食物过敏治疗的研究进展

近年来，食物过敏的发生率逐年增加，严格避免对致敏食物的接触是目前有效的治疗手段，但在实际工作中困难很大。随着对过敏发生机制及食物过敏原自身结构特点的逐渐深入了解，一些新的治疗手段正在研究中。除外经典的免疫疗法，目前正在研究的免疫治疗途径包括Ｔ细胞肽免疫法、重组致敏蛋白突变免疫法及抗ＩｇＥ抗体疗法。随着基因治疗的进展，以质粒为载体的 ＤＮＡ免疫疗法和免疫共刺激序列ＤＮＡ的应用正被引入食物过敏的治疗领域。此外，由于肠道免疫系统所具有的特异性，益生菌疗法作为食物过敏的治疗手段已日益受到重视。本文综述一些食物过敏治疗的研究进展，为科学研究和临床实践提供线索。     

食物过敏治疗的研究进展

近年来，食物过敏的发生率逐年增加，严格避免对致敏食物的接触是目前有效的治疗手段，但在实际工作中困难很大。随着对过敏发生机制及食物过敏原自身结构特点的逐渐深入了解，一些新的治疗手段正在研究中。除外经典的免疫疗法，目前正在研究的免疫治疗途径包括T细胞肽免疫法、重组致敏蛋白突变免疫法及抗IgE抗体疗法。随着基因治疗的进展，以质粒为载体的DNA免疫疗法和免疫共刺激序列DNA的应用正被引入食物过敏的治疗领域。此外，由于肠道免疫系统所具有的特异性，益生菌疗法作为食物过敏的治疗手段已日益受到重视。本文综述一些食物过敏治疗的研究进展，为科学研究和临床实践提供线索。     

儿童食物过敏免疫治疗研究进展

儿童食物过敏的发生率逐年增加,目前对食物过敏的治疗主要是缓解症状而难以治愈.随着分子免疫学的发展及对食物过敏发生机制等的深入研究,一些行之有效的治疗措施正应用于临床.该文就食物过敏的免疫治疗方法,包括T细胞肽及重组致敏蛋白突变免疫疗法、免疫刺激的DNA序列、辅助T细胞激活作用的抑制、过敏诱导的细胞因子的抑制及炎性细胞迁移的抑制等作一综述.     

尘螨过敏性支气管哮喘的舌下免疫治疗研究进展

在尘螨过敏性哮喘的治疗方法中,螨变应原舌下免疫疗法日益受到关注.其机制尚不十分明确,但可以调节Th1/Th2失衡,促进Th1反应.治疗过程中可降低IgE,升高IgG4,抑制过敏反应的发生.口腔黏膜中的朗格汉斯细胞对提高机体耐受性也发挥着一定的作用.近年来越来越多的研究证明舌下免疫疗法具备有效性、安全性及其良好的依从性....     

儿童支气管哮喘的免疫疗法及其进展

支气管哮喘(哮喘)的免疫疗法分特异性和非特异性两类,特异性免疫疗法目前的进展主要集中于研究作用机制以及纯化优化变应原制剂这两个方面.随着哮喘分子及细胞免疫学机制研究的日益深入,各种新的非特异性免疫治疗策略也层出不穷,其中抗IgE单克隆抗体发展最为成熟,已获得美国食品药品管理局认可用于中、重度哮喘的治疗.其他如抗免疫刺激序列DNA疫苗、辅助T细胞2型细胞因子疗法和抗T细胞疗法等也陆续投入哮喘治疗的研究.该文对特异性免疫疗法和非特异性免疫疗法及其研究进展进行综合性评述,并总结免疫疗法的进一步发展方向.     

血清特异性IgE和IgG检测在儿童特应性皮炎过敏原诊断中的应用

目的探讨血清特异性IgE和IgG检测在儿童特应性皮炎过敏原诊断中的应用和意义。方法对64例患特应性皮炎的儿童,采用酶联免疫方法检测血清中食物过敏原的特异性IgG,同时采用免疫印迹方法检测血清中食物过敏原和吸入性过敏原的特异性IgE。结果食物过敏原特异性IgG和特异性IgE的检测结果不一致(P<0.01),食物过敏原特异性IgG的总阳性率为93.75%,主要食物过敏原是牛奶和鸡蛋。食物过敏原特异性IgE的总阳性率为46.88%,主要食物过敏原是鸡蛋和鱼虾蟹。吸入性过敏原特异性IgE的总阳性率为34.38%,主要过敏原是尘螨和霉菌。在0～1岁的特应性皮炎患儿中,以食物过敏原特异性IgE阳性多见;1岁以上的患儿吸入性过敏原特异IgE阳性多见,同时合并呼吸道过敏症状增多(P均<0.05)。结论食物过敏原和吸入性过敏原均是引起儿童特应性皮炎的重要原因。联合测定食物过敏原的特异性IgE和特异性IgG是变态反应性皮肤病患儿诊断食物过敏原的有效方法。尽早采取有效的环境控制,对治疗儿童特应性皮炎和预防呼吸道过敏性疾病的发生非常重要。     

