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.50 02 /2 1/ 51 me otiec a ,5 00 2/0 1 /72 me odite mbus ogitrA .olua P o S ed lau datsE ocilbP rodivreS od latipsoH od aigrelA ed oivre S od roteriD ,anicide M me r otuoD ,atsigrelA ocidM .3 . o l u a P o S e d l a u d a t s E o c i l b P r o d i v r e S o d l a t i p s o H o d a i g r e l A e d o i v r e S o d o i r i g a t s e/ e t n e d i s e r o c i d M . 2 .CBA od anicideM ed edadlucaF ad aigolotamreD ed oivres od acidM ,anicideM me ertseM ,atsigrelA acidM .1 olua P oS ed la udatsE ocilb P rodivreS od latipsoH od aigrelA ed oivreS

.5remiehtnoS rop atircsed ,)DMU( emred ad ralucsav orcim edadinu a meutitsnoc sadalev salulc e setiltas salulc sa moc etnematnujnoc siauq so ,sotictsam e emred ad soticrdned moc oisopatsuj me etnematerid ,laicifrepus emred ad seralipac sod onrot me sodubirtsid ,etnemraluc -itrap ,soticfnil ed oremn on otnemua somavresbo ,os -simsnart ed acinrtele aipocsorcim a bos ,sotnemacidem a oisopxe alep adizudni aduga aircitru an airtamalfni atsopser ad siaruturtse-artlu searetla sad odutse mE .4adnuforp an e aidm emred an etnemlaicnereferp es-azilacol odartlifni o aidrat osserp ed aircitru aN .acinrc aircitru an etnem -laicepse ,serotua snugla rop odavresbo odis met sotict -sam ed oremn on odaredom otnemuA .serailixua - T opit od soticfnil e sogafrcam ,solifnisoe uo/e solifrtuen rop odutitsnoc ,levirav edadisnetni ed ralucsavirep otsim oir -tamalfni odartlifni h ,acitru ad oarud ad odnednepeD .1oentucbus on e adnuforp emred an merroco seralimis searetla sa ,amedeoigna oN .1laicifrepus emred ad socit -fnil sosav e seralipac-sp salunv sad oatalid moc ,aid -m e laicifrepus emred ad e emredipe ad amede artsnom -ed acisslc acitru a zul ed acitp aipocsorcim a boS

:sociglotapotsih sotcepsA
.3sacitru oaler me atnel siam amrof ed ,saroh 27 ed onrot me ord -auq od ouloser )vi( e ,sasocum sanarbmem sad etneq -erf otnemitemoca )iii( ;odirurp oa oaler me rod ed amot -nis od aicnqerf roiam )ii( ;oentucbus e adnuforp emred
tnemtaert/ airacitrU .eniropsolcyC ,senomroH xetroC lanerdA ,stsinogatnA enimatsiH ,stsinogatnA enimatsiH ,enimatsiH ,air -acitrU 382-372:)6(82 ;5002 .lotaponumi .grela .sarb .veR .)srot -aludomonummi( seipareht enil-driht dna )seneirtokuel-itna dna sdioretsocitroc( dnoces ,)senimatsihitna( tsrif otni depuorg era hcihw ,snoitnevretni gurd dna serusaem lacigolocamrahp -non evlovni yam syawhtap tnemeganaM .)skeew 6 dnoyeb( cinorhc ro )skeew 6 naht ssel( etuca ni noitulove laropmet no desab si airacitru fo noitacifissalc ehT .emitefil reh ro sih gnirud noitpure etuca eno tsael ta sah noitalupop eht fo %02 ot %51 :snoitidnoc lacigolotamred tneuqerf tsom eht fo eno si tI .sesuac dna snoitatneserp lacinilc lareves sah airacitrU tca r tsbA

ad odaicnunorp e otibs amede )i( :rop odinifed amede -oigna O .1acitru ad oamrof a moc oaicossa me ralip -ac epacse e osnetni ralucsav onad olep ,etilucsav aircitru ed acinlc atiepsus a mavel saecloiv uo sacirprup ,odaut -neca ohlemrev ametire ed sacitru sA .oesr ametire mu rop sadadnucric ,aralc roc ed os animatsih alep sadizudni sacitru sA .acitru ad roc a etnaveler otcepsa ortuO .3sar -oh 42 a amu ed ortned etnemlareg lamron otcepsa ues oa odnanroter elep a moc ,aremfe azerutan )iii( ;oam -ieuq ed oasnes sezev s e odaicossa odirurp )ii( ;oxelf -er ametire mu rop odadnucric etnemlevairavni euq esauq ,odairav ohnamat ed lartnec amede )i( :sacipt sacitsr -etcarac srt atneserpa acitru A .ocinlc etnemlatnem -adnuf ocitsngaid ueS .3-1lanitsetnirtsag otart od e oen -tucbus od ,adnuforp emred ad amede o atneserper euq ,amedeoigna rop adahnapmoca res on uo edoP .2,1laicif -repus emred ad ametire e amede o atneserper euq acitru animoned es euq mumoc osel ad aneserp ad edutriv me emon omsem o bos sadapurga sedadimrefne ed opurg mu omoc adidnetne ejoh aircitru a acin aneod amu om -oc adacifissalc setnA .1odutse ues od aicntropmi a odnart -som ,lam etse rop soditemoca setneicap sod adiv ed ed -adilauq ad adrep etnatropmi odnasuac sona 02 ed mla rit -sisrep medop %02 e ona mu ed siam rop metsisrep sairc -itru sad otnec rop atneqniC .3-1ocisf emaxe bos odnauq aircitru atneserpa oalupop ad %1,0 euq avresbo es mb -maT .%52 e %51 ertne mairav euq savitalumuca aicnlav -erp ed saxat moc setneqerf secefa os saircitru sA

