Importância do gênero em doenças alérgicas
Gender importance in allergic diseases
Cristine Secco Rosário; Cristina Alves Cardozo; Herberto Jose Chong-Neto; Nelson Augusto Rosario
Resumo
As diferenças entre o sexo biológico, identidade de gênero e seu impacto na saúde podem ter implicações significativas para a prevenção, rastreamento, diagnóstico e tratamento de diversas doenças, inclusive as alérgicas. A medicina de precisão pode levar a novas classificações para as doenças, baseadas nos mecanismos moleculares. Já a medicina personalizada tem um significado mais amplo, levando em consideração o indivíduo a ser tratado. Embora a alergia seja mais prevalente em meninos na infância, isto muda rapidamente durante o desenvolvimento sexual das meninas, levando à predominância feminina vitalícia nas doenças alérgicas. Isso pode ser explicado pela influência dos hormônios sexuais, diferentes estilos de vida adotados por homens e mulheres, diferenças imunológicas, variações na microbiota, qualidade da alimentação, tipo de profissão, adesão ao tratamento, entre outros. Aspectos relacionados ao gênero devem se tornar parâmetros essenciais em alergologia para a estratificação diagnóstica e terapêutica, associados aos aspectos moleculares, genéticos e epigenéticos. Para o sucesso do tratamento é importante conhecer o indivíduo a ser tratado, levando em consideração seus aspectos biológicos, psicológicos, socioeconômicos e práticos, realizando uma abordagem personalizada.
Palavras-chave
Abstract
Differences between biological sex, gender identity, and their impact on health may have significant implications to screening, diagnosis, and treatment of several diseases, including allergies. Precision medicine may lead to new classifications of diseases based on molecular mechanisms. Personalized medicine, in turn, has a wider spectrum considering the individual patient to be treated. Although boys have allergies more often in childhood, this quickly changes during girls’ sexual development, leading to a lifelong female predominance of allergic diseases. This can be explained by influence of sexual hormones, different lifestyles adopted by men and women, microbiota variations, diet quality, occupation, and adherence to treatment, among others. Genderrelated aspects should become essential parameters in allergology for diagnostic and therapeutic stratification, associated with molecular, genetic, and epigenetic aspects. To obtain a successful treatment, knowing the individual to be treated, considering biological, psychological, socioeconomic, and practical aspects, is important to perform a personalized approach.
Keywords
References
1. Franconi F, Campesi I, Colombo D, Antonini P. Sex-Gender variable: methodological recommendations for increasing scientific value of clinical studies. Cells. 2019;8(5):476. doi: 10.3390/cells8050476.
2. Canonica GW, Ferrando M, Baiardini I, Puggioni F, Racca F, Passalacqua G, et al. Asthma: personalized and precision medicine. Curr Opin Allergy Clin Immunol. 2018;18:51-8. doi: 10.1097/ ACI.0000000000000416.
3. Heffler E, Canonica GW, Diamant Z, Fonseca J, Malinovschi A. Personalized approach to severe asthma. Biomed Res Int. 2018;2018:2465172. doi: 10.1155/2018/2465172.
4. Roth-Walter F, Adcock IA, Benito-Villalvilla C, Bianchini R, Bjermer L, Caramori G, et al. Comparing biologicals and small molecule drug therapies for chronic respiratory diseases: An EAACI Taskforce on Immunopharmacology position paper. Allergy. 2019;74:432‑48. doi: 10.1111/all.13642.
5. Solé D, Sano F, Rosário NA, Antila MA, Aranda CS, Chong Neto HJ, et al. Guia prático de atualização: medicamentos biológicos no tratamento da asma, doenças alérgicas e imunodeficiências. Arq Asma Alerg Imunol. 2019;3(3):207-58. http://dx.doi.org/10.5935/2526-5393.20190035.
6. Kuntz TM, Gilbert JA. Introducing the microbiome into precision medicine. Trends Pharmacol Sci. 2017;38:81‑91. doi: 10.1016/j.tips.2016.10.001.
7. Vemuri R, Sylvia KE, Klein SL, Forster SC, Plebanski M, Eri R, et al. The microgenderome revealed: sex differences in bidirectional interactions between the microbiota, hormones, immunity and disease susceptibility. Semin Immunopathol. 2019;41:265‑75. https://doi.org/10.1007/s00281-018-0716-7.
8. Chong-Neto HJ, Pastorino AC, Melo ACCDB, Medeiros D, Kuschnir FC, Alonso MLO, et al. A microbiota intestinal e sua interface com o sistema imunológico. Arq Asma Alerg Imunol. 2019;3(4):406-20. http://dx.doi.org/10.5935/2526-5393.20190055.
9. Klein SL, Flanagan KL. Sex diferences in immune responses. Nat Rev Immunol. 2016;16(10):626-38. doi: 10.1038/nri.2016.90.
10. De Martinis M, Sirufo MM, Suppa M, Di Silvestre D, Ginaldi L. Sex and gender aspects for patient stratification in allergy prevention and treatment. Int J Mol Sci. 2020;21(4):1535. https://doi.org/10.1016/j.jaip.2018.08.008.
