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Resultados de imunoterapia alergénio-específica sublingual em canídeos atópicos, no concelho de Oeiras : estudo piloto
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Resumo(s)
A dermatite atópica canina (DAc) é uma doença de incidência elevada e crescente na
população canina. A par da evicção alergénica, frequentemente inviável, a imunoterapia
alergénio-específica (ITAE) é o único tratamento passível de modificar o curso natural da
doença a longo prazo, mesmo após a sua suspensão. A via de administração tradicional de
ITAE é a injeção subcutânea; no entanto, a via sublingual (SLIT) tem vindo a ganhar cada
vez mais adeptos na comunidade médica devido à sua proclamada maior segurança,
praticabilidade e conforto na aplicação. O principal objetivo deste estudo retrospetivo
centrou-se na avaliação da eficácia de um protocolo inicial de 7 meses de SLIT em 22
canídeos atópicos.
Numa primeira fase procedeu-se a análise epidemiológica dos painéis alérgicos de 72
canídeos diagnosticados clinicamente com DAc e submetidos a provas alergológicas
serológicas. Destes, 16,7% resultaram num painel alérgico negativo a todos os
aeroalergénios testados. Na amostra analisada não houve predomínio de género e a raça
indeterminada e o Retriever do Labrador foram as mais prevalentes. O grupo de alergénios
mais frequentemente envolvido no processo alérgico foi o dos ácaros, nomeadamente as
espécies Dermatophagoides farinae, Acarus siro e Tyrophagus putrescentiae. Na segunda
fase, analisou-se a resposta à terapêutica em 22 canídeos atópicos submetidos a um
protocolo de 7 meses de SLIT, face a um grupo de controlo de 22 canídeos atópicos
tratados exclusivamente com medicação antialérgica sintomática. Esta análise foi feita
através de um questionário aplicado aos donos dos animais e através do grau de redução
da necessidade de medicação antialérgica concomitante para controlo dos sinais clínicos de
DAc. Obteve-se uma redução estatisticamente significativa dos níveis de prurido no grupo
de estudo face ao grupo de controlo. Ainda, 31,8% dos animais conseguiram controlar os
sinais clínicos de DAc com recurso apenas à SLIT ou, em alguns casos, combinada com
champô hipoalergénico. De forma geral, 86,4% dos animais responderam positivamente ao
tratamento com SLIT. No entanto, o período de 7 meses de tratamento foi insuficiente para
prevenir recidivas após a suspensão, pelo que o mesmo deve ser alargado.
Este estudo, apesar das suas limitações, contribui assim para o crescente volume de
bibliografia que atesta a eficácia e segurança da SLIT, constituindo uma alternativa válida
para o tratamento da DAc.
ABSTRACT - Results of a sublingual allergenic-specific immunotherapy protocol in atopic dogs in Oeiras, Portugal: a pilot study - Canine atopic dermatitis (cAD) is a disease with a high and increasing incidence in the canine population. Only allergenic avoidance, which is frequently not viable, and allergenspecific immunotherapy (ASIT) can affect the natural course of allergic diseases, even after treatment interruption. Subcutaneous injections are the traditional route of ASIT administration; however the medical community’s interest in sublingual administration (SLIT) is growing due to its high safety profile, practicability and more comfortable administration. The main purpose of this retrospective study was to evaluate the response to a 7-month SLIT protocol executed upon 22 atopic dogs. Initially (stage 1), we conducted an epidemiological analysis on the allergenic results of 72 dogs diagnosed with cAD, both clinically and through serological testing. From these, 16,7% had negative results to all allergens tested. In our sample, no sex predisposition was found, plus crossbreed dogs and Labrador retrievers were the most frequently affected out of the sample. Mites constituted the group of allergens mostly involved in the allergic pathway, specifically Dermatophagoides farinae, Acarus siro and Tyrophagus putrescentiae. In a second stage, we analyzed the treatment response of 22 atopic dogs that endured a 7- month SLIT protocol in comparison to a control group of 22 atopic dogs submitted only to an anti-allergic symptomatic drug treatment. This analysis was conducted using questionnaires presented to the dog’s owners and through the medical records, which allowed us to evaluate the need for anti-allergic medication in order to control the pruritus. We observed a significant statistical reduction in the level of pruritus in the study group, compared to the control group. Furthermore, in 31,8% of the dogs it was possible to control the clinical signs merely using SLIT or, in some cases, SLIT combined with a hypoallergenic shampoo. Overall, 86,4% of the dogs positively responded to SLIT. However, we concluded that the 7- month treatment period is not enough to prevent relapses after SLIT’s discontinuation and, therefore, the period of treatment should be longer. Despite the limitations, this study contributes to the growing body of evidence that supports the efficacy and safety of SLIT and considers it a viable alternative treatment in AD patients.
ABSTRACT - Results of a sublingual allergenic-specific immunotherapy protocol in atopic dogs in Oeiras, Portugal: a pilot study - Canine atopic dermatitis (cAD) is a disease with a high and increasing incidence in the canine population. Only allergenic avoidance, which is frequently not viable, and allergenspecific immunotherapy (ASIT) can affect the natural course of allergic diseases, even after treatment interruption. Subcutaneous injections are the traditional route of ASIT administration; however the medical community’s interest in sublingual administration (SLIT) is growing due to its high safety profile, practicability and more comfortable administration. The main purpose of this retrospective study was to evaluate the response to a 7-month SLIT protocol executed upon 22 atopic dogs. Initially (stage 1), we conducted an epidemiological analysis on the allergenic results of 72 dogs diagnosed with cAD, both clinically and through serological testing. From these, 16,7% had negative results to all allergens tested. In our sample, no sex predisposition was found, plus crossbreed dogs and Labrador retrievers were the most frequently affected out of the sample. Mites constituted the group of allergens mostly involved in the allergic pathway, specifically Dermatophagoides farinae, Acarus siro and Tyrophagus putrescentiae. In a second stage, we analyzed the treatment response of 22 atopic dogs that endured a 7- month SLIT protocol in comparison to a control group of 22 atopic dogs submitted only to an anti-allergic symptomatic drug treatment. This analysis was conducted using questionnaires presented to the dog’s owners and through the medical records, which allowed us to evaluate the need for anti-allergic medication in order to control the pruritus. We observed a significant statistical reduction in the level of pruritus in the study group, compared to the control group. Furthermore, in 31,8% of the dogs it was possible to control the clinical signs merely using SLIT or, in some cases, SLIT combined with a hypoallergenic shampoo. Overall, 86,4% of the dogs positively responded to SLIT. However, we concluded that the 7- month treatment period is not enough to prevent relapses after SLIT’s discontinuation and, therefore, the period of treatment should be longer. Despite the limitations, this study contributes to the growing body of evidence that supports the efficacy and safety of SLIT and considers it a viable alternative treatment in AD patients.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Dermatite atópica Cão Imunoterapia alergénio-específica Sublingual SLIT Atopic dermatitis Dogs Allergen-specific immunotherapy Sublingual
Contexto Educativo
Citação
Vicente, M.A.N. (2015). Resultados de imunoterapia alergénio-específica sublingual em canídeos atópicos, no concelho de Oeiras : estudo piloto. Dissertação de mestrado. Universidade de Lisboa, Faculdade de Medicina Veterinária, Lisboa.
Editora
Universidade de Lisboa. Faculdade de Medicina Veterinária