saircitrU
.acituparet /air -citru ,sediretsocitroC ,animatsih ed serotpecer sod satsinog -atnA ,animatsih ad satsinogatnA ,sotictsaM ,animatsiH ,airc -itrU 382-372:)6(82 ;5002 .lotaponumi .grela .sarb .veR .)serodaludomonumi sotnemacidem( ahnil ariec -ret e )soneirtocuel-itna e sediretsocitroc( adnuges ,)socinm -atsih-itna( ariemirp ed sotnematart me sadapurga os siauq sa ,sasotnemacidem senevretni e saciglocamraf on sadid -em redneerpmoc edop aircitru ad otnematart O .)sanames sies ed mla( acinrc uo )sanames sies euq ronem oarud( aduga me oulove a odnuges adacifissalc .acitrU ratnem -ele osel ad otnemicerapa o mumoc me met euq emordns omoc al-inifed aicndnet a ejoH .adiv aus me aneod ad oduga oidsipe mu sonem olep mt oalupop ad %02 a %51 :setneqerf siam sesotamred sad amu iutitsnoc aircitru A

3olleM ed .F ooJ , ocnarF .S atreboR ,2i.ppilihP .C onailuJ ,2 odairC .J .F atreboR 1

om useR

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saircitrU
OSIVER ED OGITRA
.lotaponumi .grela .sarb .veR
3 72 /6 0- 82 /50 IABSA y b 5 00 2 thgirypoC

osnetnI ada redoM eveL am uh nen

arugif an raton somedop omoc samrof sairv ed rerroco edop anamuh elep an sotictsam sod oalumitse A .9amedeoigna e aircitru ed sos -ac sod airoiam an satsinogatorp siapicnirp so sodaredisnoc os euq ,sotictsam soa snumoc ,sovita osav serodaidem soirv ed acimrdartni oejni alep sadizudorper res odned -op :siweL ed oaer ecilprt alep amrof es acitru A

:socingotapoite somsinacem e aigolotapoisiF


.acitsc esorbif moc setneicap so ertne aircitru ed aicnrroco roiam es-ataleR .sortuo ertne ,ailagemonelpse uo/e otapeh ,aitaponedafnil ,erbef :omoc ,setneserp ratse acimtsis aneod ed samotnis e sianis sortuo e ,snumocni res medop semrofiracitru sesel sa ,sosac setseN .airid acitrp an acinrc aircitru moc setneicap son sadavresbo etnemarar meres snedrosed satse ed rasepa ,ovitcenoc odicet od senumi-otua saneod ed mla ,sarar semordns uo sacimtsis senumi saneod ed oremn ednarg a adaic -ossa res edop etilucsav aircitru a uo acinrc aircitru A

o dirurP

.)1 fer ( .la te re ibre buZ ed oda tpadA . ) 6 - 0 ( = ) o d i r ur p + s a c i t r u ( s e r o c s e e d a m o S * ) sacitru e d se tn eulfnoc s aer sedn arg 3 uo s aroh 4 2/ sacit ru 0 5 >( eva rG ) saroh 2 42 /sacitr u 05 -1 2( ada redoM )s aroh 42 / sacit ru 0 2 <( eveL 1 am uh nen 0

sacitrU

*erocsE

.aircit ru a d edadisn etni ad oaila vA - II ordauQ

.otnematart od on uo aiccife ad mbmat omoc aircitru ad edadivarg ad ovitejbo ortemrap mu ocidm oa etimrep siop ,etnatropmi oautnop atsE .)II ordauq( sair -id sedadivita saus san etneicap olep otnauq ocidm olep otnat odazilaer res odnedop selpmis ametsis mu ed atart es euq .la te reibrebuZ rop otsoporp ,oautnop ed ametsis mu rop adacifissalc res edop aneod ad edadisnetni A
.) 1 f er( la t e reibre buZ ed oda tpadA railimaf oirf oa aircitrU )iii( etilucsav aircitrU )ii( ) e s o t i c o t s a m ( a s ot n e m g i p a i r c i t r U ) i ( :socirtsih sotc epsa rop aircit ru sadanoicaler satnitsid saneoD .VI acin ga uqa air citru )vi( )acigrla-oduesp uo acigrla( otatnoc ed aircitrU )iii( acigrnerda aircitrU )ii( acigrniloc aircitrU )i( :aircitru ed siaicepse sopiT .III oirta rbiv a medeoigna/air citru ralos aircit ru rolac oa ota tnoc ed aircit ru oirf oa ota tnoc ed aircit ru a i d r a t o s s er p e d a i r c i t r u o m s i f ar g o m r e d

socitmuenp sovitisopsid ,lareg me ,sairtarbiv sarof levsiv zul uo/e )VU( ateloivartlu odazilacol rolaC otn ev / a ug /oir f ra .)aicntal ed odore p ed saroh otio a s rt spa me gru s sacitr u( lacitr ev o sserp .)sotunim ocnic a mu me meg ru s sacitr u( elep an sacin ce m saroF

:s etna eda cneseD

opiT

:sacisF saircitrU .II

sanames a said me odnairav samotnis ed servil sodoreP .an am es a e tn ar ud e tn emairaid e uq esa uq uo airiD san am es sies euq roiaM s an am es sies e uq roneM .

etne rroceR.2 auntnoC.1 acinr C air citrU a dugA a ircitrU .

