Síndromes imunológicas e alérgicas induzidas ou exacerbadas por exercício: o que o profissional de saúde do exercício precisa saber sobre doenças imunoalérgicas e esporte?
DOI:
https://doi.org/10.33233/rbfex.v20i3.4562Resumo
As doenças imunoalérgicas induzidas ou exacerbadas pelo exercício são situações significativamente importantes tanto para atletas amadores quanto profissionais. Asma, broncoespasmo, laringoespasmo e anafilaxia induzidos pelo exercício, urticárias induzidas e angioedema hereditário são exemplos destas situações. O objetivo deste artigo é contribuir para o conhecimento de profissionais de saúde com orientação ao manejo de distúrbios de hipersensibilidade induzidos por exercícios ou desencadeados durante a prática esportiva, para permitir que seus pacientes realizem, com segurança, as atividades relacionadas ao exercício.
Referências
Parsons JP, Hallstrand TS, Mastronarde JG, Kaminsky DA, Rundell KW, Hull JH, et al. An official American thoracic society clinical practice guideline: Exercise-induced bronchoconstriction. Am J Respir Crit Care Med 2013;187(9):1016-27. https://doi.org/10.1164/rccm.201303-0437ST
Kippelen P, Anderson S. Pathogenesis of exercise induced bronchoconstriction. Immunol Allergy Clin N Am 2013;33:299 312. https://doi.org/10.1016/j.iac.2013.02.002
Langdeau JB, Turcotte H, Bowie DM, Jobin J, Desgagné P, Boulet LP. Airway hyperresponsiveness in elite athletes. Am J Respir Crit Care Med 2000;161:1479-84. https://doi.org/ 10.1164/ajrccm.161.5.9909008
Correia MA Jr, Rizzo JA, Sarinho SW, Cavalcanti Sarinho ES, Medeiros D, Assis F. Effect of exercise-induced bronchospasm and parental beliefs on physical activity of asthmatic adolescents from a tropical region. Ann Allergy Asthma Immunol 2012;108(4):249-53. https://doi.org/10.1016/j.anai.2012.01.016
Sano F, Solé D, Naspitz CK. Prevalence and characteristics of exercise induced asthma in children. Pediatr Allerg Pediatr Allergy Immunol 1998;9(4):181-5. https://doi.org/10.1111/j.1399-3038.1998.tb00370.x
Weiler JM, Anderson SD, Randolph C, Bonini S, Craig TJ, Pearlman DS, et al. Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter. Ann Allergy Asthma Immunol 2010;105:Suppl:S1-S47. https://doi.org/10.1016/j.anai.2010.09.021
Fitch KD, Sue-Chu M, Anderson SD, Boulet S, Hancox RJ, McKenzie D, et al. Asthma and the elite athlete: summary of the International Olympic Committee’s consensus conference, Lausanne, Switzerland, January 22-24, 2008. J Allergy Clin Immunol 2008;122:254-60. https://doi.org/10.1016/j.jaci.2008.07.003
Bonsignore MR, Morici G, Vignola AM, Riccobono L, Bonanno a., Profita M, et al. Increased airway inflammatory cells in endurance athletes: What do they mean? Clin Exp Allergy 2003;33(1):14-21. https://doi.org/10.1046/j.1365-2222.2003.01557.x
Anderson SD, Kippelen P. Exercise induced bronchoconstriction: pathogenesis. Curr Allergy Asthma Rep 2005;5:116-22. https://doi.org/10.31189/2165-6193-5.3.37
Helenius I, Haahtela T. Allergy and asthma in elite summer sport athletes. J Allergy Clin Immunol 2000;106(3):444-52. https//doi.org/ 10.1067/mai.2000.107749
Pedersen BK, Ullum H. NK cell response to physical activity: possible mechanisms of action. Med Sci Sports Exerc 1994;26(2):140-6. https://doi.org/10.1249/00005768-199402000-00003
