体内和体外变应原测定在过敏性哮喘诊断中的联合应用

目的分析变应原皮肤点刺试验(SPT)和血清吸入性变应原筛查(Phadiatop)及特异性IgE测定联合应用在过敏性哮喘变应原诊断中优势。方法对57例诊断哮喘患儿进行吸入性变应原SPT测定和Phadiatop测定。对其中33例进行血清户尘螨特异性IgE测定。分析本组哮喘患儿SPT结果分布,SPT与Phadiatop结果符合率,户尘螨SPT与其特异性IgE结果符合率。结果儿童哮喘吸入性致敏原分布最常见的为尘螨、真菌、宠物等室内变应原。本组SPT和Phadiatop阳性检出率分别为86%、79%,SPT与Phadiatop符合率86%。5例Phadiatop阴性患儿经SPT和真菌特异性IgE测定证实存在真菌过敏。户尘螨SPT和特异性IgE结果符合率为97%。结论在儿童哮喘相关吸入性变应原诊断中,联合应用体内和体外变应原测定方法可互为补充,有助于提高变应原诊断的敏感性和特异性。     

变态反应性疾病患儿乳胶变应原反应性及抗原交叉性的研究

目的 探讨乳胶变应原皮试阳性与临床的相关性,以及乳胶变应原与其他变应原的交叉反应性。方法 采用国际标准化的变应原试剂13种,利用变应原皮肤点刺试验,对265例变态反应性疾病患儿进行检测。结果在79例乳胶变应原皮试呈阳性反应的患儿中,男性53例,女性26例;平均年龄为5．56岁;冬春季发病者28例,夏秋季发病者51例;哮喘者66例,过敏性皮肤病者5例,过敏性紫癜者1例,荨麻疹者1例,单纯咳嗽者6例。乳胶变应原反应率与性别和年龄无明显关系,而夏秋季反应率高于冬春季,有相应变态反应性临床症状者反应率高于无症状者。另外乳胶变应原与游虫变应原的交叉反应最为常见(100．O％),其次是动物蛋白变应原(62．O％～43．0％),与霉菌或植物花粉变应原交叉反应性最少(10．1％～3．8％)。结论 儿童变态反应人群中,有30％的患儿乳胶变应原皮试呈阳性反应,并且乳胶变应原反应性与性别和年龄无明显相关性,与相关变态反应临床痒状的有无和季节存在着明显相关件,另外乳胶变应原与多种变应原存存着交叉反府件。     

发作期儿童哮喘合并过敏性鼻炎变应原测定及与肺功能的关系

目的探讨发作期儿童哮喘、哮喘合并过敏性鼻炎皮肤变应原以及与肺功能的关系。方法测定46例哮喘组、26例哮喘合并过敏性鼻炎组特异性皮肤变应原，分别测定两组肺功能并与缓解组进行统计学处理。结果儿童支气管哮喘合并过敏性鼻炎的发病率为56．5％，儿童哮喘组及哮喘合并过敏性鼻炎组尘螨阳性率居首位，两组之间无明显差异；肺功能FEV1在哮喘组、哮喘合并鼻炎组与缓解组比较明显降低，具显著性意义；哮喘组与哮喘合并鼻炎组比较哮喘合并鼻炎组明显低于哮喘组，具显著性意义；FEF50在哮喘组、哮喘合并鼻炎组与缓解组比较明显降低，具显著性意义；哮喘组与哮喘合并鼻炎组比较无统计学意义。结论儿童哮喘、哮喘合并过敏性鼻炎两种疾病发病情况密切相关，当两种疾病同时存在时加重肺功能损害。     