: aen t nopse aircitrU .I

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air cit ru ed opiT

s a s u a c e a i c n q e r f , o ar u d a u s a n e s a b m o c a i r c i t r u a d o a c i f i s s a l C - I o r d a u Q

.7onretxe ocisf olumtse mes ,etnemaenatnopse megrus sacitru sa acinrc e aduga aircitru aN .osserp ed aidrat aircitru atief oecxe ,olumtse o odanimret ed sioped saroh saud massapartlu on etnemlamron euq samotnis sues ed aremfe oarud alep e serodaedacnesed serotaf sues sod laicepse azerutan ad asuac rop sadapurga missa os sacisf saircitru sa odutnoC .acinrc azerutan mt mb -mat sacisf saircitru sa ,olpmexe rop ,omoc saicntsisnoc -ni samugla h euq otsiv ,atiefrep adnia on oacifissalc
saircitr U

atsE .I ordauq o odnuges sadacifissalc res medop saircitru sa 64002 ed ymedacA naeporuE ad osnesnoc o odnugeS .6etneicap omsem mu me aircitru ed sopitbus siam uo siod ritsixeoc odnedop ,olpma otium aircitru ed sopitbus setnerefid sod sacinlc se -atsefinam sad ortcepse o mrop ,saigoloite sievvorp sa odnuges sadacifissalc mare saircitru sa etnemacirotsiH

:ocinlc ordauq e aircitru ad oacifissalC


5002 ,6 N ,82 .loV .lotaponumi .grela .sarb .veR 472

.61socimtsis samotnis ed adahnapmoca res edop e adazilareneg uo adazilacol res edop aircitru ed opit etsE .xetl oa aigrela a oaer atsed opittorp O .sacingrela saicntsbus moc otatnoc spa saroh a sotunim erroco e 5791 me zev ariemirp alep adinifed iof euq uo aircitru ed laicepse opit mu omoc adac -ifissalc otatnoc ed aircitru A :otatnoc ed aircitrU .51,41senumi-otua sotneve omoc ,alelarap amrof ed sodanoicaler mairatse etnemlevavorp euq odnalutsop ,acinrc aircitru ad ainegot -apoite an edierit a artnoc soprocitna-otua sod aterid o -apicitrap a uonoicalerroc on euq ,mettoR rop adarofer aidi atsE .51enumi oaluger an arutpur amu uo/e enumi -otua ossecorp mu a oirdnuces aneod ed odatse mu ed aicntsixe a racidni ecerap acinrc aircitru moc setneod snugla me IR cF-itna soprocitna e edierititna soprocit -na-otua ed aentlumis aneserp ad ortnocne O .41siamron soudvidni sod %4 a %3 ed acrec sanepa me sol-rtnocne es-arepse lareg oalupop an ,euq otnauqne ,)anilubolgoer -ititna e esadixorepitna( edierititna soprocitna ed sodav -ele solutt sodartnocne res medop ,otnematart oa airtarf -er acinrc aircitru moc setneod sod %02 ta me euq es -artsnomed arutaretil aN :edierit edadinumi-otuA a5C uo a3C odnarebil IR cF oa adagil EgI

31

a uo IR cF oa soprocitnaotua setsed oagil alep otnem -elpmoc od oavita alep erroco airticotsam oalunarg -ed A .213GgI e 1GgI opitosi od os soprocitna-otua setsE .31,21enumi-otua acinrc aircitru adanimoned a aziretcarac soprocitna-otua setsed aneserp A .sobma uo ,EgI etnem -etneqerf sonem ,uo ) IR cF( EgI arap edadinifa atla ed serotpecer so artnoc sodanoicerid animatsih ed serodarebil soprocitna-otua martsnomed satsed %05 a %52 euq odnes ,sacinrc saircitru sad %07 ed acrec iutitsnoc acitpoidi acinrc aircitru A :aircitru an edadinumi-otuA:riuges a sodatnemoc ores aicnveler roiam ed sotcepsa snuglA .saircitru sad ainegotapoite an sodivlovne somsinacem sievssop so animircsid III ordauq o acittnis amrof eD .9animatsih ad oarebil a aieuqolb euq ,rodibini rotaf mu ed oudorp alep otiefe etse retnoc medop B soticfnil so e ,ortiv ni ,semlup son e elep an sonamuh sotictsam so mavita euq ,animatsih ad serodarebil serotaf materces soticnom so e seraelcunofromilop soticcuel sO .)ECP( acilfonisoe acinitac anetorp e )PBP( lapicnirp acisb anetorp adavele edadivitaer amu h aircitru ed ses -el san mrop , 01anitor ed aigolotapotsih ed semaxe son semrofiracitru sesel ed sopitbus socuop snugla me sodart -nocne os e ,sotictsam ed setnedneped sacigrla sane -od sa moc sadaicossa salulc meutitsnoc solifnisoe sO

aircitru an sodivlovne sociglotapoisif somsinaceM - 1 arugiF

.)1 arugif( aircitru ad aidrat esaf ed atsopser ed odanimoned ,)1991( ztrawhcS odnuges euq ,oamalf -ni ed etnetsisrep siam odatse raedacnesed ed zapac res edop e ,aircitru an ataidemi atsopser amu aicini sodavita sotictsam solep sodaterces serodaidem ed ossecus A .)1 arugif( .01soedpil ed sodavired sotilbatem sovon ed o -areg e sodamrof-rp serodaidem ed oarebil a evomorp sotictsam sod oalunarged A .11)cPMG( ocilcc anisonaug ed otafsofonom od sievn so ravele rop animatsih ad o
572 5002 ,6 N ,82 .loV .lotaponumi .grela .sarb .veR

