Resumen
Antecedentes: El asma es una enfermedad frecuente en el mundo y la vitamina D (Vit-D) se ha asociado con la presencia y severidad de esta enfermedad.
Objetivo: Establecer la asociación entre los niveles de Vit-D y la respuesta IgE en escolares con asma residentes de cuatro ciudades colombiananas.
Métodos: Estudio de casos y controles en 1340 escolares (687 asmáticos y 653 controles) de comunidades en extrema pobreza de Barranquilla, Cartagena, Santa Marta y Montería. Se midieron las concentraciones séricas de Vit-D, IgE total e IgE específica anti Dermatofagoides farinae, Periplaneta americana y Ascaris lumbricoides (AL).
Resultados: Los controles reportaron concentraciones mayores de Vit-D [61.9 ± 28.4 ng/mL] que los casos [53 ± 23.3 ng/mL] (p<0.05). La IgE total fue mayor en los casos (p<0.05). Solo IgE anti-AL mostró una diferencia clara: controles, densidad óptica 0.27 ± 0.25; casos 0.22 ± 0.24 (p<0.05). La Vit-D presentó diferencias entre casos y controles en cada población.
Conclusiones: No se pudo demostrar la asociación entre deficiencia de Vit-D y asma, dado que la IgE total estuvo elevada en los pacientes y en los controles. Los resultados sugieren que la Vit-D influye en la respuesta IgE específica en niños asmáticos pobres en zonas endémicas para helmintiasis.
Referencias
Dennis RJ, Caraballo L, Garcia E, Rojas MX, Rondon MA, Perez A, et al. Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study. BMC Pulm Med. 2012;12:17. doi: 10.1186/1471-2466-12-17
Dennis R, Caraballo L, Garcia E, Caballero A, Aristizabal G, Cordoba H, et al. Asthma and other allergic conditions in Colombia: a study in 6 cities. Ann Allergy Asthma Immunol. 2004;93(6):568-574. doi: 10.1016/S1081-1206(10)61265-3
Milligan KL, Matsui E, Sharma H. Asthma in urban children: epidemiology, environmental risk factors, and the public health domain. Curr Allergy Asthma Rep. 2016;16(4):33. doi: 10.1007/s11882-016-0609-6.
Martinez Aguilar NE. [Pathogenesis, trigger and risk factors in asthma]. Rev Alerg Mex. 2009;56 Suppl 1:S10-23.
Zakzuk J, Acevedo N, Cifuentes L, Bornacelly A, Sanchez J, Ahumada V, et al. Early life IgE responses in children living in the tropics: a prospective analysis. Pediatr Allergy Immunol. 2013;24(8):788-797. doi: 10.1111/pai.12161
Acevedo N, Mercado D, Vergara C, Sanchez J, Kennedy MW, Jimenez S, et al. Association between total immunoglobulin E and antibody responses to naturally acquired Ascaris lumbricoides infection and polymorphisms of immune system-related LIG4, TNFSF13B and IRS2 genes. Clin Exp Immunol. 2009;157(2):282-290. doi: 10.1111/j.1365-2249.2009.03948.x
Acevedo N, Caraballo L. IgE cross-reactivity between Ascaris lumbricoides and mite allergens: possible influences on allergic sensitization and asthma. Parasite Immunol. 2011;33(6):309-321. doi: 10.1111/j.1365-3024.2011.01288.x
Uitterlinden AG, Fang Y, Van Meurs JB, Pols HA, Van Leeuwen JP. Genetics and biology of vitamin D receptor polymorphisms. Gene. 2004;338(2):143-156. doi: 10.1016/j.gene.2004.05.014
Matheu V, Back O, Mondoc E, Issazadeh-Navikas S. Dual effects of vitamin D-induced alteration of TH1/TH2 cytokine expression: enhancing IgE production and decreasing airway eosinophilia in murine allergic airway disease. J Allergy Clin Immunol. 2003;112(3):585-592.
Vergara C, Caraballo L, Mercado D, Jimenez S, Rojas W, Rafaels N, et al. African ancestry is associated with risk of asthma and high total serum IgE in a population from the Caribbean Coast of Colombia. Human Genetics. 2009;125(5-6):565-579. doi:10.1007/s00439-009-0649-2
Acevedo N, Erler A, Briza P, Puccio F, Ferreira F, Caraballo L. Allergenicity of Ascaris lumbricoides tropomyosin and IgE sensitization among asthmatic patients in a tropical environment. Int Arch Allergy Immunol. 2011;154(3):195-206. doi:10.1159/000321106
Caraballo L, Acevedo N. New Allergens of Relevance in Tropical Regions: The Impact of Ascaris lumbricoides Infections. World Allergy Organ J. 2011;4(5):77-84. doi: 10.1097/WOX.0b013e3182167e04
Social Science Research Network. [Sitio web]. Rueda FA, Espinosa AE. ¿Los pobres de hoy serán los pobres del mañana? Determinantes de la pobreza y magnitud de la vulnerabilidad en Cartagena de Indias, Colombia. [Citado 2009 March 15]. Disponible en: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1411775
Asher M, Keil U, Anderson H, Beasley R, Crane J, Martinez F, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Res J. 1995;8(3):483-491.
Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96(1):53-58. doi: 10.1210/jc.2010-2704
Mendoza Meza DL, Garavito Lancheros G, Lozano Socarrás S, Navarro Meza J, Egea Bermejo E. Identificación de fracciones electroforéticas de unión a IgE en extractos de Ascaris sp. Revista Cubana Invest Biomed. 2013;32(2):171-177. Disponible en http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-03002013000200006
Kroegel C. Global Initiative for Asthma (GINA) guidelines: 15 years of application. Expert Rev Clin Immunol. 2009 May;5(3):239-249. doi: 10.1586/eci.09.1.
Burrows B, Martinez FD, Halonen M, Barbee RA, Cline MG. Association of asthma with serum IgE levels and skin-test reactivity to allergens. N Engl J Med. 1989;320(5):271-277. doi: 10.1056/NEJM198902023200502
Marsh DG, Bias WB, Ishizaka K. Genetic control of basal serum immunoglobulin E level and its effect on specific reaginic sensitivity. Proc Natl Acad Sci U S A. 1974;71(9):3588-3592.
Grant AV, Araujo MI, Ponte EV, Oliveira RR, Cruz AA, Barnes KC, et al. High heritability but uncertain mode of inheritance for total serum IgE level and Schistosoma mansoni infection intensity in a schistosomiasis-endemic Brazilian population. J Infect Dis. 2008 Oct 15;198(8):1227-1236. doi: 10.1086/591946.
Grundbacher FJ, Massie FS. Levels of immunoglobulin G, M, A, and E at various ages in allergic and nonallergic black and white individuals. J Allergy Clin Immunol. 1985;75(6):651-658.
de Jesus AM, Almeida RP, Bacellar O, Araujo MI, Demeure C, Bina JC, et al. Correlation between cell-mediated immunity and degree of infection in subjects living in an endemic area of schistosomiasis. Eur J Immunol. 1993;23(1):152-158. doi: 10.1002/eji.1830230125
Arruda LK, Santos AB. Immunologic responses to common antigens in helminthic infections and allergic disease. Curr Opin Allergy Clin Immunol. 2005;5(5):399-402.
Schneider M, Hilgers RH, Sennekamp J. Allergy, total IgE and eosinophils in East and West -- serious effects of different degrees of helminthiasis and smoking. Eur J Med Res. 2002;7(2):63-71.
Scrivener S, Yemaneberhan H, Zebenigus M, Tilahun D, Girma S, Ali S, et al. Independent effects of intestinal parasite infection and domestic allergen exposure on risk of wheeze in Ethiopia: a nested case-control study. Lancet. 2001;358(9292):1493-1499. doi: 10.1016/S0140-6736(01)06579-5
Dombrowicz D, Capron M. Eosinophils, allergy and parasites. Curr Opin Immunol. 2001;13(6):716-720.
Caraballo L, Puerta L, Fernandez-Caldas E, Lockey RF, Martinez B. Sensitization to mite allergens and acute asthma in a tropical environment. J Investig Allergol Clin Immunol. 1998;8(5):281-284.
Giraldo-Gomez JM, Lora F, Henao LH, Mejia S, Gomez-Marin JE. (Prevalence of giardiasis and intestinal parasites in pre-school children from homes being attended as part of a state programme in Armenia, Colombia). Rev Salud Publica (Bogota). 2005;7(3):327-338.
Alvarado BE, Vasquez LR. (Social determinants, feeding practices and nutritional consequences of intestinal parasitism in young children]. Biomedica. 2006;26(1):82-94.
Knudson A, Ariza Y, Lopez MC, Fajardo OS, Reyes P, Moncada LI, et al. (The effect of ivermectin on geohelminth frequency (i.e. as used in the onchocerciasis control program in Colombia)). Rev Salud Publica (Bogota). 2012;14(4):681-694.
Pullan RL, Smith JL, Jasrasaria R, Brooker SJ. Global numbers of infection and disease burden of soil transmitted helminth infections in 2010. Parasit Vectors. 2014;7:37. doi: 10.1186/1756-3305-7-37
Acevedo N, Sanchez J, Zakzuk J, Bornacelly A, Quiroz C, Alvarez A, et al. Particular characteristics of allergic symptoms in tropical environments: follow up to 24 months in the FRAAT birth cohort study. BMC Pulm Med. 2012;12:13. doi: 10.1186/1471-2466-12-13
van den Biggelaar AH, Rodrigues LC, van Ree R, van der Zee JS, Hoeksma-Kruize YC, Souverijn JH, et al. Long-term treatment of intestinal helminths increases mite skin-test reactivity in Gabonese schoolchildren. J Infect Dis.. 2004;189(5):892-900.doi: 10.1086/381767
Cooper PJ, Chico ME, Rodrigues LC, Ordonez M, Strachan D, Griffin GE, et al. Reduced risk of atopy among school-age children infected with geohelminth parasites in a rural area of the tropics. J Allergy Clin Immunol. 2003;111(5):995-1000.