变态反应性疾病患儿猫、狗上皮的变应原反应性及抗原交叉性

目的探讨猫、狗上皮变应原与临床的相关性，以及与其他变成原的交叉反应性。方法采用国际标准化的变应原试剂13种，利用变应原皮肤点刺试验，对548例变态反应疾病患儿进行检测。结果判定以变应原试剂所致的皮肤红晕或风团的大小为标准，并以组胺液（1g／L）作为阳性对照，生理盐水作为阴性对照。结果猫上皮变应原皮试呈阳性143例。男98例，女45例；平均5.84岁。狗上皮变应原皮试呈阳性96例。男60例，女36例；平均6．06岁。夏秋季发病最多。许变态反应疾病最多为哮喘，其次是单纯咳嗽。猫和狗上皮变应原皮试均呈阳性64例。与其他变应原交叉反应性：螨虫〉乳〉动物蛋白〉霉菌〉花粉〉杂草。结论儿童变态反应人群中约20％患儿猫、狗上皮变应原皮试呈阳性反应；与年龄和季节有一定关系；此外，猫、狗上皮与其他变应原存在着广泛抗原交叉性。     

超重与正常体重过敏性哮喘儿童特异性免疫治疗前后尘螨皮肤点刺试验强度分析

目的对超重和正常体重过敏性哮喘患儿屋尘螨变应原标准化皮下注射特异性免疫治疗前后皮肤点刺试验(SPT)尘螨过敏原强度的分析。方法 215例SPT屋尘螨、粉尘螨均阳性的过敏性哮喘患儿纳入该研究,按照体重指数分为超重组(63例)和正常体重组(152例),比较两组标准化皮下注射特异性免疫治疗6个月及1年后屋尘螨、粉尘螨过敏原皮肤指数(SI)变化情况。结果在控制检测时间点变异的情况下,超重组组胺皮丘直径大于正常体重组(P0.05);在控制体重变异的情况下,患儿屋尘螨SI、粉尘螨SI均随治疗时间的变化差异有统计学意义(P0.05)。治疗后6个月及1年,两组屋尘螨SI、粉尘螨SI均可见明显下降,但超重组较正常组下降更显著。结论超重过敏性哮喘患儿对组胺反应更强烈;特异性免疫治疗能降低哮喘患儿尘螨过敏强度;在特异性免疫治疗后1年内,超重过敏性哮喘患儿尘螨过敏程度下降更明显。     

标准化变应原皮肤试验与哮喘儿童年龄的关系

目的 探讨标准化变应原皮肤试验结果与哮喘儿童年龄的关系,为避免接触变应原及进行早期特异性免疫治疗提供参考依据.方法 对重庆医科大学附属儿童医院哮喘门诊2005年6月-2007年1月收治的913例哮喘患儿采用欧州丹麦ALK-ABELLO公司提供的13种标准化变应原皮肤点刺液进行试验,以变应原及组胺所致风团直径比判定其反应级别.分析各变应原的阳性率、皮肤指数(SI)、变应性哮喘的危险因素及各年龄组变应原SI和阳性项数.采用SAS 8.2软件进行统计学分析.结果 粉尘螨、屋尘螨和热带螨阳性率和SI分别居前3位.年龄是变应性哮喘的危险因素,其OR值为1.16,95%Cl为1.09～1.24.>5岁哮喘儿童变应原SI显著高于≤5岁哮喘儿童(Z=5.68 P<0.01).2～8岁组哮喘患儿,无论变应原SI还是阳性项数都逐渐增加,其中>5～8岁组哮喘患儿变应原SI和阳性项数水平高且增长快,>8～10岁为高峰平台期,10岁后则呈下降趋势.结论 年龄是变应性哮喘的危险因素.>5岁哮喘患儿的变应原SI显著高于≤5岁哮喘患儿.>5～8岁为变应性哮喘患儿特异性免疫治疗的最佳年龄期.应抓住这个特异性免疫治疗的窗口年龄期,尽早进行特异性免疫治疗.     