-arebil a atnemua ,zev aus rop ,anilocliteca A .11,01cPMA ad sievn so odnavele e 2H serotpecer so odnevlovne ,avitagen oatnemilaorter ed omsinacem rop oalunarged arutuf amu ribini edop mbmat adarebil animatsih A .11anilubut anetorp ad oamrof a moc e solubtorcim sod otneman -oicnuf o moc merefretni siauq sa ,anicihcloc e B anisalac -otic alep omoc meb ,socilcc soedtoelcun son mauta siauq so ,)cPMA( ocilcc litubid otafsofonomanisoneda e anilifoet ,anilanerda alep odibini res edop euq oalunarged ed os -secorp mu maicini sotictsam so sodalumitse zev amU .011
saircitrU

Estmulos Fsicos e no-Imunes

EgI
Anticorpo anti-IgE Antgeno Anticorpo anti- receptor da IgE MBP

Reao tipo II Reao tipo III

ANAFILOTOXINAS

Clivagem de C3

C3a + C5a

Triptase Heparina ECF

Inibio da coagulao

Ligao com FcRIa

Mediadores pre-formados

eosinfilos

neutrfilos

NCF Histamina

Prurido, vasodila -tao permeabilidade

PAF Lib. Neuro- Metabolismo peptdeos cido aracdnico ( subst. P)

EOS

Permeabilidade vascular por reflexo axonal

IL-3 GM-CSF

Via LIPO Via COX

LT

(+)

(+)

LTC4 PGD2 D4,E4 Permeabilidade vascular

(+)

Produo de Citocinas

HRFs

IL-1 IL-8

Moncito

IL-3

TNF (, IL-1, IL4, IL-6)

GM-CSF

Permeabilidade vascular, recrutamento de eosinfilos

ENDO

(+)

(+)

-itru ed oaicossa )%9,01( 42 ,acisf aircitru mavatnes -erpa )%2,33( setneod 27 ,setseD .aircitru moc sotluda setneod 022 marailava 91la te lezoK ,1002 mE .atluda ed -adi ed oninimef oxes o egnita ,lareg mE .aigoloite a artnoc -ne es ,adauqeda oagitsevni ed rasepa ,etnemaraR .air -citru moc setneicap sod %05-03 ed acrec moc erroco e sanames sies ed siam rop ritsisrep odnauq acinrc atid

acinrc aircitrU

a pse v e ahleba ed sadaciP sir bef sa neod e siariv secefnI se ts artnocoidaR sodaviredomeH anedoc e anifrom ,socitibitna sianomroh -on soirtamalfniitna e ocilcilas-liteca odic :sagorD soincital ed sotudorp e etalocohc ,hc ,sotnemidnoc ,sahnatsac ,ram od soturf ,saturf :sotnemilA acitpoidI
12

.a du ga aircit ru ad sas ua C - VI ordauQ

.22oiem osson me etneqerf acitrp euq oacidemotua alep zevlat ,socisglana e sianomroh on soirtamalfniitna rop adartnocne a iof sagord rop saduga saircitru ed as -uac roiam a euq es-uovresbo oivres osson me odizudnoc odutse me sianoicanretni sacitstatse sad etnerefid euq ratlasser ebac sagord s otnauQ .ocinlc otxetnoc o moc odanoicalerroc res eved sobma ed odatluser o ,odazirolav res arap euq ratlasser es ed H .02)TSAR( acifcepse EgI ed megasod uo oentuc etset olep sadacitsongaid res medop e aircitru ed opit etsen snumoc siam os EgI alep sadaid -em sasuac sA .etneqerf etnatsab adacifitnedi on asuac a aircitru ed opit etse ertne omsem mrop ,02)VI ordauq( odartnocne etnemlicaf siam etnaedacnesed rotaf O .02sar -oh etnemlareg marud ;siareg sonemnef ed ,aicnqerf moc sadahnapmoca sednarg sacalp moc atibs etnem -lareG .02sanames sies euq ronem oarud moc aleuqa

aduga aircitrU
.81emixorufec e adimarp -olcotem ,anetsicliteca ,aniuqorolc ,anizalardihid ,ocinluv

-alc odic ,adizainosi ,limaparev ,anidimatnep ,oinrucnap ,animatubod ,menepimi :setniuges so ,animatsih ad oros -ba roiam ranimreted e lanitsetni esadixo onimaid ad oa -uta a ribini medop euq sotnemacidem meutitsnoC .81etner -rocer uo acinrc aircitru moc setneod sod soticretne son esadixo-onimaid ad aicnicifed odartsnomed mt sotnem -irepxe sosreviD .amizne atsed edadivita a riunimid med -op sotnemacidem snugla e loocl O .81lanitsetni asocum an etnanimoderp edadivita moc ,animatsih ad oadarged an adivlovne amizne lapicnirp a esadixo-onimaid A .81)es -adixo onimaid ad aicnicifed( animatsih ad lamrona om -silobatem uo/e ateid an aditnoc animatsih ed agracerbos rop adanimreted ,animatsih aicnrelotni amu adivlovne ratse assop euq es-alutsop sacinrc e setnerrocer saircitru saN :esadixo-onimaid e animatsih aicnrelotnI .71sedipl e sot -ardiobrac moc oarapmoc me ,anirtsag ad roiam etnem -avitacifingis oerces acovorp sanetorp ed otsegni a euq es-ebaS .ratnemila aigrela ed sotiepsus sosac son levssop erpmes on onegtna mu a acifcepse EgI ed oceted a moc socinlc samotnis so ertne aterid oalerroc amu euq ed oavresbo a es-artnocne airoet atse odnarofeR .elep ad sotictsam sod serodaidem ed oarebil a uocovorp anirtsagatnep uo anirtsag ed acimrdartni oejni a euq marartsnomed serotua setsE .sotnemila sotrec ed otseg -ni a spa sadataler ,saircitru san e sacitlifana seaer san adivlovne ratse airedop ,oatnemila a spa etnem -ataidemi ,lamixorp onedoud e ocirtsg ortna od G salul -c salep adarebil ,sodiconima 71 ed oedtpep ed oudser mu ,anirtsag a euq mariregus 71la te prahT :anirtsaG A .acinrc aircitru a e saneod satse ertne lasuac oaler amu atsixe euq rartsom me mahlaf sodalortnoc sodutse soirv odutnoC .3sosac ed sotaler e sesiver saremni ed ovitom odis met ,sacin -rc sa etnemlapicnirp ,saircitru san sacimtsis seatsef -inam sad lepap O :sacimtsis seatsefinaM sartuO .8sanairetcab uo siariv sale majes secefni moc oaler etnatropmi ahnet aicnfni an aircitru a euq es-atidercA .31acinrc aircitru e )olpmexe rop ,siasunis uo sairtned secefni( satluco sanairet -cab secefni ed oaicossa ad saicndive marartnocne es on 5osnesnoC omsem etseN .sovitsegid samotnis revuoh odnauq sanepa airtcab ad asiuqsep a odnadnemocer ,acin -rc aircitru ad osruc o e irolyp retcabocileH olep ocefni a ertne oaler ed aicnsua a eregus , 3002 me odazilaer
31 aircitru erbos scnarF osnesnoC O :sanairetcab se -cefni sartuo e irolyp retcabocileH od oapicitraP

