EL INCREMENTO DE LAS ENFERMEDADES ALÉRGICAS Y SU IMPACTO EN SALUD PÚBLICA
Palabras clave:
Alergias, sistema inmunológico, helmintos, inmunomodulación, investigación científicaResumen
Introducción
La frecuencia de las enfermedades alérgicas y otras enfermedades crónicas no infecciosas ha aumentado durante los últimos años en la mayoría de los países donde se tienen registros epidemiológicos y varias de ellas se han convertido en problemas de salud pública. Estos procesos tienen un componente inmunológico importante y para explicar su incremento se han propuesto varias hipótesis, algunas relacionadas con los cambios ambientales derivados del desarrollo económico y los avances de la medicina y salud pública y sus repercusiones sobre la maduración y la homeostasis del sistema inmunológico. Los enfoques, investigaciones, publicaciones e informes sobre este problema pueden servir de ejemplo para valorar las relaciones entre la comunidad científica y los gobiernos y en particular entre los investigadores colombianos y las entidades gubernamentales de salud pública.
Biografía del autor/a
Luis Caraballo, Universidad de Cartagena
MD, PhD, EAC. Instituto de Investigaciones Inmunológicas Universidad de Cartagena. Cartagena, Colombia
Referencias bibliográficas
1. Gupta S. Trials and tribulations. Nature. 2017; 548: S28-S31.
2. Lundback B, Backman H, Lotvall J, Ronmark E. Is asthma prevalence still increasing? Expert Rev Respir Med. 2016; 10: 39-51.
3. Platts-Mills TA. The allergy epidemics: 1870-2010. Journal Allergy Clin Immunol. 2015; 136: 3-13.
4. Caraballo L, Zakzuk J, Lee BW, Acevedo N, Soh JY, et al. Particularities of allergy in the Tropics. World Allergy Organ J. 2016; 9: 20.
5. Dennis R, Caraballo L, Garcia E, Caballero A, Aristizabal G, et al. Asthma and other allergic conditions in Colombia: a study in 6 cities. Ann Allergy Asthma Immunol. 2004; 93: 568-574.
6. Dennis RJ, Caraballo L, Garcia E, Rojas MX, Rondon MA, et al. (2012) Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study. BMC Pulm Med 12: 17.
7. Strachan DP (1989) Hay fever, hygiene, and household size. BMJ 299: 1259-1260.
8. Bach JF (2002) The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med 347: 911-920.
9. Rook GA, Martinelli R, Brunet LR (2003) Innate immune responses to mycobacteria and the downregulation of atopic responses. Curr Opin Allergy Clin Immunol 3: 337-342.
10. Rook G, Backhed F, Levin BR, McFall-Ngai MJ, McLean AR (2017) Evolution, human-microbe interactions, and life history plasticity. Lancet 390: 521-530.
11. Haahtela T, Holgate S, Pawankar R, Akdis CA, Benjaponpitak S, et al. The biodiversity hypothesis and allergic disease: world allergy organization position statement. World Allergy Organ J. 2013; 6: 3.
12. Gerrard JW, Geddes CA, Reggin PL, Gerrard CD, Horne S. Serum IgE levels in white and metis communities in Saskatchewan. Ann Allergy. 1976; 37: 91-100.
13. Hotez PJ, Wilkins PP. Toxocariasis: America's most common neglected infection of poverty and a helminthiasis of global importance? PLoS Negl Trop Dis. 2009; 3: e400.
14. Caraballo L. Ascaris and Allergy. In: Holland CV, editor. Ascaris: the neglected parasite: Elsevier. 2013; 21-50.
15. Caraballo L. Los diversos efectos de las helmintiasis sobre la inflamación alérgica. Rev Acad Colomb Cienc Ex Fis Nat. 2016; 40: 200-2008.
16. Cooper PaFC. Immunology of Ascaris and immunomodulation. In: Holland CV, editor. Ascaris the neglected parasite. London: Elsevier. 2013; 3-19.
17. Caraballo L AN, Buendía E. Human Ascariasis Increases the Allergic Response and Allergic Symptoms. Curr Trop Med Rep. 2015; 2: 224–232.