非IgE介导食物过敏的免疫机制和潜在生物标志物北大核心CSCD

非IgE介导食物过敏免疫机制复杂, 缺乏具有特异性的实验室指标, 诊断和治疗方式单一, 常出现疾病误诊和诊断延迟, 因此迫切需要深入了解其发病机制, 寻找特异性生物标志物和新的治疗靶点。现从特异性免疫和非特异性免疫两方面总结目前关于非IgE介导食物过敏免疫机制的研究成果, 探讨能够辅助疾病诊断和病情评估的潜在生物标志物, 并为该类过敏性疾病的治疗提供新的思路。     

加强对儿童食物过敏相关胃肠道疾病的认识

食物过敏是儿童常见疾病,可累及多个系统。如果引起消化道黏膜损伤,以消化道症状为主要表现的一类疾病称为食物过敏相关胃肠道疾病,以非IgE介导为主,也可经IgE介导或IgE和非IgE混合介导。食物过敏相关胃肠道疾病的临床表现大多非特异性,诊断有赖于食物回避+激发试验。治疗原则主要包括治疗食物过敏引起的急性全身反应、回避食物过敏原及营养治疗、变应原治疗和长期管理。同时初步提出了该领域的主要研究方向。     

儿童过敏性疾病免疫治疗新进展

变应原特异性免疫治疗（AIT）属主动免疫疗法,能调节固有免疫和适应性免疫。变应性鼻结膜炎、哮喘的AIT新途径为淋巴结内免疫治疗和表皮内免疫治疗,但有效性及标准方案仍需进一步研究。低变应原性的重组变应原衍生物和具有免疫原性的肽段,联合新佐剂均是新的AIT研究方向。食物过敏口服免疫治疗具有一定疗效,但不良反应尤其是严重过敏反应的风险仍是需要解决的问题。近年来,被动免疫疗法应用于过敏领域的进展迅速,多种单克隆抗体生物制剂在传统治疗控制不佳的哮喘、特应性皮炎中有着较好效果,AIT联合生物制剂治疗提供了新的治疗选择。     

特异性免疫治疗在过敏性疾病中的作用研究进展

特异性免疫治疗是目前惟一一种针对过敏性疾病的对因、对症治疗方法,包括特异性皮下免疫治疗及特异性舌下免疫治疗.研究证实特异性舌下免疫治疗在过敏性疾病中疗效肯定,其通过产生特异性抗体,调节变应原特异性T细胞的反应类型而发挥抗过敏作用,而且不良反应相对较轻,近年来应用较为普遍.

Abstract：

The specific immunotherapy is the etiological treatment and remission the symptoms of anaphylactic disease. It includes subcutaneous immunotherapy and sublingual immunotherapy(SLIT). SLIT is a new pathway. Many studies have confirmed its effectiveness in the treatment of anaphylactic disease. Due to its mild side effect, it is used commonly.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Psychopathologie du syndrome d’Asperger et « aspérigisation » de la société contemporaine

The author has attempted here to point out, just for a start, the characteristics of Asperger syndrome from the point of view of psychopathology through a rereading of Hans Asperger's original paper (1944). This thesis merits reevaluation, if for no other reason than to fill the gaps in operational diagnostics based on the DSM. It is found by rereading that Asperger's view of the principal disturbances of autistic psychopathy include a “disturbance of natural evidence” or a “crisis of common sense”. This question of natural evidence that he evokes with regard to autistic psychopathy corresponds to W. Blankenburg's natural evidence, which constitutes a key concept for comprehending schizophrenia in the form poor-symptom (“symptomarme Schizophrenie”) that he observes in the speech of his patient Anne Rau. One can deduce from this that in terms of fundamental disturbances, Asperger syndrome and this “symptom-poor” schizophrenia overlap at the level of loss of natural evidence. It is moreover possible to classify Asperger syndrome among the disturbances of spacing in the sense meant by the evolutionary psychiatry of A. Stevens and J. Price. The author then develops our comprehension of Asperger syndrome from the point of view of the perspective proposed by the notion of resilience in people with Asperger syndrome and of the possibility for them, through these mechanisms of adaptation, to find in the organization of the personality of the “as if” type a position of relative equilibrium. They concur or overlap in the creation of crutches, of borrowed personalities secondarily legitimated by the reaction of the socius. This will end up in the production of inventions and œuvres (works). Clearly, one rarely encounters several cases that one could consider pertinently to be “successful” Asperger syndrome. Finally, the author notes that one can find a sort of isomorphism between Asperger syndrome and contemporary society when he proposes the term “asperigisation” to characterize our society, given that the equilibrium between emotion and logic is strongly disturbed in these patients, in whom logic undergoes hypertrophy while emotion is impoverished. From this perspective, the author hopes to suggest reasons for the increase in the number of cases of Asperger syndrome in the clinical setting and in society in general in our contemporary era.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.