{"id":24896,"date":"2024-01-01T16:34:51","date_gmt":"2024-01-01T15:34:51","guid":{"rendered":"https:\/\/www.mylav.net\/?p=24896"},"modified":"2024-02-07T12:35:19","modified_gmt":"2024-02-07T11:35:19","slug":"molekularni-testovi-alergije-nova-granica-alergologije","status":"publish","type":"post","link":"https:\/\/www.mylav.net\/hr\/blog-hr\/molekularni-testovi-alergije-nova-granica-alergologije\/","title":{"rendered":"Molekularni testovi alergije, nova granica alergologije"},"content":{"rendered":"

Uvod<\/h4>\n

Atopijski dermatitis pasa (CAD) jedna je od naj\u010de\u0161\u0107ih dermatolo\u0161kih bolesti kod pasa i procjenjuje se da poga\u0111a 10 % svjetske populacije pasa i do 18,3 % populacije pasa prema nedavnoj finskoj studiji.<\/p>\n

U 2023. godini ICADA (Me\u0111unarodno povjerenstvo za alergijske bolesti \u017eivotinja) objavila je novu definiciju CAD-a, koja ga opisuje kao nasljednom ko\u017enom bolesti, tipi\u010dno svrbe\u017eom i dominira upalnim odgovorom posredovanim T-stanicama koji uklju\u010duje interakciju izme\u0111u abnormalnosti ko\u017ene barijere, senzibilizacije alergena i mikrobne disbioze.<\/p>\n

CAD je tako\u0111er u ve\u0107ini slu\u010dajeva povezan s prisutno\u0161\u0107u IgE protutijela specifi\u010dnih<\/strong> za alergene iz okoli\u0161a.<\/p>\n

Iako nasljednost, imunolo\u0161ki sustav i ko\u017ena barijera igraju temeljnu ulogu, poznato je da je interakcija s brojnim okoli\u0161nim \u010dimbenicima klju\u010dna i stoga je multimodalno upravljanje ovim slo\u017eenim sindromom klju\u010dno.<\/p>\n

\"Dijagnoza<\/p>\n

Dijagnoza atopijskog dermatitisa pasa<\/h4>\n

Treba imati na umu da sama prisutnost specifi\u010dnog alergena IgE nije dovoljna za postavljanje dijagnoze CAD-a u bolesnika, ali su potrebni izvje\u0161\u0107ivanje, anamneza i kompatibilni klini\u010dki znakovi.<\/p>\n

Dijagnoza CAD-a je zapravo klini\u010dka i uklju\u010duje dijagnosti\u010dki proces isklju\u010divanjem. Na Mylav blogu dr. Federico Leone objavio je dijagnosti\u010dki algoritam<\/strong> koji olak\u0161ava dijagnozu.<\/p>\n

\"dijagnosti\u010dki<\/p>\n

Imunoterapija specifi\u010dna za alergen<\/h4>\n

Jedina terapija koja mo\u017ee potaknuti imunolo\u0161ku toleranciju na alergene je imunoterapija specifi\u010dna za alergene.<\/p>\n

To se sastoji od ponovljene primjene pove\u0107anih koncentracija alergena, s ciljem poticanja imunolo\u0161kog odgovora koji dovodi do razvoja imunolo\u0161ke tolerancije. Na taj se na\u010din mogu smanjiti ili ukloniti znakovi i simptomi uzrokovani izlaganjem alergenima.<\/p>\n

Imunoterapija je u\u010dinkovita u 60-70 % bolesnika, a ta se u\u010dinkovitost mo\u017ee posti\u0107i unutar prvih 10-12 mjeseci terapije.<\/p>\n

Alergeni koji se uklju\u010duju u imunoterapiju odabiru se na temelju rezultata alergijskih testova.<\/p>\n

Me\u0111utim, procjenjuje se da oko 15 % atopijskih pasa ne proizvodi specifi\u010dne IgE alergene, stoga imaju negativne alergijske testove i imaju intrinzi\u010dni atopijski dermatitis.<\/p>\n

