Resumo
El asma y alergia representan un motivo de consulta habitual, siendo frecuentemente abordadas desde la medicina tradicional. En muchas ocasiones, no se logra un control completo de de los síntomas y la enfermedad. Ha habido un fuerte aumento de las enfermedades alérgicas y autoinmunes, alcanzando proporciones epidémicas, y con una mayor prevalencia en los países industrializados. Se ha demostrado que existiría una relación entre estas patologías y una barrera epitelial intestinal defectuosa. Además, la permeabilidad del epitelio intestinal estaría implicada en condiciones metabólicas y autoinmunes sistémicas. En el presente trabajo, se describe el caso de una paciente de 31 años con reiteradas consultas al sistema de salud por cuadros desde su infancia, caracterizados por crisis de asma, ansiedad, síntomas digestivos, rinitis y alergias de piel a repetición. El abordaje y el tratamiento indicado fueron realizados desde la mirada de la medicina de precisión, enfocando el tratamiento sobre el síndrome de Leaky Gut, inflamación crónica y Disbiosis intestinal. A tal fin, se proscribió una dieta antiinflamatoria, libre de gluten y lácteos, y la incorporación de probióticos, glutamina, Omega 3, y multivitamínicos. Luego de 6 meses, la paciente presentó una reducción significativa de su sintomatología, alergias y cuadros de asma.
Referências
Akdis, C. A. (2021). Does the epithelial barrier hypothesis explain the increase in allergy, autoimmunity and other chronic conditions? Nature reviews. Immunology, 21(11), 739-751. https://doi.org/10.1038/s41577-021-00538-7
Andújar-Espinosa, R., Salinero-González, L., Illán-Gómez, F., Castilla-Martínez, M., Hu-Yang, C., & Ruiz-López, F. J. (2021). Effect of vitamin D supplementation on asthma control in patients with vitamin D deficiency: the ACVID randomised clinical trial. Thorax, 76(2), 126-133. https://doi.org/10.1136/thoraxjnl-2019-213936
Britton, J., Pavord, I., Richards, K., Wisniewski, A., Knox, A., Lewis, S., . . . Weiss, S. (1994). Dietary magnesium, lung function, wheezing, and airway hyperreactivity in a random adult population sample. Lancet, 344(8919), 357-362. https://doi.org/10.1016/s0140-6736(94)91399-4
Caio, G., Lungaro, L., Segata, N., Guarino, M., Zoli, G., Volta, U., & De Giorgio, R. (2020). Effect of Gluten-Free Diet on Gut Microbiota Composition in Patients with Celiac Disease and Non-Celiac Gluten/Wheat Sensitivity. Nutrients, 12(6). https://doi.org/10.3390/nu12061832
Camargo, C. A., Jr., Rifas-Shiman, S. L., Litonjua, A. A., Rich-Edwards, J. W., Weiss, S. T., Gold, D. R., . . . Gillman, M. W. (2007). Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr, 85(3), 788-795. https://doi.org/10.1093/ajcn/85.3.788
DiNicolantonio, J. J., & O'Keefe, J. (2021). The Importance of Maintaining a Low Omega-6/Omega-3 Ratio for Reducing the Risk of Autoimmune Diseases, Asthma, and Allergies. Mo Med, 118(5), 453-459.
Farshchi, M. K., Azad, F. J., Salari, R., Mirsadraee, M., & Anushiravani, M. (2017). A Viewpoint on the Leaky Gut Syndrome to Treat Allergic Asthma: A Novel Opinion. J Evid Based Complementary Altern Med, 22(3), 378-380. https://doi.org/10.1177/2156587216682169
Fasano, A. (2020). All disease begins in the (leaky) gut: role of zonulin-mediated gut permeability in the pathogenesis of some chronic inflammatory diseases. F1000Res, 9. https://doi.org/10.12688/f1000research.20510.1
Holgate, S. T., Wenzel, S., Postma, D. S., Weiss, S. T., Renz, H., & Sly, P. D. (2015). Asthma. Nat Rev Dis Primers, 1(1), 15025. https://doi.org/10.1038/nrdp.2015.25
Horak, F., Doberer, D., Eber, E., Horak, E., Pohl, W., Riedler, J., . . . Studnicka, M. (2016). Diagnosis and management of asthma - Statement on the 2015 GINA Guidelines. Wien Klin Wochenschr, 128(15-16), 541-554. https://doi.org/10.1007/s00508-016-1019-4
Hufnagl, K., Pali-Schöll, I., Roth-Walter, F., & Jensen-Jarolim, E. (2020). Dysbiosis of the gut and lung microbiome has a role in asthma. Semin Immunopathol, 42(1), 75-93. https://doi.org/10.1007/s00281-019-00775-y