18. Alcantara-Neves NM, Veiga RV, Dattoli VC, Fiaccone RL, Esquivel R, et al. The effect of single and multiple infections on atopy and wheezing in children. J Allergy Clin Immunol. 2012; 129: 359-367, 367 e351-353.
19. Elliott DE, Weinstock JV. Nematodes and human therapeutic trials for inflammatory disease. Parasite Immunol 39. 2017.
20. Smallwood TB, Giacomin PR, Loukas A, Mulvenna JP, Clark RJ, et al. Helminth Immunomodulation in Autoimmune Disease. Front Immunol. 2017; 8: 453.
21. Evans H, Mitre E. Worms as therapeutic agents for allergy and asthma: understanding why benefits in animal studies have not translated into clinical success. J Allergy Clin Immunol. 2015; 135: 343-353.
22. Briggs N, Weatherhead J, Sastry KJ, Hotez PJ. The Hygiene Hypothesis and Its Inconvenient Truths about Helminth Infections. PLoS Negl Trop Dis 10: e0004944.
23. Maizels RM, Pearce EJ, Artis D, Yazdanbakhsh M, Wynn TA (2009) Regulation of pathogenesis and immunity in helminth infections. J Exp Med. 2016; 206: 2059-2066.
24. McSorley HJ, Hewitson JP, Maizels RM. Immunomodulation by helminth parasites: defining mechanisms and mediators. Int J Parasitol. 2013; 43: 301-310.
25. Weinstock JV, Elliott DE. Helminth infections decrease host susceptibility to immune-mediated diseases. J Immunol. 2014; 193: 3239-3247.
26. Steinfelder S, O'Regan NL, Hartmann S. Diplomatic Assistance: Can Helminth-Modulated Macrophages Act as Treatment for Inflammatory Disease? PLoS Pathog. 2016, 12: e1005480.
27. Lambrecht BN, Hammad H. The immunology of the allergy epidemic and the hygiene hypothesis. Nat Immunol; 2017; 18: 1076-1083.
28. Wammes LJ, Mpairwe H, Elliott AM, Yazdanbakhsh M. Helminth therapy or elimination: epidemiological, immunological, and clinical considerations. Lancet Infect Dis. 2014; 14: 1150-1162.
29. Salgame P, Yap GS, Gause WC. Effect of helminth-induced immunity on infections with microbial pathogens. Nat Immunol. 2013; 14: 1118-1126.
30. Urban JF, Jr., Steenhard NR, Solano-Aguilar GI, Dawson HD, Iweala OI, et al. Infection with parasitic nematodes confounds vaccination efficacy. Vet Parasitol. 2007; 148: 14-20.
31. Hunninghake GM, Soto-Quiros ME, Avila L, Ly NP, Liang C, et al. Sensitization to Ascaris lumbricoides and severity of childhood asthma in Costa Rica. J Allergy Clin Immunol. 2007; 119: 654-661.
32. Buendía E. The IgE respons e to Ascaris molecular components is associated with clinical indicat rs of asthma severity. WAO Journal. 2015; 8: 8.
33. Ahumada V, Garcia E, Dennis R, Rojas MX, Rondon MA, et al. IgE responses to Ascaris and mite tropomyosins are risk factors for asthma. Clin Exp Allergy. 2015; 45: 1189-1200.
34. Jex AR, Liu S, Li B, Young ND, Hall RS, et al. Ascaris suum draft genome. Nature. 2011; 479: 529-533.
35. Titz TO, de Araujo CAA, Enobe CS, Rigato PO, Oshiro TM, et al. Ascaris suum infection modulates inflammation: Implication of CD4(+) CD25(high) Foxp3(+) T cells and IL-10. Parasite Immunol 39. 2017.
36. Oshiro TM, Macedo MS, Macedo-Soares MF. Anti-inflammatory activity of PAS-1, a protein component of Ascaris suum. Inflamm Res. 2005; 54: 17-21.
37. Araujo CA, Perini A, Martins MA, Macedo MS, Macedo-Soares MF. PAS-1, a protein from Ascaris suum, modulates allergic inflammation via IL-10 and IFN-gamma, but not IL-12. Cytokine. 2008; 44: 335-341.
38. de Araujo CA, Perini A, Martins MA, Macedo MS, Macedo-Soares MF. PAS-1, an Ascaris suum protein, modulates allergic airway inflammation via CD8+gammadeltaTCR+ and CD4+CD25+FoxP3+ T cells. Scand J Immunol. 2010; 72: 491-503.
