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Mecanismos, cofactors y factores de aumento involucrados en la anafilaxia
Mechanisms, Cofactors, and Augmenting Factors Involved in Anaphylaxis.
Muñoz-Cano R1,2, Pascal M2,3, Araujo G1,2, Goikoetxea MJ4, Valero AL1,2, Picado C1,2, Bartra J1,2.
Front Immunol. 2017 Sep 26;8:1193. doi: 10.3389/fimmu.2017.01193. eCollection 2017.
Abstract
Anaphylaxis is an acute and life-threatening systemic reaction. Many triggers have been described, including food, drug, and hymenoptera allergens, which are the most frequently involved. The mechanisms described in anaphylactic reactions are complex and implicate a diversity of pathways. Some of these mechanisms may be key to the development of the anaphylactic reaction, while others may only modify its severity. Although specific IgE, mast cells, and basophils are considered the principal players in anaphylaxis, alternative mechanisms have been proposed in non-IgE anaphylactic reactions. Neutrophils, macrophages, as well as basophils, have been involved, as have IgG-dependent, complement and contact system activation. A range of cationic substances can induce antibody-independent mast cells activation through MRGPRX2 receptor. Cofactors and augmenting factors may explain why, in some patients, food allergen exposure can cause anaphylaxis, while in other clinical scenario it can be tolerated or elicits a mild reaction. With the influence of these factors, food allergic reactions may be induced at lower doses of allergen and/or become more severe. Exercise, alcohol, estrogens, and some drugs such as Non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, β-blockers, and lipid-lowering drugs are the main factors described, though their mechanisms and signaling pathways are poorly understood.
KEYWORDS: IgE; IgG; adenosine; anaphylaxis; cofactor; exercise; mast cell; non-steroidal anti-inflammatory drug
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Rutas anafilácticas alternativas: el papel potencial de los macrófagos.
Alternative Anaphylactic Routes: The Potential Role of Macrophages.
Front Immunol. 2017 May 8;8:515. doi: 10.3389/fimmu.2017.00515. eCollection 2017.
Abstract
Anaphylaxis is an acute, life-threatening, multisystem syndrome resulting from the sudden release of mediators from effector cells. There are two potential pathways for anaphylaxis. The first one, IgE-dependent anaphylaxis, is induced by antigen (Ag) cross-linking of Ag-specific IgE bound to the high-affinity IgE receptor (FcεRI) on mast cells and basophils. The second one, IgG-dependent anaphylaxis is induced by Ag cross-linking of Ag-specific IgG bound to IgG receptors (FcγRI, FcγRIIA, FcγRIIB, FcγRIIC, and FcγRIIIA) on macrophages, neutrophils, and basophils. Macrophages exhibit a huge functional plasticity and are capable of exerting their scavenging, bactericidal, and regulatory functions under a wide variety of tissue conditions. Herein, we will review their potential role in the triggering and development of anaphylaxis. Thereby, macrophages, among other immune cells, play a role in both anaphylactic pathways (1) by responding to anaphylactic mediators secreted by mast cells after specific IgE cross-linking or (2) by acting as effector cells in the anaphylactic response mediated by IgG. In this review, we will go over the cellular and molecular mechanisms that take place in the above-mentioned anaphylactic pathways and will discuss the clinical implications in human allergic reactions.
KEYWORDS: IgE; IgG; anaphylaxis; macrophages; serotonin
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ANAFILAXIA Y REACCIONES ANAFILACTOIDES
El presente artículo es una actualización al mes de enero del 2006 del Capítulo del Dr. Carlos Lovesio, del Libro Medicina Intensiva, Dr. Carlos Lovesio, Editorial El Ateneo, Buenos Aires (2001)
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XXVII Congreso Peruano de Anestesiología
Lima, Noviembre 2-4, 2017
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