Palabras clave
Mecanismos inmunológicos
Alergia mediada por IgE
Alergia no mediada por IgE
Células T
Microbioma
Dermatitis atópica
Esofagitis eosinofílica
Resumen
La alergia alimentaria es una reacción adversa a ciertos los alimentos que han demostrado "mecanismos inmunológicos”; por lo tanto, este término abarca tanto las alergias alimentarias mediadas o no por la inmunoglobulina E (IgE). El mecanismo fisiopatológico común entre las formas de alergia a alimentos mediadas o no por IgE se encuentra en la falla de la tolerancia clínica e inmunológica hacia ese alimento. La inducción y el mantenimiento de la tolerancia inmunológica depende de la generación activa de células T reguladoras específicas para antígenos alimentarios. Este proceso está influenciado por factores genéticos (genes FOXP3) y epigenéticos condicionados por el medio ambiente (dieta, microbiota y sus productos). Puesto que el microbioma intestinal normalmente puede promover la tolerancia oral, la evidencia actual sugiere que las perturbaciones del microbioma pueden correlacionarse, o incluso predisponer, con la alergia alimentaria. Comprender el mecanismo patógeno subyacente a las alergias alimentarias mediadas por IgE permite implementar las medidas destinadas a restaurar la tolerancia clínica e inmunológica. El conocimiento de los mecanismos de la alergia alimentaria mejorará la perspectiva de los pacientes con alergias alimentarias inmediatas más graves y la anafilaxia, además de quienes tienes tienen enfermedades concomitantes (dermatitis atópica, esofagitis eosinofílica y los EGEID).
Referencias
Muraro A, Werfel T, et al. Pautas de alergia alimentaria y anafilaxia de la EAACI: diagnóstico y manejo de la alergia alimentaria. Alergia 2014; 69 (8): 1008-25. doi: 10.1111/all.12429. Epub 2014.
Macías-Iglesias EM. Alergia a alimentos. Pediatra Integral 2018; 22 (2): 87-93.
Ortega-Martell JA, Huerta-Hernandez RE. Diagnosis of food allergy. Pediatr Allergy Asthma Immunol 2020; 29 (1): 31-36.
Tordesillas L, Berin MC, Sampson HA. Immunology of Food Allergy. Immunity 2017; 18; 47 (1): 32-50. doi: 10.1016/j.immuni.2017.07.004.
Pimentel-Hayashi JA, Del Río-Navarro BE, Saucedo-Ramírez OJ. Food allergy, key points for clinical practice. Rev Alerg Mex 2020; 67 (3): 245-267.
Devdas JM, Mckie C, Fox AT, et al. Food Allergy in Children: An Overview. Indian J Pediatr 2018; 85 (5): 369-74. doi: 10.1007/s12098-017-2535-6.
Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol 2018; 141 (1): 41-58. doi: 10.1016/j.jaci.2017.11.003.
Barni S, Liccioli G, Sarti L, Giovannini M, et al. Immunoglobulin E (IgE)-Mediated Food Allergy in Children: Epidemiology, Pathogenesis, Diagnosis, Prevention, and Management. Medicina (Kaunas) 2020; 56 (3): 111. doi: 10.3390/medicina56030111.
Sheng J, Chen W, Zhu HJ. The immune suppressive function of transforming growth factor-β (TGF-β) in human diseases. Growth Fact 2015; 33 (2): 92-101. doi: 10.3109/08977194.2015.1010645.
Chinthrajah RS, Hernandez JD, Boyd SD, et al. Molecular and cellular mechanisms of food allergy and food tolerance. J Allergy Clin Immunol 2016; 137 (4): 984-97. doi: 10.1016/j.jaci.2016.02.004.
Muraro A, Lemanske RF, Castells M, Torres MJ, et al. Precision medicine in allergic disease-food allergy, drug allergy, and anaphylaxis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology. Allergy 2017; 72 (7): 1006-1021. doi: 10.1111/all.13132.