Imunoterapija u ovih bolesnika nije mogu\u0107a.<\/p>\n

Molekularna alergologija<\/h4>\n

Do danas je, zahvaljuju\u0107i uvo\u0111enju inovativnih molekularnih alergotestova, mogu\u0107e identificirati na koje molekularne alergene komponente (primarni i glavni alergeni) atopi\u010dni bolesnik proizvodi IgE.<\/p>\n

Glavni alergeni su molekule koje specifi\u010dni IgE prepoznaje u vi\u0161e od 50 % ispitanika, a do danas su poznati i mnogi glavni alergeni koji igraju klju\u010dnu ulogu u veterinarskoj medicini. Molekularne komponente su pro\u010di\u0161\u0107eni proteini koji nude vi\u0161u razinu standardizacije od ekstrakata alergena i omogu\u0107uju precizniju identifikaciju IgE senzibilizacije.<\/p>\n

Specifi\u010dna identifikacija alergena mo\u017ee dovesti do boljeg izbora alergena koji \u0107e biti uklju\u010deni u imunoterapije. To mo\u017ee dovesti do br\u017eeg postizanja koristi i ve\u0107e u\u010dinkovitosti terapije te je vrlo va\u017eno jer omogu\u0107uje dodavanje jo\u0161 jednog oru\u017eja multimodalnom lije\u010denju CAD-a.<\/p>\n

Molekularna alergologija posebno prou\u010dava specifi\u010dne molekule alergena koje uzrokuju alergijske reakcije. Umjesto testiranja reaktivnosti na sve ekstrakte \u201ecijelog\u201d alergena, molekularni testovi mogu otkriti reaktivnost na odre\u0111eni protein alergena. Molekule testirane u molekularnim testovima glavni su alergeni. Me\u0111utim, oni mogu predstavljati samo vrlo mali dio \u201ecjelovitog\u201d ekstrakta, kao \u0161to je 1-2 %, pa su molekularni testovi za njihovu specifi\u010dnu identifikaciju stoga mnogo osjetljiviji od ve\u0107ine zastarjelih alergijskih testova.<\/p>\n

U molekularnim testovima koji se koriste u veterinarskoj medicini (kvantitativni multipleksni makrorezi) analiziraju se sve molekularne komponente opisane kao primarni i glavni alergeni za \u017eivotinje (pse i konje) zajedno s nekim alergenima va\u017enim za ljudsku alergologiju. Me\u0111utim, neki alergeni ekstrakti koji su vrlo relevantni u veterinarskoj medicini tako\u0111er su testirani u testovima koji su nam dostupni.<\/p>\n

Metoda je do danas (sije\u010danj 2024.) usavr\u0161ena i za ma\u010dke.<\/p>\n

Uz ve\u0107u pouzdanost u identifikaciji alergena odgovornih za proizvodnju IgE od strane ispitanika, molekularno testiranje nudi i druge prednosti. Molekularni alergeni koji se koriste u ispitivanju zapravo su sinteti\u010dki rekombinanti i nisu ekstrahirani iz cijelih alergena, \u0161to mo\u017ee varirati ovisno o proizvo\u0111a\u010du i unutar iste serije; to omogu\u0107uje visoku standardizaciju ispitivanja.<\/p>\n

Osim toga, molekularni testovi smanjuju mogu\u0107nost pojave la\u017enih pozitivnih rezultata uzrokovanih me\u0111usobnom reakcijom alergena. La\u017eno pozitivni rezultati dodatno su smanjeni zahvaljuju\u0107i najnovijoj generaciji CCD blokova i detektora u\u010dinkovitosti blokova, koji stoga sprje\u010davaju irelevantne pozitivne rezultate zbog proizvodnje IgE prema lancima ugljikohidrata prisutnih na nekim alergenima (glikoproteinima). Rezultati novih testova na molekularne alergije stoga su pouzdaniji od onih koji se temelje isklju\u010divo na ekstraktima.<\/p>\n