39. Antunes MF, Titz TO, Batista IF, Marques-Porto R, Oliveira CF, et al. Immunosuppressive PAS-1 is an excretory/ secretory protein released by larval and adult worms of the ascarid nematode Ascaris suum. J Helminthol. 2015; 89: 367-374.
40. Coronado S, Barrios L, Zakzuk J, Regino R, Ahumada V, et al. A recombinant cystatin from Ascaris lumbricoides attenuates inflammation of DSS-induced colitis. Parasite Immunol 39. 2017.
41. Schuijs MJ, Hartmann S, Selkirk ME, Roberts LB, Openshaw PJ, et al. The Helminth-Derived Immunomodulator AvCystatin Reduces Virus Enhanced Inflammation by Induction of Regulatory IL-10+ T Cells. PLoS One. 2016; 11: e0161885.
42. Venugopal G, Mueller M, Hartmann S, Steinfelder S. Differential immunomodulation in human monocytes versus macrophages by filarial cystatin. PLoS One. 2017; 12: e0188138.
43. Coronado S, Zakzuk J, Regino R, Ahumada V, Benedetti I, et al. Cystatin from the nematode ascaris lumbricoides reduces inflammation in a mouse model of allergic asthma. Allergy. 2017; 72: 386-387.
44. Coronado S MM, Zakzuk J, Caraballo L. Ascaris lumbricoides cystatin induces specific IgE but not allergic response. Front Immunol. 2015. DOI: 10.3389/conf.fimmu.2015.05.00295.
45. Rook GA. 99th Dahlem conference on infection, inflammation and chronic inflammatory disorders: darwinian medicine and the 'hygiene' or 'old friends' hypothesis. Clin Exp Immunol. 2010; 160: 70-79.
46. Zakzuk J, Casadiedo S, Mercado A, Alvis-Guzman N, Caraballo L. Ascaris lumbricoides induces, both, reduction and increase of asthma symptoms in a rural community. ALLERGY. 2017; 72: 494-495.
47. Agudelo-López S ea. Prevalencia de Parasitosis Intestinales y Factores Asociados en un Corregimiento de la Costa Atlántica Colombiana. Rev Salud Publica. 2008; 10: 633-642.
2. Lundback B, Backman H, Lotvall J, Ronmark E. Is asthma prevalence still increasing? Expert Rev Respir Med. 2016; 10: 39-51.
3. Platts-Mills TA. The allergy epidemics: 1870-2010. Journal Allergy Clin Immunol. 2015; 136: 3-13.
4. Caraballo L, Zakzuk J, Lee BW, Acevedo N, Soh JY, et al. Particularities of allergy in the Tropics. World Allergy Organ J. 2016; 9: 20.
5. Dennis R, Caraballo L, Garcia E, Caballero A, Aristizabal G, et al. Asthma and other allergic conditions in Colombia: a study in 6 cities. Ann Allergy Asthma Immunol. 2004; 93: 568-574.
6. Dennis RJ, Caraballo L, Garcia E, Rojas MX, Rondon MA, et al. (2012) Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study. BMC Pulm Med 12: 17.
7. Strachan DP (1989) Hay fever, hygiene, and household size. BMJ 299: 1259-1260.
8. Bach JF (2002) The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med 347: 911-920.
9. Rook GA, Martinelli R, Brunet LR (2003) Innate immune responses to mycobacteria and the downregulation of atopic responses. Curr Opin Allergy Clin Immunol 3: 337-342.
10. Rook G, Backhed F, Levin BR, McFall-Ngai MJ, McLean AR (2017) Evolution, human-microbe interactions, and life history plasticity. Lancet 390: 521-530.
11. Haahtela T, Holgate S, Pawankar R, Akdis CA, Benjaponpitak S, et al. The biodiversity hypothesis and allergic disease: world allergy organization position statement. World Allergy Organ J. 2013; 6: 3.
12. Gerrard JW, Geddes CA, Reggin PL, Gerrard CD, Horne S. Serum IgE levels in white and metis communities in Saskatchewan. Ann Allergy. 1976; 37: 91-100.
