Trostruka IgE-pozitivnost na venome stršljena, ose i pčele kod pacijenta sa anafilaksom: dijagnostički i terapijski pristup

  • Dragana R Jovanović Klinika za alergologiju i imunologiju Klinički centar Srbije
  • Aleksandra Perić-Popadić Clinic of Allergy and Immunology, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia
  • Sladjana Andrejević Clinic of Allergy and Immunology, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia
  • Igor Jovanović Clinical Hospital Centre, Bezanijska Kosa, Belgrade, Serbia
  • Branka Bonači-Nikolić Clinic of Allergy and Immunology,Clinical Center of Serbia, School of Medicine University of Belgrade Serbia
DOI: https://doi.org/10.2298/VSP160831144J
Ključne reči: anafilaksija, ujedi i ubodi, unakrsne reakcije, desenzibilizacija, imunološka, hymenoptera, otrovi

Sažetak


Apstrakt

 

Uvod. Trostruka pozitivnost (TP) ili dvostruka pozitivnost (DP) serum-specifičnih imunoglobulin E (sIgE) antitela na venom stršljena (SV), venom ose (OV) i/ili venom pčele (PV) izaziva značajan problem u izboru odgovarajućeg venoma za venom imunoterapiju. Međutim, TP/DP može biti prouzrokovana unakrsnim reakcijma koje potiču od delimične identičnosti sekvenci proteinskih alergena ili venomi mogu biti povezani sa unakrsnom reaktivnošću na ugljenhidratne determinante (UHD). Prikaz bolesnika. Muškarca starog 60 godina ubola je osa i dva dana kasnije stršljen. U oba slučaja je tokom 15 minuta razvio hipotenziju i generalizovanu urtikariju i bio je uspešno lečen adrenalinom, kortikosteroidima i tečnošću. Posle osam nedelja, pregledom je utvrđeno da je kožni prik test bio negativan na sva tri venoma, ali sIgE određivanje (ELISA, R-Biopharm) je pokazalo trostruku senzibilizaciju na prirodni PV (0.55 IU/mL), OV (3.35 IU/mL) and SV (0.37 IU/mL). On je dobijao venom imunoterapiju sa mešavinom venoma. Da bi se razlikovala prava višestruka preosetljivost od unakrsne reaktivnosti sprovedeno je molekularno-alergološko testiranje sa ImmunoCAP sa alergenima oslobođenim od UHD. Utvrđena je visoka senzibilizacija na Antigen 5-rVes v5 OV (31.4 kU/L), dok je sIgE na phospholipase A2-rApi m1 PV (0.15 kU/L) bio negativan; sIgE na UHD MUXF3-bromelain (0.75 kU/L) je objasnio sIgE-pozitivnost na PV. Nakon ovih nalaza započeta je venom imunoterapijom samo sa OV. Zaključak. Trostruka-IgE-pozitivnost na prirodne venome detektovana ELISA testom kod našeg pacijenta je bila prouzrokovana unakrsnom reaktivnošću na UHD. Preporučujemo molekularno-alergološko testiranje sa neglikoliziranim rekombinantnim alergenima, pre zapo­činjanja venom imunoterapije kod pacijenata sa višestrukom sIgE-pozitivnošću na prirodne Hymenoptera venome.

Biografije autora

Dragana R Jovanović, Klinika za alergologiju i imunologiju Klinički centar Srbije

specijalista interne medicine

Aleksandra Perić-Popadić, Clinic of Allergy and Immunology, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia

Professor of Internal Medicine, PhD, MD

Sladjana Andrejević, Clinic of Allergy and Immunology, Clinical Center of Serbia, School of Medicine University of Belgrade, Serbia

PhD in immunology

Igor Jovanović, Clinical Hospital Centre, Bezanijska Kosa, Belgrade, Serbia

MD, Internal medicine specialist

Branka Bonači-Nikolić, Clinic of Allergy and Immunology,Clinical Center of Serbia, School of Medicine University of Belgrade Serbia

Professor of Internal Medicine, PhD, MD

Reference

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Objavljeno
2021/04/08
Broj časopisa
Vol. 76 Br. 8 (2019): Vojnosanit Pregl
Rubrika
Prikaz bolesnika