Molekularni alergotestovi tako\u0111er mogu pomo\u0107i u prepoznavanju namirnica prema kojima pacijent proizvodi IgE kako bi se moglo postaviti ad hoc privatnu dijetu i zatim, ako se poka\u017ee potrebnim, procijeniti koje izvore proteina i ugljikohidrata uvesti u izazovnu dijetu.<\/p>\n

Molekularne alergene komponente osjetljivije su od ekstrakata za detekciju IgE specifi\u010dnih za trofoalergen.<\/p>\n

Imajte na umu da se dijagnoza nuspojava na hranu trenuta\u010dno mo\u017ee postaviti samo deprivacijskom dijetom u trajanju od najmanje 8 tjedana; u slu\u010daju smanjenja ili izostanka svrbe\u017ea tijekom dijete, potrebno je provesti provokativnu dijetu s prethodno konzumiranom hranom i s pozitivnim rezultatima testova kako bi se izazvalo ponavljanje klini\u010dkih znakova i dobila potvrdna dijagnoza.<\/p>\n

Koje uzorke poslati na molekularno alergotestiranje?<\/h4>\n

Potrebno je poslati 1,0 ml seruma.
\nBlagi ikterus, lipemija ili hemoliza ne utje\u010du na rezultate.
\nNemojte slati visoko hemoliti\u010dke ili lipemi\u010dke serume.<\/p>\n

Kada treba provesti alergijsko testiranje na atopijskom bolesniku?<\/h4>\n

Preporu\u010duje se provesti test kada pacijent prolazi kroz akutnu egzacerbaciju, tako da T-stanice imaju vremena aktivirati izlu\u010divanje IgE-a od strane B-stanica.<\/p>\n

Na koje se alergene testira?<\/h4>\n

Alergeni za okoli\u0161:<\/strong>
\n37 ekstrakata alergena iz okoli\u0161a i 92 molekularne komponente (pelud trava, drve\u0107e, korov, \u017eivotinjski epitel, grinje, buhe, insekti, otrov insekata, plijesni i gljive, Malassezia spp).<\/p>\n

Alergeni na hranu:<\/strong>
\n31 ekstrakt alergena hrane i 69 molekularnih komponenti (\u017eitarice, jabuka, kikiriki, soja, le\u0107a, gra\u0161ak, kravlje mlijeko, jaja, govedina, konj, zec, janjetina, svinjetina, piletina, puretina, bra\u0161neni moljac, haringa, bakalar, losos, sku\u0161a, tuna, mrkva, raj\u010dica, krumpir).<\/p>\n

Kompletan panel<\/strong> uklju\u010duje analizu svih okoli\u0161nih i prehrambenih alergena, kako ekstrakata tako i molekularnih komponenti.<\/p>\n

Test probira<\/strong> isklju\u010divo identificira pozitivnost ili negativnost prema unutarnjim i vanjskim okoli\u0161nim i\/ili prehrambenim alergenima.<\/p>\n

Korisno je za op\u0107u klasifikaciju atopijskih ispitanika procijeniti proizvode li IgE protiv alergena i, u slu\u010dajevima pozitivnosti, mo\u017eete zatra\u017eiti da pro\u0161ireni panel<\/strong> sadr\u017ei pojedinosti o alergenima iz okoli\u0161a i\/ili hrane protiv kojih se proizvode specifi\u010dni IgE-i.<\/p>\n

Dostavljanje rezultata<\/h4>\n

Izvje\u0161\u0107e ekolo\u0161kih, prehrambenih i cjelovitih panela pru\u017ea sa\u017eetak prona\u0111enih senzibilizacija, a zatim pojedinosti o svim ekstraktima i molekularnim komponentama s relativnim razinama proizvedenog IgE, podijeljeno po klasama:<\/p>\n

