El asma premenstrual y su relación con las hormonas sexuales femeninas, marcadores de atopia y las variaciones menstruales de los leucotrienos

Zusammenfassung

INTRODUCTION: Premenstrual asthma (PMA) has been associated with severe and difficult asthma control. The causes of asthma exacerbation in the premenstrual period are unclear. OBJECTIVES: 1. To analyze the role of female sex hormones (estrogen and progesterone) in the PMA. 2. To analyze the relationship between markers of atopy (total IgE and specific IgE Phadiatop®) and PMA. 3. To analyze the leukotrienes such as inflammatory mediators in the pathogenesis of PMA. METHODS: It was conducted in asthmatic women of fertile age a questionnaire of respiratory symptoms and PF record for a full menstrual cycle to classify patients as asthma with or without PMA. PMA is considered to deterioration> / = 20% clinical and / or functional premenstrual respect to preovulatory. We classified each case according to the criteria of asthma severity (GINA). All of them underwent blood levels in both the premenstrual period as preovulatory: • Estrogen and progesterone • Atopy markers: total IgE and screening neumoalergenos (Phadiatop®) and specific IgE in which showed a positive screening. • Leukotriene C4. RESULTS: Women with premenstrual asthma:  They Showed premenstrual (relative to preovulatory) a slight decrease in estrogen (111.49 pg/ml preovulatory vs. 95.90 pg/ml premenstrual) and a significant increase (p = 0.001) levels of progesterone (0.83 versus 6.83 ng/ml). Women without PMA showed a similar behavior, as their estrogen levels were unchanged between the two periods (131.31 versus 123.83 pg/ml) and increased progesterone (1.39 vs. 6.31 ng/ml). The estrogen/progesterone ratio in the premenstrual period was similar for women with and without PMA (p = 0.31).  Had total IgE levels> 100 kU/l 26 (82.9%) and 12 of premenstrual asthma (46.7%) who did not meet the criteria of PMA (p = 0.013). Phadiatop® were positive in 21 (67.7%) of PMA and 14 patients (50%) of those without PMA (p = 0.17). We performed specific IgE-positive women Phadiatop® without finding regarding the PMA, and being values above 0.35 kU/l primarily for Lolium (62.9%), Olivo (60%) and Dermatophagoides pteronyssinus (54.3%).  Leukotriene C4 values showed no differences between the preovulatory and premenstrual periods in women with PMA (1.50 ng/ml vs 1.31 ng/ml; p = 0.32) or which did not meet this criterion (1.40 ng/ml vs 1.29 ng/ml; p = 0.62). There were no differences in leukotriene levels between women with and without PMA. The results were similar for each group of asthma severity. CONCLUSIONS: 1. No differences in premenstrual estrogen and progesterone levels between asthmatic women with or without PMA. Further studies are required to analyze possible etiologic factors related to PMA. 2. The PMA seems to relate more to the values of total IgE and not to specific allergens. Atopy influences the clinical manifestations of premenstrual asthma in women of fertile age. 3. Leukotriene C4 not appears to be involved in the pathogenesis of PMA, or support the use of leukotriene modifiers in the specific treatment of premenstrual asthma, at least in moderate degree. This situation is reproduced in our data at all different levels of asthma severity GINA.