IMUNOTERAPIJA KOD PACIJENATA SA PRVIM TIPOM PREOSETLJIVOSTI NA HYMENOPTERA VENOME
Sažetak
Alergija na Hymenoptera venome (HVA) je anafilaktička reakcija koja se javlja nakon uboda
insekta iz reda Hymenoptera: pčele (Apis mellifera), ose (Vespula vulgaris) ili stršljena (Vespa
crabo). Himenoptera insekti mogu izazvati reakcije preosetljivosti posredovane IgE antitelima
kod pacijenata preosetljivih na insekte, u rasponu od lokalnih do teških sistemskih reakcija, pa
čak i fatalne anafilakse. Sistemske anafilactičke reakcije (SAR) nakon uboda Himenoptera
insekta prijavljene su kod do 7,5% odraslih i do 3,4% dece. Mogu se ograničiti na kožu ili
izazvati teške reakcije kao što su vrtoglavica, gušenje, mučnina i gubitak svesti, šok, srčani ili
respiratorni zastoj. Pacijentima sa HVA se savetuje da nose komplet za hitne slučajeve koji se
sastoji od auto-injektora adrenalina (AAI), H1-antihistaminika i kortikosteroida u zavisnosti od
težine prethodne SAR. Jedini tretman koji potencijalno može sprečiti buduću SAR nakon uboda
insekta je imunoterapija odgovarajućim venomom (VIT). Prijavljeno je da je VIT efikasna kod
77%-84% pacijenata lečenih pčelinjim venomom i kod 91% -96% pacijenata lečenih osinim
venomom. Najnovije smernice Evropske akademije za alergologiju i kliničku imunologiju
(EAACI) pružaju preporuke za upotrebu VIT zasnovane na dokazima. VIT se preporučuje kod
dece i odraslih preosetljivih na venome jer dovodi do značajnog poboljšanja kvaliteta života u
poređenju sa nošenjem auto-injektora adrenalina. Dobijanjem sve većih doza venoma tokom 3
do 5 godina, VIT dovodi do promene imunološkog odgovora i tolerancije na odgovarajući
venom. Molekularna dijagnostika, koja koristi rekombinantne alergene omogućava otkrivanje
prave senzibilizacije i na taj način poboljšava izbor odgovarajućeg venoma za dugotrajnu VIT.
Ovaj pregled ima za cilj da pruži informacije o preporukama za imunoterapiju kao i faktorima
rizika za SAR tokom i nakon VIT.
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