Caldwell JM, Paul M. Rothenberg ME. New immunologic mechanisms in eosinophilic esophagitis. Curr Opin Immunol 2017; 48: 114-121.
Fiocchi A, Risso D, et al. Food labeling issues for severe food allergic patients. World Allergy Organ J 2021; 14 (10): 100598. doi: 10.1016/j.waojou.2021.100598.
Fenotipo y endotipo
Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol 2011; 127 (3): 594-602. doi: 10.1016/j.jaci.2010.11.044.
Baker MG, Sampson HA. Phenotypes and endotypes of food allergy: A path to better understanding the pathogenesis and prognosis of food allergy. Ann Allergy Asthma 2018; 120 (3): 245-253. doi: 10.1016/j.anai.2018.01.027.
Deschildren A, Lejeune S, Cap M, Flammarion S, et al. Food allergy phenotypes: The key to personalized therapy. Clin Exp Allergy 2017; 47 (9): 1125-1137. doi: 10.1111/cea.12984.
Baker MG, Sampson HA. Phenotypes and endotypes of food allergy: A path to better understanding the pathogenesis and prognosis of food allergy. Ann Allergy Asthma Immunol 2018; 120 (3): 245-253. doi: 10.1016/j.anai.2018.01.027.
Savage J, Sicherer S. The natural history of allergy. J Allergy Clin Immunol 2016; 4: 196-203.
Sampson HA. Food allergy. Part 1: Immunopathogenesis and clinical disorders. J Allergy Clin Immunol 1999: 5; 717-728.
Leonard MD, Caubet JC, et al. Baked Milk and Egg Containing Diet in the Management of Milk and Egg Allergy. J Allergy Clin Immunol 2011; 128: 125-131.
Cox AL, Eigenmann PA. Clinical Relevance of Cross-Reactivity in Food Allergy. J Allergy Clin Immunol Pract 2021; 9 (1): 82-99. doi: 10.1016/j.jaip.2020.09.030.
Barni S, Caimmi C, et al. Phenotypes and Endotypes of Peach Allergy: What Is New? Nutrients 2022; 14: 998. https://doi.org/10.3390/nu14050998
Chung C, Mirakhur B, et al. Cetuximab-Induced Anaphylaxis and IgE Specific for Galactosa-a-1,3-Galactosa. N Eng J Medi 2008; 358: 1109-1117.
Anamnesis y examen físico
Mayorga C, Palomares F, et al. New Insights in Therapy for Food Allergy. Foods 2021; 10; 10 (5): 1037. doi: 10.3390/foods10051037.
Chinthrajah RS, Tupa D, et al Diagnosis of Food Allergy. Pediatr Clin North Am 2015; 62 (6): 1393-408. doi: 10.1016/j.pcl.2015.07.009.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee on Food Allergies: Global Burden, Causes, Treatment, Prevention, and Public Policy. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Oria MP, Stallings VA, editors. Washington (DC): National Academies Press (US); 2016 Nov 30.
Sicherer SH, Wood RA; American Academy of Pediatrics Section On Allergy And Immunology. Allergy testing in childhood: using allergen-specific IgE tests. Pediatrics 2012; 129 (1): 193-7. doi: 10.1542/peds.2011-2382.
Sicherer SH, Allen K, et al. Critical Issues in Food Allergy: A National Academies Consensus Report. Pediatrics 2017; 140 (2): e20170194. doi: 10.1542/peds.2017-0194.
Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol 2018; 141 (1): 41-58. doi: 10.1016/j.jaci.2017.11.003.
Gargano D, Appanna R, et al P. Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns. Nutrients 2021; 13 (5): 1638. doi: 10.3390/nu13051638.
Yu W, Freeland DMH, et al. Food allergy: immune mechanisms, diagnosis and immunotherapy. Nat Rev Immunol 2016; 16 (12): 751-765. doi: 10.1038/nri.2016.111.
