Alergia y Dermatitis por Contacto

La inmunotolerancia inducida por el uso de la vía oral y sublingual, tiene una importante aplicación en el tratamiento de desensibilización de procesos alérgicos, (46, 51, 58, 67, 68, 70-77, 89, 102, 103, 110, 112, 138, 141, 147, 155, 173) dermatitis por contacto a níquel, cromo y estaño (4, 12, 45, 173).

Es en este campo es donde se ha acumulado más experiencia investigativa y se ha logrado pasar sutilmente de la fase puramente experimental a la aplicación en el humano (173, 174-176).

La dermatitis por contacto a níquel es las más estudiada, la utilización de pequeñas dosis de este metal, por vía oral a un animal impiden la inducción intencional de esta patología (4-12, 45,102).

Debemos recordar que el estaño y el níquel son metales muy conocidos por su gran capacidad de producir dermatitis por contacto en el humano cuando son usados en adornos de fantasía de uso femenino, como aretes, cadenas, pulsos, etc.

La experimentación en este tipo de enfermedades ha arrojado resultados muy interesantes, además de inducirse tolerancia específica, ésta es persistente, con períodos de observación superiores a los dos años (45).

En pediatría, la alergia a la leche de vaca (46, 52, 65, 74, 137, 112) y al huevo (1, 28, 51, 112, 137) son las más exploradas. En trabajos experimentales con ratones, administrándoles inicialmente caseína bobina (S1CN) como alimento y luego al inocular los animales por vía parenteral con esta proteína, no se evidenció ningún tipo de respuesta inmunitaria, por el contrario hubo tolerancia plena a la S1CN (46).

Algunos investigadores sugieren que la inmunotolerancia oral se da por una anergia inducida en LT (51).

Como lo demuestran diversas investigaciones, la administración de extracto de polen de gramíneas por vía oral produce un estado de tolerancia, muy útil en los procesos alérgicos respiratorios ocasionados por pólenes estacionales, de esta manera, se suministra el tratamiento de inmunoterapia sublingual, nasal u oral con estos pólenes antes de la estación en la cual se producen; cuando llega la estación respectiva con su polinización característica no se observa la recaída de la enfermedad alérgica, por tanto, nos indica que el paciente ha sido desensibilizado eficazmente (58, 156, 158, 159, 162-164, 166, 169, 170, 173).

Relacionado con la alergia a pólenes existe un trabajo realizado con el antígeno Parietaria judaica administrado por vía sublingual (128); se realizó en 40 pacientes alérgicos que padecían rinoconjuntivitis y asma bronquial secundaria a este alérgeno. Se procedió de la siguiente manera:

• 20 pacientes como control.
• 20 tratados con el alergeno Parietaria judaica por vía sublingual.

En los pacientes tratados con el alergeno no se presentaron efectos colaterales y durante la estación en la cual predomina este polen en el ambiente, ellos no tuvieron recaídas de su rinoconjutivitis (128).

En la desensibilización de los procesos alérgicos se deben administrar dosis bien estandarizadas, requiriendo de múltiples administraciones del alergeno, sujetas a las recomendaciones del fabricante o al estudio que haga el investigador para cada alergeno en particular (54, 67, 113, 114, 135).

Trabajos similares se han realizado en alergia alimentaria al huevo. Animales previamente sensibilizados con este producto por vía parenteral, se les indujo tolerancia al administrarles por vía oral clara de huevo obteniéndose como resultado una desensibilización efectiva contra esta proteína (1, 28, 51, 54, 65, 112, 137).

En este caso también es muy importante las dosis e intervalos de administración pues de esto depende el hecho de no pasar de un estado de tolerancia a una sensibilización o provocación de inmunidad ante un alergeno (54).

Lo que respecta a alergia alimentaria uno de los trabajos más interesantes fue el llevado a cabo con proteínas de leche de soya (68), descrito a continuación:

• Se seleccionaron cerditos de dos, ocho y trece semanas de edad ocho en cada grupo, fueron previamente inmunizados intraperitonealmente con proteínas de soya con adyuvante Quica. Luego se alimentaron durante doce semanas con leche de soya.
• Se seleccionó un grupo control al cual se inyectó por vía intraperitoneal (VIP) con adyuvantes Quica únicamente.

Todos los animales alimentados con leche de soya demostraron respuesta IgG a esta proteína, esto indicó que la alimentación con proteínas de soya no indujo tolerancia a la misma, después de haber sido previamente inmunizado el animal.

La experiencia se repitió administrando la proteína de soya antes de la sensibilización ip, se obtuvo un estado de tolerancia que se demostró cuando los animales fueron posteriormente inmunizados por vip.

El hallazgo más importante de esta investigación fue que al inmunizar por vip con la proteína de la leche de soya, sólo se obtuvo tolerancia en los animales que habían sido destetados después de la semana 12 de su nacimiento, es decir, en aquellos que tenían un sistema inmunitario de mucosas más maduro y en condiciones de producir una adecuada respuesta inmunitaria.

En pollos se ha inducido tolerancia a la caseína de la leche después de administrar el antígeno por vía oral. Este caso no fue posible sensibilizar al animal por vía parenteral al aplicarle la caseína (74).

En las dermatitis por contacto provocada por los metales níquel, cromo y estaño de los aretes de fantasía, se han realizado varios trabajos experimentales consistentes en inducir tolerancia por vía oral administrando dosis mínimas del metal por esta vía. Procedimiento que impidió el establecimiento de la dermatitis por contacto, cuando se trató intencionalmente de sensibilizar con estos metales, por vía cutánea (4, 12, 45).

En este momento se trabaja en la obtención de tolerancia inmunitaria por vía oral y sublingual en los procesos alérgicos a drogas; ejemplos exitosos de esta terapia se tienen los siguientes:

– En la obtención de tolerancia a la trimetoprin sulfa en pacientes con SIDA que resultaron alérgicos a este antimicrobiano (147).
– En pacientes alérgicos a penicilinas y, en general, a antibióticos con el anillo beta lactámico (141).

Como una conclusión de la revisión que hecha sobre los elementos moleculares, humorales y celulares que se ponen de manifiesto en las respuestas de inmunotolerancia loca, según que se ha descubierto hasta la fecha, se sugiere el siguiente perfil de laboratorio:

• Interleucinas : TGF-b1, IL-4,IL-10.
• Células que se activan: LTh2, y LTh3 (175).

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