Prevalence and severity of asthma and allergies in schoolchildren in Lhasa, Tibet

BACKGROUND: The International Study of Asthma and Allergies in Childhood (ISAAC) demonstrated that large variations existed in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis and eczema throughout the world and that environmental factors and lifestyle customs are major determinants of the prevalence and severity of these diseases. However, the relevant data about children living at high-altitude locations were considered to be underreported. OBJECTIVE: The ISAAC Phase III programme was carried out in Lhasa, the Tibetan Autonomous Region in China, at an elevation of 3658 m above sea level to examine the occurrence of asthma, allergic rhinoconjunctivitis and eczema in schoolchildren aged 13-14 years. METHODS: All 3196 schoolchildren in eight public junior high schools in urban Lhasa who were confirmed to be 13-14 years old were invited and participated in both written and video questionnaire investigations, among which 3190 pieces of data (49.8% of boys and 50.2% of girls) were validated and analysed. RESULTS: Among the overall observations, the prevalence of 'having ever experienced wheezing', 'current wheezing' and 'diagnosed to have asthma' was 1.4%, 0.8% and 1.1%, respectively. The prevalence of current exercise-induced asthma and current nocturnal cough was 7.1% and 4.6%, respectively. The current prevalence of allergic rhinoconjunctivitis and eczema was 5.2% and 0.4%, respectively. In addition, the prevalence of rhinoconjunctivitis symptoms during the past 12 months showed no discernable differences throughout the year. CONCLUSION: The prevalence of asthma, allergic rhinoconjunctivitis and eczema over the past 12 months was the lowest among the centres, that performed ISAAC worldwide.     

PLGA为佐剂的OVA纳米疫苗皮下注射可预防小鼠过敏反应性气道炎症和调节Th1/Th2反应

目的 探讨聚乳酸.羟基乙酸共聚物[poly（D,L-lactic-co-glycolic）acid,PLGA]包裹的卵清蛋白（OVA）纳米癌苗（POM）对哮喘小鼠的免疫治疗效果.方法 包裹不同剂量（低、中、高）的OVA纳米粒子和对照（OVA、空白纳米粒子、PBS）通过皮下注射给予小鼠,再用OVA进行致敏和激发,通过肺组织学、支气管肺泡灌洗液（BALF）细胞计数、测定BALF和脾细胞培养上清液中细胞因子的含量,观察小鼠呼吸道炎症和免疫学改变.结果 肺部组织学和BALF中细胞计数结果显示,与PBS对照组相比,OVA治疗组、中剂量和高剂量OVA纳米组的肺部嗜酸性浸润显著减轻,BALF中总细胞和嗜酸性细胞显著减少.卸胞因子测定结果显示,与PBS对照组相比,中、高剂量OVA纳米组的BALF和脾细胞培养上清液中IFN-γ显著升高,Ⅱ,4水平显著降低.OVA治疗组中IL-4水平显著下降,而IFN-γ水平无显著差异.结论 OVA纳米疫苗可预防哮喘嗜酸性气道炎症,其可能的机制之一是调节了过敏性哮喘的Th1/Th2失平衡反应.     

The effect of immunotherapy on eosinophil accumulation and production of eosinophil chemotactic activity in the lung of subjects with asthma during natural pollen exposure

Two groups of birch pollen--allergic patients with seasonal rhinoconjunctivitis and asthma were followed during two consecutive birch-pollen seasons, one group, N = 10, during a season with high pollen load, and one group, N = 15, during a season of low pollen load. Half the patients were treated with immunotherapy (IT) for 3 and 4 years, respectively. The other half of the patients served as control group (non-IT). Bronchoalveolar lavage (BAL) was performed once before each season and once during the pollen season. Eosinophil (EOS) numbers in BAL were increased (p less than 0.01) during the season with high pollen load but not in the season with a low pollen load, and this increment was absent in the IT-treated group. Also, the EOS cationic protein levels were raised in the non-IT-treated group during the season with a high pollen load. The levels of EOS and neutrophil chemotactic activity were raised in BAL in both seasons in the non-IT-treated group compared with the IT-treated group (p less than 0.02, p less than 0.003, p less than 0.04, and p less than 0.005 in high- and low-load pollen season, respectively). Serum and BAL eosinophil chemotactic activity (ECA) were positively correlated (p less than 0.001). We conclude that there is an influx of active EOSs into the lung of pollen-allergic patients with asthma during a pollen season, which may be abrogated by IT. Furthermore, the generation of ECA appears to be an extremely sensitive marker of antigenic exposure, and the potent inhibition of the generation of ECA by IT may provide a clue as to the mechanism of this treatment.     

