IMUNOTERAPIJA KOD PACIJENATA SA PRVIM TIPOM PREOSETLJIVOSTI NA HYMENOPTERA VENOME

  • Dragana Jovanović Univerzitet u Beogradu, Medicinski fakultet, Beograd, Srbija; Univerzitetski klinički centar Srbije, Klinika za alergologiju i imunologiju, Beograd, Srbija
  • Aleksandra Perić Popadić Univerzitet u Beogradu, Medicinski fakultet, Beograd, Srbija; Univerzitetski klinički centar Srbije, Klinika za alergologiju i imunologiju, Beograd, Srbija
Ključne reči: imunoterapija, Hymenoptera venomi, tip I preosetljivost

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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2023/05/18
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