness in a personalized medicine.
Keywords
Referências
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Submetido em:
08/04/2019
Aceito em:
31/05/2019
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