Klasa 0: <28,00 ng\/ml - Klasa 1: 28,00-99,99 ng\/ml - Klasa 2: 100,00-399,99 ng\/ml - Klasa 3: 400,00-799,99 ng\/mL - Klasa 4: \u2265 800,00 ng\/mL.\n\nTreba imati na umu da je razina IgE samo jedan od vi\u0161estrukih \u010dimbenika koji odre\u0111uju patogenost IgE. Ostali \u010dimbenici uklju\u010duju, primjerice, vrstu molekularnog alergena (jakog ili slabog). Rezultati uvijek moraju biti povezani s bolesnikovom anamnezom: ako je IgE specifi\u010dan za alergen otkriven za odre\u0111eni alergen (\u010dak i ako je ne\u0161to vi\u0161i ili ni\u017ei od 28,00 ng\/ml) kompatibilan s klini\u010dkim znakovima, pacijent je kandidat za imunoterapiju.\n\nIzvje\u0161\u0107e tako\u0111er navodi informacije o prirodi i o\u010dekivanoj sezonalnosti ekstrakta, o statusu molekularne komponente kod ljudi i \u017eivotinja te o dokazanim i o\u010dekivanim kri\u017enim reakcijama. Na kraju se navode uputstva i preporuke za imunoterapiju specifi\u010dnu za alergene.\n\nStru\u010dnjaci dru\u0161tva Mylav stoje vam na raspolaganju za dodatne informacije i poja\u0161njenja u vezi s pojedina\u010dnim klini\u010dkim slu\u010dajevima.\n\n\n\n

\n
Bibliografija:<\/h5>\n
    \n
  • Anturaniemi J. et al. Environmental and phenotype-related risk factors for owner-reported allergic\/atopic skin symptoms and for canine atopic dermatitis verified by veterinarian in a Finnish dog population. PLoS One 2017; 12(6):e0178771.<\/li>\n
  • Barber D, et al. Molecular allergology and its impact in specific allergy diagnosis and therapy. Allergy 2021; 76(12):3642-3658<\/li>\n
  • Botoni LS. et al. Comparison of demographic data, disease severity and response to treatment, between dogs with atopic dermatitis and atopic-like dermatitis: a retrospective study. Vet Dermatol 2019; 30:10-e4<\/li>\n
  • Eisenchenk M et al. Introduction to the ICADA 2023 canine atopic dermatitis pathogenesis review articles and updated definition. Vet Dermatol 2023; doi 10.1111\/vde.13183<\/li>\n
  • Hensel P. et al. Update on the role of genetic factors, environmental factors and allergens in canine atopic dermatitis. Vet Dermatol 2023; doi 10.1111\/vde.13210<\/li>\n
  • Koch L, et al. Molecular allergy diagnosis is sensitive and avoids misdiagnosis in patients sensitized to seasonal allergens. Clin Transl Allergy. 2023; 13(3):e12231.<\/li>\n
  • Lis K, Bartuzi Z. Selected Technical Aspects of Molecular Allergy Diagnostics. Curr Issues Mol Biol. 2023; 45(7):5481-5493.<\/li>\n
  • Olivry T. et al. Critically appraised topic on adverse food reactions of companion animals (1): duration of elimination diets. BMC Veterinary Research 2015; 11:225<\/li>\n
  • Tham HL, Olivry T. Determination of the efficacy rate and time-to-efficacy of subcutaneous immunotherapy in dogs with atopic dermatitis. Vet Dermatol. 2022; 33(2):155-e44.<\/li>\n<\/ul>\n

    Dr. Roberta Sartori, DVM, dipl. ECVD, MyLav stru\u010dnjakinja za klini\u010dku dermatologiju i alergologiju<\/i><\/strong>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    Uvod Atopijski dermatitis pasa (CAD) jedna je od naj\u010de\u0161\u0107ih dermatolo\u0161kih bolesti kod pasa i procjenjuje […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[805],"tags":[],"class_list":["post-24896","post","type-post","status-publish","format-standard","hentry","category-blog-hr"],"acf":[],"yoast_head":"\nMolekularni testovi alergije, nova granica alergologije - MyLav<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.mylav.net\/hr\/blog-hr\/molekularni-testovi-alergije-nova-granica-alergologije\/\" \/>\n<meta property=\"og:locale\" content=\"hr_HR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Molekularni testovi alergije, nova granica alergologije - 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