Jackson, D. J., Hartert, T. V., Martinez, F. D., Weiss, S. T., & Fahy, J. V. (2014). Asthma: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases. Ann Am Thorac Soc, 11 Suppl 3(Suppl 3), S139-145. https://doi.org/10.1513/AnnalsATS.201312-448LD
Kim, J., Kim, B. E., & Leung, D. Y. M. (2019). Pathophysiology of atopic dermatitis: Clinical implications. Allergy Asthma Proc, 40(2), 84-92. https://doi.org/10.2500/aap.2019.40.4202
Kim, M. H., & Kim, H. (2017). The Roles of Glutamine in the Intestine and Its Implication in Intestinal Diseases. Int J Mol Sci, 18(5). https://doi.org/10.3390/ijms18051051
Le Phan, T. H., Park, S. Y., Jung, H. J., Kim, M. W., Cho, E., Shim, K. S., . . . Oh, S. H. (2021). The Role of Processed Aloe vera Gel in Intestinal Tight Junction: An In Vivo and In Vitro Study. Int J Mol Sci, 22(12). https://doi.org/10.3390/ijms22126515
Lise, M., Mayer, I., & Silveira, M. (2018). Use of probiotics in atopic dermatitis. Rev Assoc Med Bras (1992), 64(11), 997-1001. https://doi.org/10.1590/1806-9282.64.11.997
Martineau, A. R., Cates, C. J., Urashima, M., Jensen, M., Griffiths, A. P., Nurmatov, U., . . . Griffiths, C. J. (2016). Vitamin D for the management of asthma. Cochrane Database Syst Rev, 9(9), Cd011511. https://doi.org/10.1002/14651858.CD011511.pub2
Mauer, Y., & Taliercio, R. M. (2020). Managing adult asthma: The 2019 GINA guidelines. Cleve Clin J Med, 87(9), 569-575. https://doi.org/10.3949/ccjm.87a.19136
Milan, S. J., Hart, A., & Wilkinson, M. (2013). Vitamin C for asthma and exercise-induced bronchoconstriction. Cochrane Database Syst Rev, 2013(10), Cd010391. https://doi.org/10.1002/14651858.CD010391.pub2
Miyata, J., & Arita, M. (2015). Role of omega-3 fatty acids and their metabolites in asthma and allergic diseases. Allergol Int, 64(1), 27-34. https://doi.org/10.1016/j.alit.2014.08.003
Neerven, R., & Savelkoul, H. (2017). Nutrition and Allergic Diseases. Nutrients, 9(7). https://doi.org/10.3390/nu9070762
Protocolo de orientación para el diagnóstico y manejo del asma en adultos. (2017).
Reddel, H. K., Bateman, E. D., Becker, A., Boulet, L. P., Cruz, A. A., Drazen, J. M., . . . FitzGerald, J. M. (2015). A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J, 46(3), 622-639. https://doi.org/10.1183/13993003.00853-2015
Ried, K., Travica, N., Dorairaj, R., & Sali, A. (2020). Herbal formula improves upper and lower gastrointestinal symptoms and gut health in Australian adults with digestive disorders. Nutr Res, 76, 37-51. https://doi.org/10.1016/j.nutres.2020.02.008
Siripornpanich, S., Chongviriyaphan, N., Manuyakorn, W., & Matangkasombut, P. (2022). Zinc and vitamin C deficiencies associate with poor pulmonary function in children with persistent asthma. Asian Pac J Allergy Immunol, 40(2), 103-110. https://doi.org/10.12932/ap-100620-0878
Wandalsen, G. F., & Solé, D. (2018). VITAMIN D AND ASTHMA: A RELATIONSHIP TO BE CLARIFIED. Rev Paul Pediatr, 36(3), 250-251. https://doi.org/10.1590/1984-0462/;2018;36;3;00020 (Vitamina d e asma: uma relaÇÃo ainda por esclarecer.)
Wang, B., Wu, G., Zhou, Z., Dai, Z., Sun, Y., Ji, Y., . . . Wu, Z. (2015). Glutamine and intestinal barrier function. Amino Acids, 47(10), 2143-2154. https://doi.org/10.1007/s00726-014-1773-4
Weiss, S. T., & Litonjua, A. A. (2011). The in utero effects of maternal vitamin D deficiency: how it results in asthma and other chronic diseases. Am J Respir Crit Care Med, 183(10), 1286-1287. https://doi.org/10.1164/rccm.201101-0160ED
Wise, S. K., Lin, S. Y., Toskala, E., Orlandi, R. R., Akdis, C. A., Alt, J. A., . . . Zacharek, M. (2018). International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol, 8(2), 108-352. https://doi.org/10.1002/alr.22073
Yeh, G. Y., & Horwitz, R. (2017). Integrative Medicine for Respiratory Conditions: Asthma and Chronic Obstructive Pulmonary Disease. Med Clin North Am, 101(5), 925-941. https://doi.org/10.1016/j.mcna.2017.04.008
Zajac, A. E., Adams, A. S., & Turner, J. H. (2015). A systematic review and meta-analysis of probiotics for the treatment of allergic rhinitis. Int Forum Allergy Rhinol, 5(6), 524-532. https://doi.org/10.1002/alr.21492
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.