婴幼儿哮喘诊断指标意义的探讨

目的研究哮喘诊断的实验室指标在婴幼儿哮喘中的意义。方法支气管哮喘患儿115例，分为婴幼儿即3岁以下、6岁以下和7岁以上3组，正常对照20例。同位素放射免疫法测定血清总IgE(T—IgE)；抗凝静脉血、嗜伊红染色、光学显微镜下计数外周血嗜酸性细胞(EC)；荧光免疫法测定血清嗜酸性细胞阳离子蛋白(ECP)；变应原皮肤点刺试验(SPT)检测过敏原；详细询问哮喘息儿个人及家族过敏性疾病史。结果(1)婴幼儿哮喘组T-IgE,EC,ECP和变应原皮肤点刺试验阳性率与年长儿比较差异无显著性；(2)婴幼儿哮喘组个人过敏性疾病阳性率高于年长儿；(3)哮喘组T—IgE、EC以及ECP较正常对照组显著升高；(4)哮喘组患儿具有较高的个人和家族过敏性疾病史阳性率以及皮肤点刺试验阳性率。结论T—IgE、EC、ECP和变应原皮肤点刺试验适用于婴幼儿哮喘的诊断；在诊断过程中应详细询问家族过敏性疾病史；婴幼儿个人过敏性疾病史对诊断哮喘较年长儿更有价值。     

婴幼儿哮喘的临床特征及其与喘息性疾病相互关系的探讨

本文报告婴幼儿哮喘１０５例。男７０例，女３５例。年龄６￣３６月。致喘诱因中上感占９０．１％。咳嗽、喘息以活动后及晨起为著。多数病例喘声大而全身情况好，呼吸困难仅占２８．６％。听诊除哮鸣音外，伴湿罗音６０例。有个人特应性表现４８．６％，家族特应性史５７．１％。变应原皮试阳性率４２％，血清总ＩｇＥ增高率５２．８％。胸片异常８０例，其中支气管炎性改变７０例。文中就本病喘息机制及其与毛支、喘支、儿童哮喘的     

伴特应质的哮喘患儿190例临床分析

目的 了解特应质与儿童哮喘之间的关系。方法 对190例哮喘患儿进行分析。比较有无特应质的哮喘患儿在哮喘发作频率、无症状天数、最大呼气峰流速、家族史方面的差异。结果 55．3％的哮喘患儿伴特应质，51．6％有阳性家族史，而且伴特应质的哮喘患儿69．5％有阳性家族史，特应质与非特应质的哮喘患儿间在吸入治疗前后的哮喘发作频率、无症状天数方面，差异均有非常显著性（P〈0．01）。结论 儿童哮喘的发生与特应质相关，伴特应质的哮喘患儿吸入激素治疗有效。     

哮喘儿童过敏皮肤点刺试验和血清总IgE检测结果分析

目的 调查本地区儿童哮喘过敏原,为哮喘防治提供科学依据。方法2000年9月一2002年4月对本院呼吸门诊372例患儿采用皮肤点刺过敏原皮试测定。根据临床诊断标准分成3组,儿童哮喘组、咳嗽变异型哮喘组(CVA)、慢性咳嗽组;观察各组过敏原阳性率,并对其中.162例检测血清总IgE,探讨其相关性。结果哮喘组192例,过敏原一个以上阳性161例,阳性率83.85％;CVA组98例,阳性72例.阳性率73.46％;慢性咳嗽组82例,阳性18例,阳性率21.96％。哮喘组、CVA组与慢性咳嗽组相比,差异相当显著(P<0.01),而哮喘组与CVA组无差异(P>0.05)。哮喘组与CVA组主要过敏原为粉尘螨、屋尘螨,阳性率分别为59.3％、67.2％,其次为蟑螂43.71％。血清总IgE测定数值高低与过敏原皮试阳性有相关性。结论过敏原皮肤点刺试验可以作为哮喘的辅助诊断,该方法操作简单易行,与临床疾病相关性好、安全、重复性好,几乎无风险,适于推广应用。     

