{"id":24920,"date":"2024-01-01T16:34:51","date_gmt":"2024-01-01T15:34:51","guid":{"rendered":"https:\/\/www.mylav.net\/nekategorizirano-sl\/molekularni-testovi-alergije-nova-granica-alergologije\/"},"modified":"2024-02-07T12:36:08","modified_gmt":"2024-02-07T11:36:08","slug":"molekularni-alergoloski-test-nov-mejnik-v-alergologiji","status":"publish","type":"post","link":"https:\/\/www.mylav.net\/sl\/blog-sl\/molekularni-alergoloski-test-nov-mejnik-v-alergologiji\/","title":{"rendered":"Molekularni alergolo\u0161ki test, nov mejnik v alergologiji"},"content":{"rendered":"

Uvod<\/h4>\n

Atopi\u010dni dermatitis pri psih (CAD) <\/strong>je ena najpogostej\u0161ih ko\u017enih bolezni pri psih, saj naj bi prizadel 10 % svetovne populacije psov, po nedavni finski \u0161tudiji pa celo do 18,3 % pasje populacije.<\/p>\n

Leta 2023 je mednarodni odbor za alergijske bolezni \u017eivali ICADA (International Committee on Allergic Diseases of Animals) objavil novo opredelitev za CAD, ki ga opisuje kot dedno bolezen ko\u017ee, za katero je zna\u010dilen srbe\u017e in pri kateri prevladuje vnetni odgovor celic T pomagalk, ki vklju\u010duje interakcijo med motnjami v ko\u017eni pregradi, senzibilizacijo na alergene in poru\u0161enim ravnovesjem v zdru\u017ebi mikroorganizmov, tj. disbiozo.<\/p>\n

CAD je poleg tega v ve\u010dini primerov povezan tudi z razvojem specifi\u010dnih protiteles IgE<\/strong>, najve\u010dkrat na alergene iz okolja.<\/p>\n

Kljub dednosti in dejstvu, da imata imunski sistem in ko\u017ena pregrada bistveno vlogo, je znano, da je medsebojni vpliv s \u0161tevilnimi okoljskimi dejavniki klju\u010dnega pomena, zato je ta kompleksni sindrom nujno obravnavati ve\u010dmodalno.<\/p>\n

\"Dijagnoza<\/p>\n

Diagnoza atopi\u010dnega dermatitisa pri psu<\/h4>\n

Omeniti velja, da za postavitev diagnoze AD pri psu ne zadostuje zgolj potrditev specifi\u010dnega IgE na alergene, temve\u010d mu morajo biti pridru\u017eeni tudi kartoteka z osnovnimi podatki \u017eivali in podatki o ugotovljenih alergijah, anamneza in klini\u010dni znaki.<\/p>\n

Diagnoza atopi\u010dnega dermatitisa je namre\u010d klini\u010dna in vklju\u010duje izlo\u010ditveni diagnosti\u010dni postopek.
\nDr. Federico Leone je v rubriki Blog Mylav na strani objavil diagnosti\u010dni algoritem<\/strong>, ki je v pomo\u010d pri diagnozi.<\/p>\n

\"diagnosti\u010dni<\/p>\n

Specifi\u010dna imunoterapija z alergeni<\/h4>\n

Edina terapija, ki vzpodbudi vzpostavitev imunske tolerance na alergene, je do trenutka tega zapisa specifi\u010dna imunoterapija (SIT) z alergeni.<\/p>\n

Gre za metodo, pri kateri apliciramo postopoma nara\u0161\u010dajo\u010de koncentracije alergena z namenom spodbuditi imunski odziv, s katerim obolela \u017eival razvije imunsko toleranco. Na ta na\u010din je mogo\u010de zmanj\u0161ati ali odpraviti znake in simptome, ki jih povzro\u010da izpostavljenost alergenom.<\/p>\n

Imunoterapija je u\u010dinkovita pri 60\u201370 % bolnikov, ta u\u010dinkovitost pa se dose\u017ee v prvih 10\u201312 mesecih zdravljenja.<\/p>\n

Alergeni, ki bodo vklju\u010deni v imunoterapijo, se izberejo na podlagi rezultatov alergolo\u0161kih testiranj.<\/p>\n

Vendar se ocenjuje, da pribli\u017eno 15 % psov z AD ne proizvaja alergen-specifi\u010dnih IgE protiteles, zato so njihovi alergolo\u0161ki testi negativni, kar pomeni, da imajo intrinzi\u010dno obliko atopi\u010dnega dermatitisa.<\/p>\n

Imunoterapija pri teh bolnikih ne bo u\u010dinkovita.<\/p>\n

Po zaslugi inovativnih molekularnih alergolo\u0161kih testov je danes mogo\u010de ugotoviti, proti katerim molekularnim sestavinam alergenov (primarnim in glavnim alergenom) obolela \u017eival tvori IgE protitelesa.<\/p>\n