卡介苗多糖核酸对支气管哮喘合并鼻炎患儿治疗的研究

目的 探讨卡介苗多糖核酸(BCG-PSN)对支气管哮喘合并鼻炎患儿Th1/Th2功能及肺通气功能的影响.方法 37例哮喘患儿随机分为治疗组和对照组两组.按照分级治疗的标准给与相应的糖皮质激素吸入治疗,治疗组加用BCG-PSN,随访6个月,比较治疗前和治疗后血清IFN-γ、IL-4的浓度及IFN-γ/IL-4比值、血浆总IgE、肺功能、鼻炎积分、哮喘发作需急诊就诊的次数、呼吸道感染的次数.结果治疗后治疗组,IL-4、IgE明显下降,IFN-γ及IFN-γ/IL-4比值明显升高;差异有统计学意义(P＜0.05),而对照组无明显改变,差异无统计学意义(P＜0.05).两组肺功能均明显改善,差异有统计学意义(P＜0.05).治疗组哮喘发作需急诊就诊的次数为(0.81±0.20)次,对照组为(1.72±0.80)次,差异有统计学意义,(t=4.15,P＜0.05);治疗组呼吸道感染(1.15±0.55)次,对照组(3.21±0.73)次,差异有统计学意义,(t=3.98,P＜0.05);治疗组鼻炎发作(1.31±0.42)次、对照组(1.11±0.39)次,差异无统计学意义,(t=2.31,P＜0.05).结论 BCG-PSN具有纠正Th1/Th2失衡,减轻气道炎症,改善肺通气功能,提高免疫力的作用.对于哮喘合并过敏性鼻炎的患儿,除针对气道慢性炎症使用糖皮质激素进行抗炎治疗外,同时应重视免疫调节治疗.     

发病前细菌感染抑制过敏性哮喘发作的实验研究

目的： 研究发病前细菌感染对过敏性哮喘发病的影响。 方法： 用豚鼠作动物模型，观察金黄色葡萄球菌、大肠杆菌、链球菌、肺炎双球菌等4种呼吸道常见细菌感染之后哮喘发作时肺泡灌洗液中的白细胞总数、酸性粒细胞总数和百分比以及肺部的病理变化。 结果： 各细菌感染组肺泡灌洗液(BALF)中的白细胞总数均明显低于对照组，金黄色葡萄球菌组和大肠杆菌组酸性粒细胞总数和百分比明显降低，病理结果表明各细菌感染组的病变程度都要明显轻于对照组。 结论： 部分细菌感染后能够抑制哮喘的发作。     

Allergen immunotherapy induces a suppressive memory response mediated by IL-10 in a mouse asthma model

BACKGROUND: Human studies have demonstrated that allergen immunotherapy induces memory suppressive responses and IL-10 production by allergen-specific T cells. Previously, we established a mouse model in which allergen immunotherapy was effective in the suppression of allergen-induced asthma manifestations. OBJECTIVE: In this study, we examined whether immunotherapy induces a long-lasting effect and investigated the role of IL-10 in successful immunotherapy. METHODS: Ovalbumin-sensitized BALB/c mice were treated with 3 injections of ovalbumin (1 mg, subcutaneous) on alternate days. After a short interval (1 week) and after a long interval (5 weeks), mice were challenged by ovalbumin inhalation, and subsequently, airway reactivity, airway eosinophilia, ovalbumin-specific IgE, and T(H)2 cytokine profile were measured. Flow cytometry and blocking of IL-10 receptors in vivo were used to gain insight in the role of IL-10 in the beneficial effects of allergen immunotherapy. RESULTS: After a long interval between ovalbumin immunotherapy and ovalbumin challenge, the development of airway eosinophilia and hyperresponsiveness to methacholine were as strongly suppressed as after a short interval. These suppressive effects coincided with significantly reduced serum ovalbumin-specific IgE levels and T(H)2 cytokine production. On immunotherapy, the IL-5:IL-10 ratio in the bronchoalveolar lavage fluid shifted toward IL-10. In ovalbumin-restimulated lung cell and thoracic lymph node cultures from these mice, IL-5 levels dramatically decreased, whereas the percentage of IL-10(+)CD4(+) T cells was not affected. Finally, in mice treated with mAb against IL-10 receptors, the beneficial effects of immunotherapy were largely abrogated. CONCLUSION: These data demonstrate that allergen immunotherapy induces a memory suppressive effect in which IL-10 is essential.     