esodiocra S ,seromuT B aniximilop ,anedoc ,snoitciloP sotnemila e sia nomroh -on soirtamalfniitn a )2.c sodavir edome h a se aer ,oirtide reh a medeoigna ,rolac oa aircitr u )1.c allenihcirt ,abeomatne ,ailbmal aidraiG )4.b .ps adidnaC ,.ps notyhpohcirT )3.b ococotpertse ,irolyp retcabocileH )2.b surv eik casxoC ,surivolagemotic ,B uo A etit ape h )1.b acit mu er erbef ,ocim tsis osota metire supl ,edierititna uo EgI ad rotpecer-itna soprocitna-otua moc acitpoidi acinrc aircitru )3(.a )ralos e omsifa rgomred ,oirf( sacisf saircitr u s amugla )2(.a r atnemila aigrela e sotesni a aigrela ,sa gord a aigrelA )1(.a

sa nr etni sa n eod )2.D animatsih ad serodarebil socimuq )1.D

:sortuO .D

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solpmexE
9

somsina ceM

saircit ru sad socingotapoisif somsina ce M - III ordauQ

saircitr U

5002 ,6 N ,82 .loV .lotaponumi .grela .sarb .veR 672

amedeoigna o ,etnemlareG .etnednepedni EgI amede -oigna od omsinacem O .otnitsid e odacoviuqe ocitsngaid a avel etnemetneqerf euq o ,ACE ad rodibini od onet -unam a moc omsem ta ritimer medop samotnis sO .avis -netrepih-itna acituparet ad oiutitsni a spa sesem soir -v ta otnematart od oicni od saroh samugla spa rerroco edoP .sonacirema-orfa ertne mumoc siam odnes ,ACE-I mazilitu euq setneicap sod %2,0 a %1,0 me erroco amed -eoigna o :)ACE-I rop amedeoignA( anisnetoigna ad arosrevnoc amizne ad serodibini rop amedeoignA .2soirtaripser sodur e ainpsid zudorp oirt -aripser otart oN .airraid e sotimv ,aigafsid ,sacilc omoc sairtidereh samrof san snumoc siam os sianitsetnirtsag samotnis sO .ocnort e sorbmem ,satnalp e samlap ,latineg aer ,sarbeplp ,soibl os soditemoca siam siacol sO

.2ocitpoidi omoc ecenamrep sosac sod airoiam A .2sociglonumi on somsinacem rop oduga amedeoig -na ranimreted medop anisnetoigna ad arosrevnoc amizne ad serodibini so e setsartnocoidar so ,sianomroh-on soir -tamalfniitna so omoc sagorD .ritimer otne e sona siam uo ocnic etnarud soidsipe moc rerrocer edoP .oninimef oxes on odnanimoderp ,edadi ed sona 05 soa 04 so ertne aicnrroco roiam moc mrop ,edadi reuqlauq me errocO .sosac sod %01 ed sonem me etnemadalosi es-ratsefinam edop amedeoigna O .22)epocns e osnetopih ,aidraciuqat ,aicnlibis ,ainpsid( acimtsis acitlifana oaer ed sam -otnis e sianis sortuo a adaicossa ratse edoP .etnemadalosi uo amedeoigna moc etnemetneqerf erroco aircitru A

amedeoignA

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a r ut a r e p m e t e d se aretlA

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sacisf sair citr u ed sopiT V ordauQ

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.12sacisf sair -citru ed sopit so azitetnis V ordauq O .7sacisf saircitru sartuo a sanepa sadaicossa uo adalosi amrof ed megrus etnemetneqerf rolac oa uo ralos aircitru a ,atsopo amrof eD .saircitru sartuo uo acigrniloc aircitru ,acitpoidi acinrc aircitru a moc etnematnuj ,etnemetneqerf mer -roco osserp e oirf oa saircitru sa ,omsifargomred O .12%5,52 a 6 ed acrec ed aicnqerf atse anairc aN .saircitru sad % 04-03 ed ajes euq es-atiderca sam adicehnocsed oalupop asson me sacisf saircitru sad aicnqerf A .12acigrniloc aircitru amu marbmel e sacisf saircitru omoc sadacifissalc siam os on mbmat sacig -rnerda e sacingauqa saircitru sA .12oirtatsug uo lanoic -ome olumtse rop rerroco mbmat odnedop rolac oa odaz -ilacol olumtse rop on e oproc od labolg otnemiceuqa rop erroco e rous o olumtse o edadrev me euqrop sacisf sair -citru sad etnemadarapes adacifissalc odis met acigrnil -oc aircitru A .7acitru a zudorper ocifcepse ocisf olumtse mu odnauq merrocO .aircitru ed sopit sortuo moc oaic
772 5002 ,6 N ,82 .loV .lotaponumi .grela .sarb .veR