Walsh NP, Gleeson M, Shephard RJ, Woods JA, Bishop NC, Fleshner M, et al. Position statement. Part one: Immune function and exercise. Exerc Immunol Rev 2011;17:6-63
Azizi GG, Orsini M, Dortas Júnior SD, Vieira PC, Carvalho RS, Pires CSR, et al. COVID-19 e atividade física: qual a relação entre a imunologia do exercício e a atual pandemia? Rev Bras Fisiol Exerc 2020;19(2supl):S20-S29. https://doi.org/10.33233/rbfe.v19i2.4115
Dickinson J, McConnell A, Whyte G. Diagnosis of exercise-induced bronchoconstriction: eucapnic voluntary hyperpnoea challenges identify previously undiagnosed elite athletes with exercise-induced bronchoconstriction. Br J Sports Med 2010;45(14):1126-31. https://doi.org/10.1136/bjsm.2010.072520
Subbarao P, Duong M, Adelroth E, Inman M, Pedersen S, O’Byrne PM, et al. Effect of ciclesonide dose and duration of therapy on exercise-induced bronchoconstriction in patients with asthma. J Allergy Clin Immunol 2006;117:1008-13. https://doi.org/10.1016/j.jaci.2005.11.048
Fitch KD, Morton AR. Specificity of exercise in exercise-induced asthma. BMJ 1971;4:577-81. https://doi.org/10.1136/bmj.4.5790.814-c
Global Initiative for Asthma. [Internet] 2020. [citado 2020 Nov 15]. Available from: http://www.ginasthma.org
Silva D, Couto M, Delgado L, Moreira A. Diagnosis and treatment of asthma in athletes. Breathe 2012;8(4):287-96. https://doi.org/10.1183/20734735.009612
Millqvist E, Bengtsson U, Löwhagen O. Combining a beta2-agonist with a face mask to prevent exercise-induced bronchoconstriction. Allergy 2000;55:672-5. https://doi.org/10.1034/j.1398-9995.2000.00558.x
Elkins MR, Brannan JD. Warm-up exercise can reduce exercise-induced bronchoconstriction. Br J Sports Med 2013;47:657-8. https://doi.org/10.1136/bjsports-2012-091725
World Anti-doping Agency. [Internet]. [citado 2020 Nov 13]. https://www.wada-ama.org
Autoridade Brasileira de Controle de Dopagem. [Internet]. [citado 2020 Nov 13]. https://www.gov.br/abcd/pt-br
Duong M, Amin R, Baatjes AJ, Kritzinger F, Qi Y, Meghji Z, Lou W, et al. The effect of montelukast, budesonide alone, and in combination on exercise induced bronchoconstriction. J Allergy Clin Immunol 2012;130:535-9. https://doi.org/10.1016/j.jaci.2012.02.051
Jutel M, Agache I, Bonini S, Burks AW, Calderon M, Canonica W, et al. International consensus on allergy immunotherapy. J Allergy Clin Immunol 2015;136(3):556-68. https://doi.org/10.1016/j.jaci.2015.04.047
Christensen P, Thomsen SF, Rasmussen N, Backer V, et al. Exercise induced laryngeal obstructions objectively assessed using EILOMEA. Eur Arch Otorhinolaryngol 2010;267:401-7. https://doi.org/10.1007/s00405-009-1113-6
Nielsen EW, Hull JH, Backer V. High prevalence of exercise-induced laryngeal obstruction in athletes. Med Sci Sports Exerc 2013;45(11):2030–5. https://doi.org/10.1249/MSS.0b013e318298b19a
Rundell KW, Wilber RL, Szmedra L, Jenkinson DM, Mayers LB, Im J. Exercise induced asthma screening of elite athletes: field versus laboratory exercise challenge. Med Sci Sports Exerc 2000;32:309-16. https://doi.org/10.1097/00005768-200002000-00010
Lakin RC, Metzger WJ, Haughey BH. Upper airway obstruction presenting as exercise-induced asthma. Chest 1984;86(3):499–501. https://doi.org/10.1378/chest.86.3.499
Johansson H, Norlander K, Berglund L, Janson C, Malinovschi A, Nordvall L, Nordang L, et al. Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population. Thorax 2015;70(1):57–63. https://doi.org/10.1136/thoraxjnl-2014-205738