13. Hotez PJ, Wilkins PP. Toxocariasis: America's most common neglected infection of poverty and a helminthiasis of global importance? PLoS Negl Trop Dis. 2009; 3: e400.
14. Caraballo L. Ascaris and Allergy. In: Holland CV, editor. Ascaris: the neglected parasite: Elsevier. 2013; 21-50.
15. Caraballo L. Los diversos efectos de las helmintiasis sobre la inflamación alérgica. Rev Acad Colomb Cienc Ex Fis Nat. 2016; 40: 200-2008.
16. Cooper PaFC. Immunology of Ascaris and immunomodulation. In: Holland CV, editor. Ascaris the neglected parasite. London: Elsevier. 2013; 3-19.
17. Caraballo L AN, Buendía E. Human Ascariasis Increases the Allergic Response and Allergic Symptoms. Curr Trop Med Rep. 2015; 2: 224–232.
18. Alcantara-Neves NM, Veiga RV, Dattoli VC, Fiaccone RL, Esquivel R, et al. The effect of single and multiple infections on atopy and wheezing in children. J Allergy Clin Immunol. 2012; 129: 359-367, 367 e351-353.
19. Elliott DE, Weinstock JV. Nematodes and human therapeutic trials for inflammatory disease. Parasite Immunol 39. 2017.
20. Smallwood TB, Giacomin PR, Loukas A, Mulvenna JP, Clark RJ, et al. Helminth Immunomodulation in Autoimmune Disease. Front Immunol. 2017; 8: 453.
21. Evans H, Mitre E. Worms as therapeutic agents for allergy and asthma: understanding why benefits in animal studies have not translated into clinical success. J Allergy Clin Immunol. 2015; 135: 343-353.
22. Briggs N, Weatherhead J, Sastry KJ, Hotez PJ. The Hygiene Hypothesis and Its Inconvenient Truths about Helminth Infections. PLoS Negl Trop Dis 10: e0004944.
23. Maizels RM, Pearce EJ, Artis D, Yazdanbakhsh M, Wynn TA (2009) Regulation of pathogenesis and immunity in helminth infections. J Exp Med. 2016; 206: 2059-2066.
24. McSorley HJ, Hewitson JP, Maizels RM. Immunomodulation by helminth parasites: defining mechanisms and mediators. Int J Parasitol. 2013; 43: 301-310.
25. Weinstock JV, Elliott DE. Helminth infections decrease host susceptibility to immune-mediated diseases. J Immunol. 2014; 193: 3239-3247.
26. Steinfelder S, O'Regan NL, Hartmann S. Diplomatic Assistance: Can Helminth-Modulated Macrophages Act as Treatment for Inflammatory Disease? PLoS Pathog. 2016, 12: e1005480.
27. Lambrecht BN, Hammad H. The immunology of the allergy epidemic and the hygiene hypothesis. Nat Immunol; 2017; 18: 1076-1083.
28. Wammes LJ, Mpairwe H, Elliott AM, Yazdanbakhsh M. Helminth therapy or elimination: epidemiological, immunological, and clinical considerations. Lancet Infect Dis. 2014; 14: 1150-1162.
29. Salgame P, Yap GS, Gause WC. Effect of helminth-induced immunity on infections with microbial pathogens. Nat Immunol. 2013; 14: 1118-1126.
30. Urban JF, Jr., Steenhard NR, Solano-Aguilar GI, Dawson HD, Iweala OI, et al. Infection with parasitic nematodes confounds vaccination efficacy. Vet Parasitol. 2007; 148: 14-20.
31. Hunninghake GM, Soto-Quiros ME, Avila L, Ly NP, Liang C, et al. Sensitization to Ascaris lumbricoides and severity of childhood asthma in Costa Rica. J Allergy Clin Immunol. 2007; 119: 654-661.
32. Buendía E. The IgE respons e to Ascaris molecular components is associated with clinical indicat rs of asthma severity. WAO Journal. 2015; 8: 8.
33. Ahumada V, Garcia E, Dennis R, Rojas MX, Rondon MA, et al. IgE responses to Ascaris and mite tropomyosins are risk factors for asthma. Clin Exp Allergy. 2015; 45: 1189-1200.