acigrniloc aircitru e sacisf saircitrU


.aneod ad oarud oaler me ocitsngorp roip o maratneserpa ,otnatrop ,euq 91ac -isf aircitru moc setneod sod %4,61 sanepa me arohlem a iof odutse od oavresbo artuO .oarud airprp a os -ufnoc ed rotaf o aircitru asuac adanimreted amu somra -icossa oa ,edadrev an ,euq e aneod ad adatimilotua o -arud a artsom euq o ,91setneod sod %9,82 me marunimid samotnis so odorep etsen e ona mu spa sodaruc mavatse setneod sod otnec rop ocnic e atnirT .setneod sod %1,35 me adacifitnedi res edp aigoloite amU .otatnoc ed airc -itru moc )%9,0( 2 e sanretni saneod ed aicnrroced me )%4,1( 3 ,secefni rop )%8,1( 4 ,sotnemila rop )%8,6( 51 ,sotnemacidem a adaicossa )%0,9( 02 ,acitpoidi acinrc aircitru )%63( 87 ,acitpoidi acinrc e acisf airc
saircitrU

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a dugA air citrU


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.912 arugif an sodimuser es-mart -nocne e aircitru ed opitbus od azerutan ad medneped setneqesbus sossap sO .said siod sonem olep rop otnemat -art mes ajetse etneicap o euq edsed ,omsifargomred arap etset riulcni eved mbmat etsE .egniraforo e otnemuget od oepsni ,oab ,odagf ,soilgng ed oaplap a odniulc -ni ,etneicap od otelpmoc ocisf emaxe o ossap odnuges O .22oagitsevni an setnaveler siam apate a aircitru ad azerutan a erbos sovitacifingis sotcepsa e setnaedacnesed serotaf uo setnega sievssop so sodot odnetnoc esenmana
odunimid odunimid odunimid odunimid

a ,socitsngaid sotnemidecorp so sodot eD .22ocisf emaxe e esenmana alep adacidni atiepsus asuac alep sodatneiro emrofnoc oacovorp ed setset e siairotarobal semaxe omoc meb ,otelpmoc ocisf emaxe ues o e etneicap od ad -ahlated airtsih a aulcni euq amrof ed ,odaeniled res edop ocitsngaid o arap olocotorp mu ,sopitbus sodairav sues e aneod atsed edadienegoreteh ad asuac roP .91setneic -ap sod samotnis so arap asuac amu rartnocne ajesed euq ocidm o artsurf euq aneod amu sezev rop aircitru A saircitru sad ocigloite ocitsngaiD
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) 5 2 f er ( S A h c a m u r G e d o d a t p a d A odunimid odunimid et n e m e v e l u o l a m r o n odunimid lamron odunimid odunimid lamron lamron

II opiT oir tide reH amedeoignA I opiT odiriuqdA amedeoignA II opiT oir tide reH amedeoignA I opiT oir tide reH amedeoignA

)lanoicnuf( #HNI-1C

)ovit atitnauq( #HNI-1C

q1C

4C
.a medeoigna od lairotarobal ocitsngaiD - IV ordauQ

.32IV ordauq on odaziramus res edop amedeoigna od lairot -arobal ocitsngaid O .32oirtidereh uo odiriuqda me odacif -issalc res edop sagord rop odasuac on amedeoigna O .2setneicap setsen lamron res amutsoc )HNI-1C( esaretse 1C ed rodibini O .sevarg
saircitr U

siam res a mednet ,lirponisil e lirpalane omoc ,oa agnol ed ACE-I moc merroco euq seleuqa J .sediretsocitroc e socinmatsih-itna moc odatart etnematnorp e evel res amutsoc ,lirpotpac omoc ,oa atruc ed ACE-I rop odasuac
5002 ,6 N ,82 .loV .lotaponumi .grela .sarb .veR 872

agord semrofilibrom sepurE osot ametir e s upL etirtrailoP e setilucsaV e s o t i c ot s a M osohlob edigifneP ofromilop a metirE olufr tse ogir urP .aircit ru ad siaicnerefid socit sngaiD - IIIV ordauQ

.2,1)IIIV ordauq( osufnoc rareg a amrof ed ,aircitru seralimis etnemacigolofrom res medop seidnoc samugla ,licfid ajes on aircitru a omoc aentuc opure racifitnedi arobmE :saircitrU