Zealear DL, Billante CR. Neurophysiology of vocal fold paralysis. Otolaryngol Clin North Am 2004;37(1):1–23. https://doi.org/10.1016/S0030-6665(03)00165-8
Halvorsen T, Walsted ES, Bucca C, Bucca C, Bush A, Cantarella G, et al. Inducible laryngeal obstruction (ILO) - an official joint European Respiratory Society and European Laryngological Society statement. Eur Respir J 2017;50. https://doi.org/10.1183/13993003.02221-2016
Hull JH, Backer V, Gibson PG, Fowler SJ. Laryngeal dysfunction - assessment and management for the clinician. Am J Respir Crit Care Med 2016;194(9):1062-72. https://doi.org/10.1164/rccm.201606-1249CI
Lakin RC, Metzger WJ, Haughey BH. Upper airway obstruction presenting as exercise-induced asthma. Chest 1984;86(3):499-501. https://doi.org/10.1378/chest.86.3.499
Morris MJ, Deal LE, Bean DR, Grbach VX, Morgan JA. Vocal cord dysfunction in patients with exertional dyspnea. Chest 1999;116(6):1676-82. https://doi.org/10.1378/chest.116.6.1676
Ben-Shoshan M, Clarke AE. Anaphylaxis: past, present and future. Allergy 2011;66(1):1-14. https://doi.org/10.1111/j.1398-9995.2010.02422.x
Kim H, Fischer D. Anaphylaxis. Allergy, Asthma Clin Immunol 2011;7(Suppl 1):1-7.
Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M, et al. Anaphylaxis: Guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69(8):1026–45. https://doi.org/10.1111/all.12437
McNeil BD, Pundir P, Meeker S, Han L, Undem BJ, Kulka M, et al. Identification of a mast-cell-specific receptor crucial for pseudoallergic drug reactions. Nature. 2015;519(7542):237-41. https://doi.org/10.1038/nature14022
Gonçalves DG, Giavina-Bianchi P. Receptor MrgprX2 nas anafilaxias não alérgicas. Arq Asma Alerg Imunol 2018;2(4). https://doi.org/10.5935/2526-5393.20180056
Guia para manejo da anafilaxia-2012 – Grupo de Anafilaxia da ASBAI. Rev Bras Alerg Imunopatol 2012;35(2).
Ben-Shoshan M, Clarke AE. Anaphylaxis: past, present and future. Allergy 2011;66(1):1-14. https://doi.org/10.1111/j.1398-9995.2010.02422.x
Maulitz RM, Pratt DS, Schocket AL. Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol 1979;63(6):433-4. https://doi.org/10.1016/0091-6749(79)90218-5
Miller CWT, Guha B, Krishnaswamy G. Exercise-induced anaphylaxis: a serious but preventable disorder. Phys Sportsmed 2008;36(1):87-94. https://doi.org/10.3810/psm.2008.12.16
Shadick NA, Liang MH, Partridge AJ, Bingham C, Wright E, Fossel AH, et al. The natural history of exercise-induced anaphylaxis: Survey results from a 10-year follow-up study. J Allergy Clin Immunol. 1999;104(1):123-7. https://doi.org/10.1016/s0091-6749(99)70123-5
Wong GK, Krishna MT. Food-dependent exercise-induced anaphylaxis: Is wheat unique? Curr Allergy Asthma Rep 2013;13(6):639-44. https://doi.org/10.1007/s11882-013-0388-2.
Bianchi A, Di Rienzo Businco A, Bondanini F, Mistrello G, Carlucci A, Tripodi S. Rosaceae-associated exercise-induced anaphylaxis with positive SPT and negative IgE reactivity to Pru p 3. Eur Ann Allergy Clin Immunol 2011;43(4):122-4.
Matsuo H, Morimoto K, Akaki T, Kaneko S, Kusatake K, Kuroda T, et al. Exercise and aspirin increase levels of circulating gliadin peptides in patients with wheat-dependent exercise induced anaphylaxis. Clin Exp Allergy 2005;461-6. https://doi.org/10.1111/j.1365-2222.2005.02213.x.