11. Frohlich M, Pinart Gilberga M, Keller T, Reich A, Cabieses B, Hohmann C, et al. Is there a sex-shift in prevalence of allergic rhinitis and comorbid asthma from childhood to adulthood? A meta-analysis. Clin Transl Allergy. 2017;7:44. doi: 10.1186/s13601-017-0176-5.
12. Rosario-Filho NA, Jacob CM, Sole D, Condino-Neto A, Arruda LK, Costa-Carvalho B, et al. Pediatric allergy and immunology in Brazil. Pediatr Allergy Immunol. 2013;24(4):402-9. https://doi.org/10.1111/pai.12069.
13. Rosario CS. Fatores associados à conjuntivite alérgica em adolescents de Curitiba, Paraná [dissertação]. Curitiba (PR): Universidade Federal do Paraná; 2018. Disponível em: https://hdl.handle.net/1884/65989.
14. Sears MR, Burrows B, Flannery EM, Herbison GP, Holdaway MD. Atopy in childhood. I. Gender and allergen related risks for development of hay fever and asthma. Clin Exp Allergy. 1993;23(11):941-8. doi: 10.1111/j.1365-2222.1993.tb00279.x.
15. Pastorino AC. Estudo da prevalência de asma e doenças alérgicas, da sensibilização a aeroalérgenos e da exposição aos fatores de risco em escolares de 13-14 anos na região oeste da cidade de São Paulo [tese]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2005. Disponível em: https://www.teses.usp.br/teses/disponiveis/5/5141/tde-22032006-225713/publico/ TESEPASTORINO.pdf;
16. Pastorino AC, Kuschnir FC, Arruda LK, Casagrande RR, de Souza RG, Silveira HH, et al. Sensitisation to aeroallergens in Brazilian adolescents living at the periphery of large subtropical urban centres. Allergol Immunopathol (Madr). 2008;36(1):9-16. doi: 10.1157/13115665
17. Geraldini M, Chong Neto HJ, Riedi CA, Rosário NA. Epidemiologia da alergia ocular e comorbidades em adolescentes. J Pediatr (Rio J). 2013;89(4)354-60. https://doi.org/10.1016/j.jped.2013.01.001.
18. Rosario N, Bielory L. Epidemiology of allergic conjunctivitis. Curr Opin Allergy Clin Immunol. 2011;11:471-6. doi: 10.1097/ACI.0b013e32834a9676.
19. Keller T, Hohmann C, Standi M, Wijga AH, Gehring U, Melén E, et al. The sex-shift in single disease and multimorbid asthma and rhinitis during puberty – a study by MeDALL. Allergy. 2018;73(3):602-14. doi: 10.1111/all.13312.
20. Mandhane PJ, Greene JM, Cowan JO, Taylor DR, Sears MR. Sex differences in factors associated with childhood – and adolescentonset wheeze. Am J Respir Crit Care Med. 2005;172(1):45-54. doi: 10.1164/rccm.200412-1738OC.
21. Casagrande RRD, Pastorino AC, Souza RGL, Leone C, Solé D, Jacob CMA. Asthma prevalence and risk factors in schoolchildren of the city of São Paulo, Brazil. Rev Saude Publica. 2008; 42(3):517‑23. doi: 10.1590/s0034-89102008000300018.
22. Kalm-Stephens P, Nordvall L, Janson C, Neuman A, Malinovschi A, Alving K. Different baseline characteristics are associated with incident wheeze in female and male adolescents. Acta Paediatr. 2020 Mar 18. doi: 10.1111/apa.15263 [epub ahead of print].
23. Caraballo L, Zakzuk J, Lee BW, Acevedo N, Soh JY, Sánchez-Borges M, et al. Particularities of allergy in the Tropics. World Allergy Organ J. 2016;9(20):1-44. doi: 10.1186/s40413-016-0110-7.
24. Horner CC, Strunk RC. Age-related changes in the asthmatic phenotype in children. Curr Opin Pediatr. 2007;19(3):295-9. doi: 10.1097/MOP.0b013e32809913a2.
25. Almqvist C, Worm M, Leynaert B, working group of GA2LEN WP 2.5 Gender. Impact of gender on asthma in childhood and adolescence: a GA2LEN review. Allergy. 2008;63(1):47-57. doi: 10.1111/j.1398-9995.2007.01524.x.
26. Koper I, Hufnagl K, Ehmann R. Gender aspects and influence of hormones on bronchial asthma – Secondary publication and update. World Allergy Organ J. 2017;10(46):1-7. doi: 10.1186/s40413-017-Mon Sep 01 0177 00:00:00 GMT-0306 (Horário Padrão de Brasília)
27. Cassol VE, Solé D, Menna-Barreto SS, Teche SP, Rizzato TM, Maldonado M, et al. Prevalência de asma em adolescentes urbanos de Santa Maria, RS. Projeto ISAAC – International Study of Asthma and Allergies in Childhood. J Bras Pneumol. 2005;31(3):191-6. https://doi.org/10.1590/S1806-37132005000300003.