:laicnerefid ocitsngaiD

.laroproc arutarepmet an aug me etneicap o rahnab uo ,sotunim 02 rop ,Co73 a aug me adibebme ezag ed svarta aug racilpA :acingauqa aircitrU .sacitru ed otnemigrus o arepse es odnauq ,sotunim zed ed odorep mu rop laicifitra ralos rodalumis adnia uo acitmorconom zul ,larutan ralos zul moc oacovorp A :ralos aircitrU .ovitisop etset acidni saroh sies ed odorep mu ed ortned etset od aer an acitru ed otnemigruS .etnemavitcepser sotunim 51 uo sotunim 02 rop gk 5,4 a 5,2 ed osep mu moc ,ortemid ed mc 5,1 ed ,etneicap od axoc a uo osrod o erbos etnemralucidneprep ador amu es-acilpA :aidrat osserp ed aircitrU .sotunim 03 rop ,C4 a alas me oproc od otnemairfser olep sadacovorp res medop sacitru sA .ovit -agen oleg od obuc od etset o odnes ,acitru a zudni oirf oa oproc od oisopxe a sanepA :axelfer oirf oa aircitrU .sot-unim zed rop )C01 a 5( airf aug me oarb o rigremi es-edop ,ovitagen rof oleg od obuc od etset o osaC .sotunim zed ed ortned erroco atsopser A .sotunim ocnic ed odorep mu rop elep a erbos ocitslp ocas me odivlovne oleg ed obuc ed oacilpA :adiriuqda oirf oa otatnoc ed aircitrU .abmor atnop ed otejbo mu rop odutitsbus res edop mrop ,ortemfargomred odanimoned otnemurtsni mu moc ,avit -aer siam oiger a odaredisnoc ,osrod on odazilaer etset :52,12sacisf saircitru sad oagitsevni arap lanoicanretni oazinordap a somazitetnis riuges A .aircitru ed opit etsed ocitsngaid o matilibissop e ortnec reuqlauq me edadilicaf avitaler moc sodazilaer res med -op acisf aircitru ed ocitsngaid o arap setset snuglA O .2mm/g 63 ed sonem ed osserp ed oacilpA :)aititcaf aircitrU( otaidemi ocitmotnis omsifargomreD

.oamrifnoc arap ,aid ortuo me oditeper res eved ovitagen ajes etset o osaC .sacitru ed ot -nemicerapa odipr acovorp etset O .sotunim zed rop Co24 a adiceuqa aug me oproc od laicrap osremi ,otne uo ,eserodus ed otnop a )adirroc .xe( ocisf oiccrexe a etneic -ap o retembuS .etset o spa sotunim zed ed ortned oac -ilpa ad lacol on sacitru megruS :acigrniloc aircitrU .sotunim 51 rop etneicap od oarbetna o erbos )lairotarobal xetrv ed rodarbiv mu aicnreferp ed( oirt -arbiv olumtse ed oacilpA :oirtarbiv amedeoignA .oacilpa ad lacol on sotunim ed ortned megrus sacitru sA .sotunim ocnic a mu rop Co05 a Co83 a adiceuqa aug odnetnoc ocsarf mu racilpA :adiriuqda rolac oa otatnoc ed aircitrU

RCP e amargomeh ,oingonirbifoirc e sanilubolgoirc raticolos oirf oa aircitru ed sosac me $ o r o s - o t u a o d et s e t o o d a z i l a e r r e s e d o p e n u m i - ot u a a i r c i t r u e d a t i e p s u s e d s o s a c s o N * otiepsu s )otnemila,agor d( onegt na es )-( )+( )-( $)+( *)-( )+( )+( )-( )-( )-( )-( )-( )+( )-( )+( )-( )-( )-( 4C )-( )-( )-( )-( )+( )-( )+( )-( )-( )-( )+( )-( )+( )-( )-( )-( )+( )-(

e tilucsa V air citrU ota tnoC air citrU sa citrU mes amedeoignA a cisF air citrU acinr C air citrU a cids ipE e a dugA air citrU opiT

oa covorP

aispiB

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air citr u ad lairota robal oagits evnI - IIV ordauQ

.21)B oadnemocer ed uarg( .ovitisop etset omoc odaredisnoc ,elortnoc omoc adasu ,lirtse anilas oulos ed oejni alep odacovorp amede o euq ,roiam mm 5,1 sonem olep ,ortemid moc acitru amu ed oamrof A .21sotunim 03 spa arutiel aditembus adaluconi elep an oaer A .21aircitru alep adivlovne on etnemacinilc elep an oros od lm 50,0 ed emulov mu ,acimrdartni aiv ,atejni es etnemroiretsoP .21oagufirtnec rop oros od oarapes moc ,aircitru ed oidsipe etnarud ,etneod od eugnas ed ateloc ad svarta odazilaer etset etsE .edadicificepse e edadilibisnes levozar ecerefo ogol -tua oros o moc ocimrdartni etset o aicnirepxe moc sort -nec me mrop ,animatsih ed serodarebil soprocitna-otua sod aneserp a eilava euq lairotarobal etset mu etnemlauta h oN .sodanoiceles setneicap a sodavreser res meved
972 5002 ,6 N ,82 .loV .lotaponumi .grela .sarb .veR

sianoicida semaxE .IIV ordauq on sodimuser otse airc -itru ed sopitbus soirv so arap sodadnemocer rohlem soir -idisbus semaxe sO .adacidni res edop anaedioerit onuf ad setset e edierit ad soprocitna-otua ed asiuqsep A .)sen -umi-otua saircitru samugla me e relztinhcS ed emordns an e etilucsav aircitru an adavele etnemlareg e acitpoidi acinrc aircitru an lamron( avitaer C anetorp ,)sianitsetni sacitnmleh seefni ed avitacidni ailifonisoe uo sesocuel ed oceted an ailixua euq o( otelpmoc amargomeh mu es-raticilos me etsisnoc oagitsevni ed lit aiug mu ,lanoic -nevnoc otnematart o moc arohlem mtbo on euq e evarg siam aneod moc seleuqa araP .socinmatsih-itna ed osu oa ednopser euq evel aneod moc setneicap sod airoiam a arap seagitsevni adnemocer es on 1002 ed 22stsigol -otamreD fo noitaicossA hsitirB ad senilediuG o odnugeS
saircitrU

-itnoc etnemlareg medop ,sacitbmortitna sedadilan -if moc esod axiab me aniripsa mazilitu euq setneicap sO .setneod sod %03 me acinrc aircitru a mavarga socisglana sO .anifrom e anedoc ,sianomroh-on soirtamalfniitna ,ocilcilas-liteca odic od osu o rativE .acilocla otsegni a e oproc od otnemiceuqa o ,lanoicome essertse o rizudeR .adat -imilotua azerutan e aneod ad osruc o erbos ratneirO .adacifitnedi es ,asuac a revomeR :82etneod oa siareg seatneirO )I