Cooper PJ, Chico ME, Bland M, Griffin GE, Nutman TB. Allergic symptoms, atopy, and geohelminth infections in a rural area of Ecuador. Am J Respir Crit Care Med. 2003;168(3):313-317. doi: 10.1164/rccm.200211-1320OC
Marretta J, Casey FB. Effect of Ascaris suum and other adjuvants on the potentiation of the IgE response in guinea-pigs. Immunology. 1979;37(3):609-613.
Lee TD, McGibbon A. Potentiation of IgE responses to third-party antigens mediated by Ascaris suum soluble products. Int Arch Allergy Immunol. 1993;102(2):185-190.
Stromberg BE. Potentiation of the reaginic (IgE) antibody response to ovalbumin in the guinea pig with a soluble metabolic product from Ascaris suum. J Immunol. 1980;125(2):833-836.
Sales VS, Rodrigues CE, Cavalcanti GB, Trombone APF, Lima RC, Santos ABR, et al. Infection with Ascaris lumbricoides in pre-school children: Role in wheezing and IgE responses to inhalant allergens. J Allergy Clin Immunol. 2002;109(1, Suppl 1):S27. doi: http://dx.doi.org/10.1016/S0091-6749(02)81160-5
Puerta L, Fernandez-Caldas E, Mercado D, Lockey RF, Caraballo LR. Sequential determinations of Blomia tropicalis allergens in mattress and floor dust samples in a tropical city. J Allergy Clin Immunol. 1996;97(2):689-691.
Fernandez-Caldas E, Puerta L, Caraballo L, Mercado D, Lockey RF. Sequential determinations of Dermatophagoides spp. allergens in a tropical city. J Investig Allergol Clin Immunol. 1996;6(2):98-102.
Perzanowski MS, Ng’ang’a LW, Carter MC, Odhiambo J, Ngari P, Vaughan JW, et al. Atopy, asthma, and antibodies to Ascaris among rural and urban children in Kenya. J Pediatr. 2002;140(5):582-588. doi: 10.1067/mpd.2002.122937
Erwin EA, Ronmark E, Wickens K, Perzanowski MS, Barry D, Lundback B, et al. Contribution of dust mite and cat specific IgE to total IgE: relevance to asthma prevalence. J Allergy Clin Immunol. 2007;119(2):359-365. doi: 10.1016/j.jaci.2006.12.648
Miller J, Gallo RL. Vitamin D and innate immunity. Dermatol Ther. 2010;23(1):13-22. doi: 10.1016/B978-0-12-386960-9.00002-2
Hata TR, Audish D, Kotol P, Coda A, Kabigting F, Miller J, et al. A randomized controlled double-blind investigation of the effects of vitamin D dietary supplementation in subjects with atopic dermatitis. J Eur Acad Dermatol Venereol. 2014;28(6):781-789. doi: 10.1111/jdv.12176.
Dong Y, Pollock N, Stallmann-Jorgensen IS, Gutin B, Lan L, Chen TC, et al. Low 25-hydroxyvitamin D levels in adolescents: race, season, adiposity, physical activity, and fitness. Pediatrics. 2010;125(6):1104-1111. doi: 10.1542/peds.2009-2055
Litonjua AA. Vitamin D deficiency as a risk factor for childhood allergic disease and asthma. Curr Opin Allergy Clinical Immunol. 2012;12(2):179-185. doi: 10.1097/ACI.0b013e3283507927
Signorello LB, Shi J, Cai Q, Zheng W, Williams SM, Long J, et al. Common variation in vitamin D pathway genes predicts circulating 25-hydroxyvitamin D Levels among African Americans. PloS one. 2011;6(12):e28623. doi: 10.1371/journal.pone.0028623
Brehm JM, Celedon JC, Soto-Quiros ME, Avila L, Hunninghake GM, Forno E, et al. Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Curr Opin Allergy Clin Immunol. 2012;12(2):179-185. doi: 10.1097/ACI.0b013e3283507927.
Freishtat RJ, Iqbal SF, Pillai DK, Klein CJ, Ryan LM, Benton AS, et al. High prevalence of vitamin D deficiency among inner-city African American youth with asthma in Washington, DC. J Pediatr. 2010;156(6):948-952. doi: 10.1016/j.jpeds.2009.12.033
Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M, Drug, et al. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122(2):398-417. doi: 10.1542/peds.2007-1894
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Derechos de autor 2016 Revista Alergia México