34. Jex AR, Liu S, Li B, Young ND, Hall RS, et al. Ascaris suum draft genome. Nature. 2011; 479: 529-533.
35. Titz TO, de Araujo CAA, Enobe CS, Rigato PO, Oshiro TM, et al. Ascaris suum infection modulates inflammation: Implication of CD4(+) CD25(high) Foxp3(+) T cells and IL-10. Parasite Immunol 39. 2017.
36. Oshiro TM, Macedo MS, Macedo-Soares MF. Anti-inflammatory activity of PAS-1, a protein component of Ascaris suum. Inflamm Res. 2005; 54: 17-21.
37. Araujo CA, Perini A, Martins MA, Macedo MS, Macedo-Soares MF. PAS-1, a protein from Ascaris suum, modulates allergic inflammation via IL-10 and IFN-gamma, but not IL-12. Cytokine. 2008; 44: 335-341.
38. de Araujo CA, Perini A, Martins MA, Macedo MS, Macedo-Soares MF. PAS-1, an Ascaris suum protein, modulates allergic airway inflammation via CD8+gammadeltaTCR+ and CD4+CD25+FoxP3+ T cells. Scand J Immunol. 2010; 72: 491-503.
39. Antunes MF, Titz TO, Batista IF, Marques-Porto R, Oliveira CF, et al. Immunosuppressive PAS-1 is an excretory/ secretory protein released by larval and adult worms of the ascarid nematode Ascaris suum. J Helminthol. 2015; 89: 367-374.
40. Coronado S, Barrios L, Zakzuk J, Regino R, Ahumada V, et al. A recombinant cystatin from Ascaris lumbricoides attenuates inflammation of DSS-induced colitis. Parasite Immunol 39. 2017.
41. Schuijs MJ, Hartmann S, Selkirk ME, Roberts LB, Openshaw PJ, et al. The Helminth-Derived Immunomodulator AvCystatin Reduces Virus Enhanced Inflammation by Induction of Regulatory IL-10+ T Cells. PLoS One. 2016; 11: e0161885.
42. Venugopal G, Mueller M, Hartmann S, Steinfelder S. Differential immunomodulation in human monocytes versus macrophages by filarial cystatin. PLoS One. 2017; 12: e0188138.
43. Coronado S, Zakzuk J, Regino R, Ahumada V, Benedetti I, et al. Cystatin from the nematode ascaris lumbricoides reduces inflammation in a mouse model of allergic asthma. Allergy. 2017; 72: 386-387.
44. Coronado S MM, Zakzuk J, Caraballo L. Ascaris lumbricoides cystatin induces specific IgE but not allergic response. Front Immunol. 2015. DOI: 10.3389/conf.fimmu.2015.05.00295.
45. Rook GA. 99th Dahlem conference on infection, inflammation and chronic inflammatory disorders: darwinian medicine and the 'hygiene' or 'old friends' hypothesis. Clin Exp Immunol. 2010; 160: 70-79.
46. Zakzuk J, Casadiedo S, Mercado A, Alvis-Guzman N, Caraballo L. Ascaris lumbricoides induces, both, reduction and increase of asthma symptoms in a rural community. ALLERGY. 2017; 72: 494-495.
47. Agudelo-López S ea. Prevalencia de Parasitosis Intestinales y Factores Asociados en un Corregimiento de la Costa Atlántica Colombiana. Rev Salud Publica. 2008; 10: 633-642.
Cómo citar
[1]
Caraballo, L. 2018. EL INCREMENTO DE LAS ENFERMEDADES ALÉRGICAS Y SU IMPACTO EN SALUD PÚBLICA. Medicina. 40, 1 (feb. 2018), 25–30.
Descargas
Los datos de descargas todavía no están disponibles.
Publicado
2018-02-12
Número
Sección
Artículos de Reflexión
Licencia
Copyright
ANM de Colombia
Los autores deben declarar revisión, validación y aprobación para publicación del manuscrito, además de la cesión de los derechos patrimoniales de publicación, mediante un documento que debe ser enviado antes de la aparición del escrito. Puede solicitar el formato a través del correo revistamedicina@anmdecolombia.org.co o descargarlo directamente Documento Garantías y cesión de derechos.docx
Copyright
ANM de Colombia
Authors must state that they reviewed, validated and approved the manuscript's publication. Moreover, they must sign a model release that should be sent.