,aignil ,emalas ,)aduoG ,latneme ,osemrap( sojieuq ,)avohcna ,ahnidras ,muta( sexiep sodanimreted me olpmexe rop omoc animatsih ed serodarebil sotnemila so ,etnatropmi siam e setnaroc e siarutan sotalicilas ,setnavresnoc omoc seratnemila sovitida odniulcxe at -eid a redecorp otne es-edop sovitida uo animatsih ed serodarebil sotnemila me acir ateid ed oaicossa som -revitbo oirid on eS .92said 51 rop ratnemila oirid mu ed oucexe a ailixua euq rotaf mU .saduga sairc -itru ed sarodasuac siam os seratnemila sanetorp sa euq ratlasser ebaC .92lasuac oxen riregus esenmana a es sanepa sadazilaer res oreved osulcxe ed sateid sA .82otnematart od oicni o spa sesem soirv ratneserpa es edop amedeoigna O .)ACE ad ser -odibini( anisnetoigna ad arosrevnoc amizne ad serodib -ini sod osu o rative meved amedeoigna moc setneicaP .sievnopsid majetse lergodipolc o omoc siat ,anir -ipsa savitanretla arobme ,raluger otnematart o raun

.82etneod od sacitsretcarac s odazilaudividni res eved otnematart O .ossecus ed etnemlevairavni amuhnen odutnoc ,siev -ssop os saciglocamraf-on e saciglocamraf senev -retni sairV .82aiparetocamraf a e siareg seatneiro red -neerpmoc eved otnematart o sacinrc saircitru saN

92

sacisf sair citru sa d otn em at ar T - X ordauQ

-iziritec a ,anidanefoxef a aniziritecovel a ,anidatarolsed a sele oS .52,42)oadnemocer ed B uarg( sodalortnoc sodut -se atneserpa euq acituparet onevretni acin a iutitsnoc aduga aircitru an setnades on 1H-itna sod osu O

.72,12X ordauq on odazilaus -iv res edop emrofnoc sodacidni socifcepse socinmatsih -itna etnemacissalc mt acisf aircitru ed sopit snugla euq ratlasser elav mrop ,sacinrc saircitru san oxiaba som -erev omoc sadadroba res medop sacisf saircitru sA .62otunim/L 8 a 6 ed oxulf me oingixo rartsinimda e saera saiv sad edadilibaemrep ad onetunam ,52sod -iulf ed oisoper arap asonevartni anilas oulos odnasu osonev osseca recelebatse ,seroirefni sedadimertxe sa ravele omoc lareg etropus ed sadidem sartuo sairssecen res oredop ,anirfenipe atsopser ad odnednepeD .sa -nairc san )latot esod ed gm 3,0 ed omixm( gk/gm 10,0 ;sotunim ocnic adac a otluda on lm 5,0 a 2,0 )oarb on ralucsumartni uo aentucbus oejni a euq serohlem soc -itmsalp sievn e adipr siam orosba( laretal-oretn ax -oc an ralucsumartni aicnreferp ed uo aentucbus aiv )lm /gm1( 000.1:1 asouqa oulos me )adatoda res a asotnem -acidem acituparet adidem ariemirp( anirfenipe razilitu :62)lairetra osnetopih ,sotimv ,saesun ,omapseocnorb ,etolg ed amede ,egniral ed amede( aixalifana revuoh eS .52,42said srt rop ,sanairc arap aid/gk/gm 1 e sotluda arap ,OV aid/gm 05 ed esod an )anosinderp uo anolosinderp( laro ediretsocitroc o odasu res eved ,odaicossa amedeoigna moc evarg siam aduga aneod ad oatneserpa a odnauQ .42setnades socinm -atsih-itna ed osu o amedeoigna uo osnetni odirurp met euq setneod soa ovitanretla otnematart mU .42ralimis euq ogla aiccife matneserpa euq anitsabe a e ,anidatarol ,an
saircitr U

.a medeoigna od siaicn erefid socitsngaiD - XI ordauQ

.amedeoigna od siaicnerefid socitsngaid snugla ravresbo somedop .XI ordauq oN .saruodarud siam os siaicnerefid socitsngaid meutitsnoc euq saneod sa ,saroh 69 a 84 ertne etnemacipit marud amedeoigna od sesel sa otnauq -nE .saera saiv sad ourtsbo ed edadilibissop a adar -edisnoc res eved e aixalifana ad odiugnitsid res eved sod -nuforp sodicet sod oduga amede O .sodacitsongaid etnem -licaf os amedeoigna ed socipt sosaC :amedeoignA
5002 ,6 N ,82 .loV .lotaponumi .grela .sarb .veR 082

)aid/ gm 0 3 :sesod satla( aniziriteC anosinid erP o n e f i t o t e c u o o ar e g a 2 1 H - i t n A 2H itna + anizixordiH )atsopser %87-54( anizixordiH anidadatol uo aniziriteC AVUP o e t o r p o t o f e s o n e t or a c a t e B o ar e g a 2 1 H - i t n A obecalp > )gm03( anipexod uo )aid/gm 03( aniziranic uo )gm04( enizixordiH ) % 02 ( anida tpehorpiC ) a h l o c s e ( aniziriteC )%07( onefitotec ,)atsopser %36-75( enizixordiH

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Grau de recomendao A

Grau de recomendao B

Tratamento Anti-histamnico

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1o Passo 2o Passo

Antileucotrieno
3o Passo

Corticosteride

4o Passo Drogas Imunomoduladoras

Grau de recomendao CE D

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