Geller M. Anafilaxia induzida por exercício. Braz J Allergy Immunol 2015;3(2). https://doi.org/10.5935/2318-5015.20150010
Giannetti MP. Exercise-induced anaphylaxis: literature review and recent updates. Curr Allergy Asthma Rep 2018;18(12):72. https://doi.org/10.1007/s11882-018-0830-6
Asaumi T, Yanagida N, Sato S, Shukuya A, Nishino M, Ebisawa M. Provocation tests for the diagnosis of food-dependent exercise-induced anaphylaxis. Pediatr Allergy Immunol 2016;27(1):44-9. https://doi.org/ 10.1111/pai.12489
Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy 2018;73:1393-414. https://doi.org/10.1111/all.13397
Schwartz LB, Delgado L, Craig T, Bonini S, Carlsen KH, Casale TB, et al. Exercise-induced hypersensitivity syndromes in recreational and competitive athletes: a PRACTALL consensus report (what the general practitioner should know about sports and allergy). Allergy 2008;63(8):953-61. https://doi.org/10.1111/j.1398-9995.2008.01802.x
Dortas Junior SD, Azizi GG, Sousa ACMCFF, Lupi O, França AT, Valle SOR. Urticárias crônicas induzidas: revisão do tema. Arq Asma Alerg Imunol 2020. https://doi.org/10.5935/2526-5393.20200047
Fukunaga A, Washio K, Hatakeyama M, Oda Y, Ogura K, Horikawa T, Nishigori C. Cholinergic urticaria: epidemiology, physiopathology, new categorization, and management. Clin Auton Res 2018;28(1):103-13. https://doi.org/10.1007/s10286-017-0418-6
Magerl M, Altrichter S, Borzova E, et al. The definition, diagnostic testing, and management of chronic inducible urticarias – TheEAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy 2016;71(6):780-802. https://doi.org/10.1111/all.12884
Del Giacco SR, Carlsen KH, Du Toit G. Allergy and sports in children. Pediatr Allergy Immunol 2012;23(1):11-20. https://doi.org/10.1111/j.1399-3038.2011.01256.x
Dortas Junior S, Azizi G, Valle S. Efficacy of omalizumab in chronic spontaneous urticaria associated with chronic inducible urticaria. Ann Allergy Asthma Immunol 2020;125(4):486-7. https://doi.org/10.1016/j.anai.2020.06.011
Busse PJ, Christiansen SC. Hereditary angioedema. N Engl J Med 2020;382(12):1136-48. https://doi.org/10.1056/NEJMra1808012
Giavina-Bianchi P, Arruda LK, Aun MV, Campos RA, Chong-Neto HJ, Constantino-Silva RN, et al. Diretrizes brasileiras para o diagnóstico e tratamento do angioedema hereditário - 2017. Arq Asma Alerg Imunol 2017;1(1):23-48. https://doi.org/10.5935/2526-5393.20170005
Ariano A, D'Apolito M, Bova M, Bellanti F, Loffredo S, D'Andrea G, et al. A myoferlin gain-of-function variant associates with a new type of hereditary angioedema. Allergy 2020;75(11):2989-92. https://doi.org/10.1111/all.14454
Ashrafian H. Hereditary angioedema in a martial arts family. Clin J Sport Med 2005;15(4):277-8. https://doi.org/10.1097/01.jsm.0000171884.12174.6a
Valle SOR, Alonso MLO, Tortora RP, Abe AT, Levy SAP, Dortas SD Jr. Hereditary angioedema: Screening of first-degree blood relatives and earlier diagnosis. Allergy Asthma Proc 2019;40(4):279-281. https://doi.org/10.2500/aap.2019.40.4213
Maurer M, Magerl M, Ansotegui I, Aygören-Pürsün E, Betschel S, Bork K, et al. The international WAO/EAACI guideline for the management of hereditary angioedema-The 2017 revision and update. Allergy 2018;73(8):1575-96. https://doi.org/10.1111/all.13384
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2021 Sérgio Dortas Duarte Júnior, Guilherme Gomes Azizi
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Autores que publicam nesta revista concordam com os seguintes termos: Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista; Autores têm autorização para assumir contratos adicionais separadamente, para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista; Autores têm permissão e são estimulados a publicar e distribuir seu trabalho online (ex.: em repositórios institucionais ou na sua página pessoal) a qualquer ponto antes ou durante o processo editorial, já que isso pode gerar alterações produtivas, bem como aumentar o impacto e a citação do trabalho publicado (Veja O Efeito do Acesso Livre).