The effect of passive smoking on asthma symptoms,atopy,and airway hyperresponsiveness in schoolchildren

Passive smoking is a major cause of respiratory morbidity, and is associated with increased bronchial responsiveness in children. To evaluate the effect of smoking by a parent on asthma symptoms, atopy, and airway hyperresponsiveness (AHR), we conducted a cross-sectional survey of 503 schoolchildren that involved questionnaires, spirometry, allergy testing, and a bronchial challenge test. If the PC20 methacholine was less than 16 mg/mL, the subject was considered to have AHR. The prevalence of a parent who smoked was 68.7%. The prevalence of AHR was 45.0%. The sensitization rate to common inhalant allergens was 32.6%. Nasal symptoms such as rhinorrhea, sneezing, nasal itching, and nasal obstruction were present in 42.7%. Asthma symptoms such as cough and wheezing were present in 55.4%. The asthma symptoms were significantly more prevalent in children who had a parent who smoked than in those whose parents did not. The nasal symptoms, atopy, and AHR did not differ according to whether a parent smoked. In a multiple logistic regression model, the asthma symptoms and atopy were independently associated with AHR, when adjusted for confounding variables. Passive smoking contributed to asthma symptoms in schoolchildren and was not an independent risk factor of airway hyperresponsiveness in an epidemiological survey.     

实验性过敏性哮喘豚鼠外周血液淋巴细胞β肾上腺素能受体系统的变化

在建立外周血液淋巴细胞β受体测定法的基础上,动态地观察了实验性过敏性哮喘豚鼠外周血液淋巴细胞中β受体最大结合容量(Bmax)、cAMP含量,以及血浆中儿茶酚胺(CA)含量的变化,发现它们都呈明显的时相性改变。通过分析它们发生的时间过程和相互关系,认为:在过敏性哮喘时所观察到的淋巴细胞β受体Bmax值的降低,乃是高水平内源性儿茶酚胺所致受体失敏的结果;并对所观察到的变化的意义作了初步探讨。     

208例哮喘患儿吸入性过敏原的调查分析

本文报道了208例哮喘患儿吸入性过敏原的调查结果. 采用变应原浸液皮肤点刺方法. 皮试阳性者169例, 占81.25%.变应原浸液内含18种常见吸入性过敏原. 尘螨的阳性率最高达78.85%, 其次是室尘的阳性率为35.58%, 烟的阳性率为32.69%.无一例对其它变应原呈阳性反应, 过敏原皮试阳性率无性别差异, 与有无个人及家庭过敏史无关. 哮喘婴幼儿皮试阳性率低于哮喘患儿, 哮喘皮试阳性率在年龄组之间有显著差异(P＜0.01), 有随着年龄加大而渐增的趋势. 结果提示: 尘螨、空气污染和被动吸烟是诸多哮喘触发因素中具高度危险性的因素, 加强这方面的对策研究对儿童哮喘的防治具有意义.     

Änderungen der Lungenfunktion nach Timolol-, Metipranolol-, Pindolol- und Pilocarpin-haltigen Augentropfen bei Gesunden und Patienten mit leichtem Asthma bronchiale

Summary Lung function was studied double blind and randomized in 5 patients with mild asthma bronchiale and 10 normal adults before and 30, 60 and 90 minutes after one drop of 0.5% Timolol, 0.6% Metipranolol or 0.9% NaCl in each eye.In the asthmatics bronchoconstriction was seen after both -receptor blocking agents, more pronounced after Timolol than after Metripranolol. There was a decrease in the forced expiratory volume in one second (FEV_1.0) of 32, respectively 18%. No changes were observed in the normal subjects.In a separate studie no significant changes were seen in the mean values of 10 other asthmatic subjects after 1% Pindolol, 3% Pilocarpin or 0.9% NaCl.However, in two patients FEV_1.0 was reduced by 15% and 20% of the control values after applying Pindolol.In summary, not only -receptorblocking agents without ISA produce a bronchoconstriction in asthmatic subjects, but also -blocker with ISA in individual cases.

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Abkürzungen FEV_1.0 Ein-Sekunden-Wert - ISA intrinsische sympathikotone Aktivität - MEV maximaler exspiratorischer Fluß - Rt_os oszillatorische Resistance Ein Teil der Daten wurde der Dissertationsschrift von Frau Janette Gehre entnommen.