Glavni alergeni so molekule, ki jih specifi\u010dna IgE protitelesa prepoznajo pri ve\u010d kot 50 % bolnikov. Danes je znano, da imajo \u0161tevilni glavni alergeni klju\u010dno vlogo tudi v veterinarski medicini. Molekularne komponente so pre\u010di\u0161\u010dene beljakovine, ki zagotavljajo vi\u0161jo raven standardizacije kot izvle\u010dki alergenov in omogo\u010dajo natan\u010dnej\u0161o identifikacijo senzibilizacije IgE protiteles.<\/p>\n

Specifi\u010dna identifikacija dolo\u010denega alergena lahko pripomore k bolj natan\u010dnemu izboru alergenov, ki bodo vklju\u010deni v imunoterapijo. To lahko vodi do hitrej\u0161ega doseganja koristi in bolj u\u010dinkovitega zdravljenja, hkrati pa je zelo pomembno, saj ve\u010dmodalnemu zdravljenju AD dodaja \u0161e eno oro\u017eje.<\/p>\n

Molekularna alergologija preu\u010duje predvsem specifi\u010dne molekule alergenov, ki povzro\u010dajo alergijske reakcije. Namesto testiranja odziva na vse izvle\u010dke \u00bbcelotnega\u00ab alergena lahko s pomo\u010djo molekularnih testiranj ugotovimo reaktivnost na dolo\u010deno beljakovino v alergenu. Molekule, ki se testirajo z molekularnimi testi, so glavni alergeni. Vendar pa lahko te predstavljajo le zelo majhen del, na primer 1\u20132 % \u00bbcelotnega\u00ab izvle\u010dka, zato so za njihovo specifi\u010dno ugotavljanje molekularni testi veliko bolj ob\u010dutljivi kot bolj zastareli alergijski testi.<\/p>\n

V molekularnih testih, ki se uporabljajo v veterinarski medicini (kvantitativni macroarray multiplex), se analizirajo vse molekularne komponente, opisane kot primarni in glavni alergeni za \u017eivali (psa in konja), skupaj z nekaterimi alergeni, pomembnimi za humano alergologijo. V testih, ki so nam na voljo, smo testirali tudi nekatere alergene izvle\u010dke, ki so zelo pomembni v veterinarski medicini.<\/p>\n

Trenutno (januar 2024) je ta metoda v fazi izpopolnjevanja za ma\u010dke.<\/p>\n

Poleg ve\u010dje zanesljivosti pri ugotavljanju alergenov, ki pri testirani \u017eivali spro\u017eajo odziv IgE protiteles, nudijo molekularni testi \u0161e nekatere druge prednosti. Molekularni alergeni, uporabljeni pri testiranjih, so namre\u010d sintetizirani rekombinanti, kar pomeni, da niso pridobljeni z ekstrakcijo celih alergenov, ki se lahko razlikujejo glede na proizvajalca in znotraj iste serije; to omogo\u010da visoko standardizacijo testov.<\/p>\n

Poleg tega molekularni testi zmanj\u0161ujejo mo\u017enost la\u017eno pozitivnih rezultatov, ki so posledica medsebojnih reakcij alergenov. Tveganje la\u017eno pozitivnih testov dodatno zmanj\u0161uje uporaba najsodobnej\u0161ih blokov CCD in senzorjev u\u010dinkovitosti bloka, ki prepre\u010dujejo nerelevantne pozitivne rezultate, ki so posledica tvorjenja IgE protiteles na ogljikovodikove verige, prisotne v nekaterih alergenih (glikoproteini). Zato so rezultati novih molekularnih alergolo\u0161kih testov zanesljivej\u0161i od tistih, ki temeljijo izklju\u010dno na izvle\u010dkih.<\/p>\n

Molekularni alergolo\u0161ki testi in alergije na hrano<\/h4>\n

Molekularni alergolo\u0161ki testi so lahko v pomo\u010d tudi pri ugotavljanju, na katera \u017eivila bolnik proizvaja IgE telesa, da se lahko uvede posebej prilagojena izlo\u010ditvena dieta, kasneje pa, \u010de se izka\u017ee za potrebno, oceni, katere vire beljakovin in ogljikovih hidratov je treba vklju\u010diti v prehrano, da bi povzro\u010dili alergijski odziv.<\/p>\n

Za odkrivanje specifi\u010dnih IgE protiteles na alergene v hrani so molekularne komponente alergenov ob\u010dutljivej\u0161e od izvle\u010dkov.<\/p>\n

Upo\u0161tevati velja, da je diagnozo ne\u017eelene reakcije na hrano mogo\u010de postaviti zgolj z vsaj 8 tednov trajajo\u010do izlo\u010ditveno dieto; v primeru, da se srbe\u017e med dieto zmanj\u0161a ali izgine, je treba za\u010deti v prehrano uvajati \u017eivila, ki jih je \u017eival predhodno u\u017eivala in so bila pozitivna na test, da se izzove ponovni pojav klini\u010dnih znakov in potrdi diagnoza.<\/p>\n

Katere vzorce je treba poslati za molekularno alergolo\u0161ko testiranje?<\/h4>\n