Specific fungal exposures, allergic sensitization, and rhinitis in infants

Indoor air quality has become increasingly important as we live in a society where the majority of our time is spent indoors. Specific attention has been drawn to airborne fungal spores as a factor affecting indoor air quality. This study targeted shortcomings of other studies by utilizing long-term air sampling and total fungal spore enumeration to determine associations between health outcomes and fungal spore concentrations. Infants (n = 144) were clinically evaluated and had skin prick tests (SPT) for 17 allergens. Airborne fungal spores were collected using a Button Personal Inhalable Sampler (SKC Inc.) for 48 h at a flow rate of 4 l/min. Sampling was conducted in the spring (March-May) or fall (August-October) in 2003-2004. Fungal spores were analyzed using microscopy-based total counting and identified to the genus/group level. Total spore and individual genus concentrations were analyzed for associations with rhinitis and positive SPT results. Overall, concentrations varied widely, between <2 and 2294 spores/m(3). While no relationship was observed between SPT(+) and total fungal counts, several significant associations were found when analysis was conducted on the various fungal genera and health outcomes. Positive associations were obtained between: Basidiospores and rhinitis (p < 0.01), Penicillium/Aspergillus and SPT(+) to any allergen (p < 0.01), and Alternaria and SPT(+) to any allergen (p < 0.01). Inverse associations were found between: Cladosporium and SPT(+) to any allergen (p < 0.05), and Cladosporium and SPT(+) to aeroallergens (p < 0.05). This study indicates that health outcome may vary by fungal genera; some fungal types may have sensitizing effects while others may have a beneficial role.     

儿童哮喘过敏原检测及临床意义

目的 探讨皮肤过敏原点刺试验、血清过敏原检测在儿童哮喘病因诊断、治疗的临床意义。方法 应用粉尘螨及屋尘螨过敏原对121例哮喘患儿及111例对照组儿童进行皮肤点刺试验，其中59例哮喘患儿应用免疫条带印记法进行血清过敏原检测。结果 ①121例哮喘患儿尘螨过敏原皮肤点刺试验总阳性率为28．10％，高于对照组（P〈0．05）。②粉尘螨过敏原阳性33例（27．27％）；屋尘螨过敏原阳性32例（26．45％）。③粉尘螨及屋尘螨过敏原皮肤点刺试验结果与哮喘急性发作严重程度有关。④59例哮喘患儿血清过敏原检测阳性46例（77．97％），其中猫毛26例（44．07％）。狗毛23例（38．98％），粉尘螨13例（22．03％），屋尘螨12例（20.34％），海鲜组合10例（16．95％）。⑤皮肤点刺试验与血清过敏原检测的尘螨过敏原检出率，差异无统计学意义。结论 皮肤点刺试验可作为儿童哮喘过敏原检测优先选用的方法。     

Domestic fungal viable propagules and sensitization in children with IgE mediated allergic diseases

In order to study the possible relationship between domestic fungal exposure and sensitization to fungi, the homes of 20 children with allergic diseases (mainly bronchial asthma) were inspected for visible fungal growth and airborne viable fungal propagules were sampled. Inclusion criterion was sensitization to at least one of the tested fungi as shown by proof of specific IgE in serum. Twelve of 19 homes (63%) revealed a considerable amounl of viable fungal propagules and/or visible fungal growth. Penicilli-um, Cladosporium, Aspergillus, Mycelia sterilia and yeasts were most prevalent. There was no clear-cut relationship to serologically proven sensitization.     

Allergic bronchopulmonary aspergillosis in cystic fibrosis

ABSTRACT. We determined prospectively over a 12-month period the importance of the fungus Aspergillus in patients with cystic fibrosis.
Aspergillus species was cultured from 10 out of 116 children and adolescents (8.6%), and from 25 of the 1073 sputa (2.3%) collected from these patients. Eighteen of these subjects (15.5%) had positive allergen skin prick tests to Aspergillus species or Aspergillus fumigatus . Fifty-three patients (13%) had blood collected for precipitins and 7 (13%) exhibited type III hypersensitivity to Aspergillus fumigatus . Although 26% had an IgE greater than 200 I.U./ml, only one patient had an IgE greater than 1,000 I.U./ml. We found no evidence of an association between severity of lung disease and either colonisation by or sensitisation to Aspergillus .
No patient fulfilled all our criteria for the diagnosis of allergic bronchopulmonary aspergillosis (ABPA). One teenager (with wheezing, pulmonary infiltrate, positive skin tests, positive sputum culture and markedly elevated IgE) may have had an episode of ABPA. We studied three other children with co-existent asthma in whom it was difficult to establish whether the asthma was related to sensitivity to Aspergillus .
We conclude that ABPA is an uncommon complication of cystic fibrosis in our clinic.     