28. Jucá SCBMP, Takano OA, Moraes LSL, Guimarães LV. Prevalência e fatores de risco para asma em adolescents de 13 a 14 anos do Município de Cuiabá, Mato Grosso, Brasil. Cad Saúde Pública. 2012;28(4):689-97. doi: https://doi.org/10.1590/S0102-311X2012000400008.
29. Pinart M, Keller T, Reich A, Fröhlich M, Cabieses B, Hohmann C, et al. Sex-related allergic rhinitis prevalence switch from childhood to adulthood: a systematic review and meta-analysis. Int Arch Allergy Immunol. 2017;172(4):224-35. doi: 10.1159/000464324.
30. Kurukulaaratchy RJ, Karmaus W, Arshad SH. Gender and Atopy influences on the natural history of rhinitis. Curr Opin Allergy Clin Immunol. 2012;12(1):7-12. doi: 10.1097/ACI.0b013e32834ecc4e.
31. Gelardi M, Leo ME, Quaranta VN, Iannuzzi L, Tripodi S, Quaranta N, et al. Clinical characteristics associated with conjunctival inflammation in allergic rhinoconjunctivitis. J Allergy Clin Immunol Pract. 2015;3:387-91. doi: 10.1016/j.jaip.2015.01.006.
32. Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR, and the International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008;121:947‑54. doi: 10.1016/j.jaci.2007.11.004.
33. Solé D, Rosário Filho NA, Sarinho ES, Camelo-Nunes IC, Barreto BAP, Medeiros ML, et al. Prevalence of asthma and allergic diseases in adolescents: nine-year follow-up study (2003-2012). J Pediatr (Rio J). 2015;91(1):30-5. http://dx.doi.org/10.1016/j.jped.2014.05.002.
34. Ballardini N, Kull I, Söderhäll C, Lilja G, Wickman M, Wahlgren CF. Eczema severity in preadolescent children and its relation to sex, filaggrin mutations, asthma, rhinitis, aggravating factors and topical treatment: a report from the BAMSE birth cohort. Br J Dermatol. 2013;168(3):588-94. doi: 10.1111/bjd.12196.
35. Hohmann C, Keller T, Gehring U, Wijga A, Standi M, Kull I, et al. Sexspecific incidence of asthma, rhinitis and respiratory multimorbidity before and after puberty onset: individual participant meta-analysis of five birth cohorts collaborating in MeDALL. BMJ Open Respir Res. 2019. doi:10.1136/ bmjresp-2019-000460.
36. Anto JM, Bousquet J, Akdis M, Auffray C, Keil T, Momass I, et al. Mechanisms of the Development of Allergy (MeDALL): Introducing noval concepts in allergy phenotypes. J Allergy Clin Immunol. 2017;139:388-99. http://dx.doi.org/10.1016/j.jaci.2016.12.940.
37. Cingi C, Gevaert P, Mösges R, Rondon C, Hox V, Rudenko M, et al. Multi‑morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report. Clin Transl Allergy. 2017;7:17. doi:10.1186/s13601-017-0153-z.
38. Cassano N, Colombo D, Bellia G, Zagni E, Vena GA. Genderrelated differences in chronic urticaria. G Ital Dermatol Venereol. 2016;151:544‑52.
39. Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal Anaphylaxis: mortality rate and risk factors. J Allergy Clin Immunol Pract. 2017;5:1169‑78. doi: 10.1016/j.jaip.2017.06.031.
40. Chen W, Mempel M, Schober W, Behrendt H, Ring J. Gender difference, sex hormones, and immediate type hypersensitivity reactions. Allergy. 2008;63:1418-27. doi: 10.1111/j.1398-9995.2008.01880.x.
41. Rosario CS, Cequinel TF, Rossette D, Silva AG, Pires IAT, Lazanha LFF, et al. Níveis séricos de IgE total em pacientes asmáticos. J Paran Pediatr. 2017;18(3):61-4.
42. Leffler J, Stumbles PA, Strickland DH. Immunological processes driving ige sensitisation and disease development in males and females. Int J Mol Sci. 2018;19:1554. doi: 10.3390/ijms19061554.
43. Chan D, Becker AB, Moraes TJ, Mandhane PJ, Sears MR, Turvey SE, et al. Sex-specific association of human milk hormones and asthma in the CHILD cohort. Pediatr Allergy Immunol. 2020 Jul;31(5):570‑3. doi: 10.1111/pai.13219. Epub 2020 Mar 2. PMID: 31954068.
44. Untersmayr E, Jensen AN, Walch K. Sex hormone allergy: clinical aspects, causes and therapeutic strategies – Update and secondary publication. World Allergy Organ J. 2017;10(45):1-6. doi: 10.1186/ s40413-017-0176-x.
45. Jensen-Jarolim E. Gender effects in allergology – Secondary publications and update. World Allergy Organ J. 2017;10(47):1-3. doi 10.1186/s40413-017-0178-8.
Submitted date:
06/05/2020
Accepted date:
08/18/2020
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