Microbiota en Alergia Alimentaria Prebióticos, probióticos y simbióticos
Sicherer SH, Sampson HA. Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol 2014; 133: 291-307.
Chinthrajah RS, Hernandez JD, et al. Molecular and cellular mechanisms of food allergy and food tolerance. J Allergy Clin Immunol 2016; 137 (4): 984-997.
Lambrecht BN, Hammad H. The immunology of the allergy epidemic and the hygiene hypothesis. Nat Immunol 2017; 18 (10): 1076-1083. doi: 10.1038/ni.3829.
Strachan DP. Hay fever, hygiene, and household size. BMJ 1989; 299: 1259-60.
Robertson RC, Manges AR, Finlay BB, Prendergast AJ. The Human Microbiome and Child Growth - First 1000 Days and Beyond. Trends Microbiol 2019; 27 (2): 131-147. doi: 10.1016/j.tim.2018.09.008.
Stephen-Victor E, Chatila TA. Regulation of oral immune tolerance by the microbiome in food allergy. Curr Opin Immunol 2019; 60: 141-147. doi: 10.1016/j.coi.2019.06.001.
Robertson RC, Manges AR, et al.The Human Microbiome and Child Growth - First 1000 Days and Beyond. Trends Microbiol 2019; 27: 131-47.
Ganal-Vonarburg SC, Hornef MW, et al. Microbial-host molecular exchange and its functional consequences in early mammalian life. Science 2020; 368: 604-7.
Pannaraj PS, Li F, et al. Association Between Breast Milk Bacterial Communities and Establishment and Development of the Infant Gut Microbiome. JAMA Pediatr 2017; 171: 647-54.
Knoop KA, Gustafsson JK, et al. Microbial antigen encounter during a preweaning interval is critical for tolerance to gut bacteria. Sci Immunol 2017; 2 (18): eaao1314. doi: 10.1126/sciimmunol.aao1314.
Atarashi K, Tanoue T, et al. Induction of colonic regulatory T cells by indigenous Clostridium species. Science 2011, 331: 337-341.
Feehley T, Plunkett CH, et al. Healthy infants harbor intestinal bacteria that protect against food allergy. Nat Med 2019, 25: 448-453.
Al Nabhani Z, Dulauroy S, et al. Reaction to Microbiota Is Required for Resistance to Immunopathologies in the Adult. Immunity 2019; 50: 1276-88 e5.
Ramanan D, Sefik E, et al. An Immunologic Mode of Multigenerational Transmission Governs a Gut Treg Setpoint. Cell 2020; 181: 1276-90 e13.
Verma R, Lee C, et al. Cell surface polysaccharides of Bifidobacterium bifidum induce the generation of Foxp3(+) regulatory T cells. Sci Immunol 2018; 3 (28): eaat6975. doi: 10.1126/sciimmunol.aat6975.
Ohnmacht C, Park JH, et al. MUCOSAL IMMUNOLOGY. The microbiota regulates type 2 immunity through RORgammat(+) T cells. Science 2015; 349: 989-93.
Turner JA, Stephen-Victor E, Wang S, et al. Regulatory T Cell-Derived TGF-beta1 Controls Multiple Checkpoints Governing Allergy and Autoimmunity. Immunity 2020; 5; 53 (6): 1202-1214.e6. doi: 10.1016/j.immuni.2020.10.002.
Stefka AT, Feehley T, et al. Commensal bacteria protect against food allergen sensitization. Proc Natl Acad Sci USA 2014; 111: 13145-50.
Keir M, Yi Y, Lu T, et al. The role of IL-22 in intestinal health and disease. J Exp Med 2020; 217: e20192195.
Zhou L, Chu C, et al. Innate lymphoid cells support regulatory T cells in the intestine through interleukin-2. Nature 2019: 568(7752):405-409. doi: 10.1038/s41586-019-1082-x. Epub 2019 Apr 3.
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Derechos de autor 2023 Revista Alergia México