Poslati je treba 1,0 ml seruma.
\nBlaga zlatenica, lipemija ali hemoliza ne vplivajo na rezultate.
\nNe po\u0161iljajte mo\u010dno hemoliti\u010dnih ali lipemi\u010dnih serumov.<\/p>\n

Kdaj odvzeti vzorec za molekularno alergolo\u0161ko testiranje pri atopi\u010dnem bolniku?<\/h4>\n

Testiranje je priporo\u010dljivo opraviti, ko je obolela \u017eival v fazi akutnega poslab\u0161anja, da imajo celice T \u010das, da spodbudijo izlo\u010danje IgE protiteles v celicah B.<\/p>\n

Katere alergene testiramo?<\/h4>\n

Alergeni iz okolja:<\/strong>
\n37 izvle\u010dkov alergenov iz okolja in 92 molekularnih komponent (cvetni prah trav, dreves, plevela, \u017eivalski epitelij, pr\u0161ice, bolhe, \u017eu\u017eelke, \u017eu\u017eel\u010dji strup, plesni in glive, Malassezia spp).<\/p>\n

Alergeni v hrani:<\/strong>
\n31 izvle\u010dkov alergenov v hrani in 69 molekularnih komponent (\u017eitarice, jabolka, ara\u0161idi, soja, le\u010da, grah, kravje mleko, jajca, govedina, konjsko meso, zajec jagnjetina, svinjina, pi\u0161\u010danec, puran, moka, sled, trska, losos, sku\u0161a, tuna, koren\u010dek, paradi\u017enik, krompir).<\/p>\n

Kompletni panel<\/strong> vklju\u010duje analizo vseh alergenov iz okolja in v hrani, tako izvle\u010dkov kot tudi molekularnih komponent.<\/p>\n

Presejalni test<\/strong> dolo\u010da samo pozitiven ali negativen rezultat na alergene iz zunanjega in notranjega okolja in\/ali alergene v hrani.
\nZa splo\u0161no obravnavo bolnikov z AD je smiselno oceniti, ali proizvajajo IgE protitelesa na alergene in, \u010de je izid pozitiven, naro\u010diti preiskave iz raz\u0161irjenega panela<\/strong>, da se podrobno navedejo alergeni iz okolja in\/ali hrane, proti katerim se proizvajajo specifi\u010dna IgE protitelesa.<\/p>\n

Poro\u010danje o rezultatih<\/h4>\n

Izvid za pakete preiskav na alergene iz okolja, alergene v hrani in kompletnih panelov vklju\u010duje povzetek ugotovljenih preob\u010dutljivosti, v nadaljevanju pa podrobnen seznam vseh izvle\u010dkov in molekularnih komponent z pripadajo\u010dimi ravnmi proizvedenih IgE protiteles, razvr\u0161\u010denih v razrede:<\/p>\n

Razred 0: <28,00 ng\/ml - Razred 1: 28,00\u201399,99 ng\/ml - Razred 2: 100,00\u2013399,99 ng\/ml - Razred 3: 400,00\u2013799,99 ng\/ml - Razred 4: \u2265 800,00 ng\/ml.\n\nUpo\u0161tevati je treba, da je raven IgE le eden od ve\u010d dejavnikov, ki dolo\u010dajo patogenost IgE. Drugi dejavnosti so na primer vrsta molekularnega alergena (mo\u010dan ali \u0161ibek). Rezultate je treba vedno povezati z klini\u010dno anamnezo obolele \u017eivali: \u010de je za dolo\u010den alergen ugotovljeni specifi\u010dni IgE (tudi \u010de je nekoliko nad ali pod 28,00 ng\/ml) skladen s klini\u010dnimi znaki, je \u017eival kandidat za imunoterapijo.\n\nIzvid vklju\u010duje tudi informacije o vrsti in pri\u010dakovani sezonski naravi izvle\u010dka, o stanju molekularne komponente pri ljudeh in \u017eivalih ter o dokazanih in pri\u010dakovanih navzkri\u017enih reakcijah. Na koncu so podane indikacije in priporo\u010dila za specifi\u010dno imunoterapijo za ugotovljene alergene.\n\nStrokovnjaki laboratorija Mylav so vam na voljo za dodatne informacije in pojasnila glede posameznih klini\u010dnih primerov.\n\n\n\n

\n
Literatura:<\/h5>\n
    \n
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    Dr. Roberta Sartori, DVM, Dip. ECVD, Strokovnjak MyLav v Klini\u010dnoj Dermatologiji in Alergologiji<\/i><\/strong>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    Uvod Atopi\u010dni dermatitis pri psih (CAD) je ena najpogostej\u0161ih ko\u017enih bolezni pri psih, saj naj […]<\/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":[806],"tags":[],"class_list":["post-24920","post","type-post","status-publish","format-standard","hentry","category-blog-sl"],"acf":[],"yoast_head":"\nMolekularni alergolo\u0161ki test, nov mejnik v alergologiji - 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\/sl\/blog-sl\/molekularni-alergoloski-test-nov-mejnik-v-alergologiji\/\" \/>\n<meta property=\"og:locale\" content=\"sl_SI\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Molekularni alergolo\u0161ki test, nov mejnik v alergologiji - 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