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2010, vol. 16, br. 1-2, str. 56-62
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Inhalatorni alergeni kao uzročnici bronhijalne astme
Inhalant allergens as a cause of bronchial asthma
Sažetak
Uvod. Astma je hronična bolest disajnih puteva, koja se karakteriše reverzibilnom opstrukcijom protoka vazduha, bronhijalnom hipersenzibilizacijom i patološkim nalazom inflamacije svih struktura disajnih puteva. Prema podacima Svetske zdravstvene organizacije (SZO), oko 300 miliona ljudi u svetu boluje od astme. U patofiziologiji astme mnoge ćelije imaju značajnu ulogu: mast ćelije, eozinofili i T-limfociti. Ona je rezultat imunih događaja u brohnijalnom stablu i obično je povezana s tipom I reakcije preosetljivosti. Atopija se definiše kao lična ili porodična predispozicija. Najčešći inhalatorni alergeni su: grinje, kućna prašina, poleni korova, trava i drveća. Svaki astmatičar treba da uradi kožni test (Prick test) za utvrđivanje atopije i identifikaciju alergena. Cilj rada. Ispitati povezanost inhalatornih alergena i astme i utvrditi koji su najčešći inhalatorni alergeni koji izazivaju astmu. Metod. Sprovedena je retrospektivna studija u Domu zdravlja Ruma, Služba pneumoftiziologije. Uključena su 92 pacijenta obolela od astme, stariji od 18 godina; 60 (65,2%) žena i 32 (34,8%) muškaraca. Pregledani su zdravstveni kartoni pacijenata kojima je od 1. januara 2007. do 31. decembra 2009. godine postavljena dijagnoza bronhijalne astme. Analizirani su rezulati kožnih testova (Prick test) na inhalatorne alergene kod obolelih od astme. U statističkoj analizi upotrebljavan je χ² test. Rezultati. Pozitivan kožni test na inhalatorne alergene je imalo 66 (71,7%) ispitanika. Najčešći inhalatorni alergeni su grinje (57,5%), kućna prašina (53%), poleni trava (44%), korova (34,8%), drveća (9%), buđ (7,5%), dlaka mačke (6%), dlaka psa (3%), perje (7,5%). Oko 83,3% ispitanika je imalo pozitivan odgovor na dva ili više alergena. Nije postojala statistički značajna razlika u rezultatima senzibilizacije na inhalatorne alergene između 2007-2008. i 2009 godine (χ²=1,185; p>0,05). Postojala je statistički značajna korelacija između hipersenzitivnosti i astme (χ²=37,2; p<0,01). Zaključak. Kožni alergotest je pouzdan i reproduktivan u dijagnozi uzročnika alergije. Astma je u visokom procentu povezana sa alergijom. Edukacija pacijenata je veoma značajan segment u lečenju astme i potrebno je sprovoditi je stalno, prilikom svake posete lekaru.
Abstract
Introduction. Asthma is a chronic disorder of the airways, characterized by reversible airway obstruction, bronchial hypersensitivity and an underlying inflammation1. As reported by the WHO, about 300 million people all over the world suffer from asthma. Many cells play a role in the pathophysiology of asthma, particularly mast cells, eosinophiles and T- lymphocytes. Asthma is result of an immune response in the bronchial airways, it is usually classified as type I hypersensitivity. Atopy, classically defined as a personal or familial predisposition to become sensitized and produce IgE antibodies in response to normal exposure to common environmental allergens, is the strongest identifiable predisposing factor for developing asthma. Common inhalant allergens include house dust mites, house dust, weed, and grass and tree pollens. Every asthmatic should have skin test to confirm atopy and identify allergic triggers. Aim. The aim of this paper is to examine the correlation between inhaled allergens and asthma, and to determine which inhalant allergens are the most common causes of asthma. Method. The retrospective research was conducted in Health Center 'Ruma' and included 92 patients with asthma older then 18 years: 60 (65.2%) women and 32 (34.8%) men. The medical records of patients in whom the diagnosis of asthma was established in period 2007 to 2009 were reviewed, and the Prick test results for the inhaled allergens analyzed. The collected data were statistically processed by χ² test. Results. Skin prick test was positive in 66 (71,3%). The majority of the patients were allergic to house dust mites (57.5%), house dust (53%), grass pollen (44% ), weed pollen (9%), tree pollen (9%), mold (7.5%), feathers (7.5%), cat hair (6%), dog hair (3%). About 83.3% of the patients exhibited hypersensitivity to more than two allergens. No significant differences were found between results of hypersensitivity tests in 2009 and 2007/08 (χ²=1.185 p> 0.05). Significant correlation were found between hypersensitivity and asthma (χ²=37.2 p<0.01). Conclusion. Skin allergy testing is the most sensitive and accurate way for diagnosing the cause of allergies. The education is very important part of asthma management, and should be implemented continually during every visit to the physician.
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