Respiratory allergy in cystic fibrosis

Allergen skin testing has been used to define allergy in cystic fibrosis. The incidence and significance of allergy, particularly the presence of co-existent asthma, remains controversial. We performed allergen skin prick tests on 78 children with C.F. and most had measurement of pulmonary function: Fifteen of those with positive skin tests and fifteen with negative skin reactions were selected for further analysis. Although we confirmed that there was a higher incidence (42%) of positive tests in the C.F. population than in a general population, the allergen distribution was different from that seen in asthma, with a much higher incidence of reactions to moulds. This probably represents passage of allergens through damaged bronchial mucosa rather than a genetically inherited atopic tendency. There was no correlation between positive allergen skin tests and objective evidence of asthma. We conclude that allergen skin tests are an unreliable guide to the presence of co-existent asthma in children with C.F.     

温州地区402例哮喘患儿特应质现象分析

目的 对温州地区15岁以下哮喘患儿特应质现象进行分析,探讨其临床及理论价值.方法 回顾性分析402例哮喘患儿皮肤过敏原诊断试验、血清特异性IgE、总IgE、个人过敏史、家族史、过敏原检出率、类型及与年龄关系.结果 哮喘发病有家族聚集倾向,家族过敏史总阳性率为52.74%.个人过敏史总阳性率为61.69%.过敏原皮肤诊断试验和过敏原血清特异IgE阳性率达83.58%,吸人性过敏原阳性人数占检测患儿的74.13%,其中以粉尘螨(61.44%)、屋尘螨(58.96%)为主;食人性过敏原阳性占24.38%,以小虾(16.67%)、牛奶(8.46%)为主.血清总IgE阳性率87.9%,总IgE阳性组和阴性组的哮喘患儿血清嗜酸性细胞阳离子蛋白(ECP)、户尘螨sIgE(D1)、粉尘螨sIgE(D2),皮肤过敏原诊断试验(pt)、家族过敏史、个人过敏史差异有统计学意义(P均≤0.05).哮喘患儿3岁前、后过敏原分布不同,3岁以后吸人性过敏原阳性为主.发病诱因中以上呼吸道感染为最多,哮喘症状发作的时间主要集中在临睡、夜晚、清晨.结论 儿童哮喘存在明显特应质现象,对其的正确认识和诊断对哮喘免疫机制的深入研究、综合治疗如在糖皮质激素吸入治疗的基础上,增加患儿教育、过敏原避免、特异性的免疫治疗等具有实用和理论指导意义.     

908例哮喘儿童皮肤点刺试验分析

目的：分析哮喘儿童皮肤点刺试验结果,探讨皮肤点刺试验的临床应用及理论价值。 方法：使用丹麦爱尔开-阿贝优公司的吸入组点刺试剂和德国默克公司生产的阿罗格食入组点刺试剂进行皮肤点刺试验,组胺液为阳性对照,生理盐水为阴性对照。结果：①908例哮喘儿童皮肤点刺试验阳性率为77.4%。吸入变应原总阳性率76.9%,吸入变应原中以粉尘螨和屋尘螨阳性率居高,分别为72.4%和74.7%;食入变应原总阳性率37.1%,食入变应原在前3位的为小虾22.9%,金枪鱼7.3%,蚌6.7%。②皮肤点刺结果为强阳性（++++）的以粉尘螨和屋尘螨为主,分别为64.0%和66.4%,其次为霉菌1,阳性率为7.1%。③1～14岁哮喘儿童吸入变应原与食入变应原阳性率随年龄增加均有升高趋势,在各年龄分组中吸入变应原与食入变应原各年龄组两两比较差异均有显著性意义（P<0.05）。结论：908例哮喘儿童皮肤点刺试验有较高的变应原检出率,对哮喘的流行病学调查及特异性免疫治疗均有一定的指导意义。［中国当代儿科杂志,2009,11（7）：559-561］     

Fungal allergy in children

One hundred and thirty-nine children (85 hoys) from a paediatric allergy clinic were included in a study which aimed to relate disease traits of fungal allergy to measured serum IgE antibodies to fungi. A structured case history was recorded and the children were subject to a panel of skin prick tests which included common inhalant allergens and two fungi, Cladosporium herbarum and Alternoria alternata . Serum IgE antibodies to 16 different fungi were assayed by RAST using the Pharmacia extended panel. Forty-seven of the children were positive to fungal RAST and many of them were positive to multiple fungi. C. herbarum gave the highest frequency of positive results. The best combination of three fungi for detecting fungal sensitization was C. Herbarum, Penicillium notatum and Mucor racemosus . Skin prick test (SPT) failed to uncover fungal sensitization in many children with broad RAST sensitivity. Children with RAST positivity to fungi generally had more severe asthma and more frequently recognised summer and autumn to be a difficult period compared with children without such positivity. In stepwise regression analysis, positive SPT for cat had the best explanatory value for asthma and positive C. herbarum RAST the second best. Children with fungal RAST positivities were not over-represented among cases with allergic rhino-conjunctivitis but there was a strong association to eczema. The latter is possibly explained by concomitant sensitization to fungi colonizing the human skin. It is suggested that the identification of fungal allergy in asthmatic children will help ensure that proper anti-inflammatory treatment is instituted during peak spore periods.     

具有喘息症状或过敏性疾病的年幼儿皮肤点刺试验结果分析

目的：通过分析0~5岁儿童变应原皮肤点刺试验结果,了解具有喘息症状的可疑哮喘及过敏性疾病症状的患儿对吸入变应原过敏反应的特点,为儿童哮喘及过敏性疾病的早期诊断提供依据。方法：选择2010年9月1日至12月31日长沙市某社区0~5岁具有喘息症状或过敏性疾病症状的患儿共102例为变应原筛查组;对照组选择同年龄组无喘息及过敏性疾病史的儿童94例。两组均进行变应原皮肤点刺试验。结果：变应原筛查组皮肤点刺试验阳性率61.8%（63/102）明显高于对照组的9.6%（9/94）,差异有统计学意义（P<0.05）;反复喘息合并过敏性鼻炎者的皮肤点刺试验阳性率明显高于单纯喘息组（P<0.05）;喘息次数与皮肤点刺试验阳性率呈正相关（r=0.91,P<0.05）;对螨虫的皮肤点刺试验阳性率（24.2%）明显高于其他过敏原（3.5%）,差异有统计学意义（P<0.05）;粉尘螨的皮肤点刺阳性率（50.0%）明显高于屋尘螨（14.7%）,差异有统计学意义（P<0.05）。结论：早期儿童喘息可能是发生过敏性哮喘的重要因素;变应原皮肤点刺试验是诊断过敏性疾病的重要依据,并有助于评估喘息患儿对吸入性变应原的过敏反应特点。     

海南儿童哮喘常见吸入性变应原的调查

目的 了解海南地区儿童哮喘常见吸入性变应原,探讨有效实施变应原避免的措施,为成功开展特异性免疫治疗提供依据.方法 对2 361例哮喘儿童进行13种常见过敏原皮肤点刺试验,对其中450例患儿进行10种过敏原体外特异性IgE检测.结果 2 361例哮喘患儿皮肤点刺阳性率为86.0%,其中,屋尘螨及粉尘螨阳性率分别为91.2%及89.3%,热带螨为86.3%,且阳性级别高.对三种螨呈三级以上皮肤点刺阳性反应的患者分别占65.7%、65.4%和58.2%.动物皮毛中,狗毛阳性率为22.4%,猫毛14.4%;德国小蠊及美洲大蠊分别为28.7%及21.9%,但其阳性级别通常很低.450例体外过敏原检测阳性率为72.4%,其中仍以螨虫阳性率最高,屋尘螨66.2%,粉尘螨59.6%.结论 屋尘螨、粉尘螨和热带螨是海南地区最重要的过敏原,其阳性率和阳性级别均比国内其他地区高.狗毛、猫毛、蟑螂等过敏原在海南也占一定比例.