幼儿变应性鼻炎临床特征分析

目的 分析1～3岁变应性鼻炎(allergic rhinitis,AR)患儿的特应性分布状态及其临床特征.方法 采集2009年8月至2010年11月96例1～3岁具有AR症状患儿病史资料,包括就诊年龄、性别、出现症状年龄、病史月数、个人过敏史、父母过敏史.采用敏筛定量过敏原检测系统( Allergy Screen)筛查共计19类吸入组和食物组变应原特异性lgE( specific IgE,sIgE)及血清总IgE水平.归纳该组患儿吸人性变应原和食物变应原致敏的分布状态,按月龄(A组,≥12月龄;B组,≥24月龄;C组,≥36月龄,但不满48月龄)、变应原类别及湿疹或哮喘任一阳性分组分析各临床特征因子的影响作用,Logistic回归方法分析各临床特征与变应原致敏的相互关系.结果 变应原筛查总阳性率为81.3％;吸入组变应原、食物组变应原阳性率分别为62.5％、53.1％;混合真菌阳性率最高(50.0％),其次为牛奶(34.4％)、羊肉(31.3％)、牛肉(26.0％)、屋尘螨(21.0％)、小麦(18.8％)、艾蒿(12.5％)、鸡蛋白或鸡蛋黄(11.5％).62.5％可确诊为AR,其余可暂视为非变应性鼻炎.按月龄分组进行临床特征的单因素分析提示:吸入组变应原(x2=13.699,P=0.001)、父亲患AR(x2=14.060,P=0.001)和父亲或母亲患AR(x2=7.396,P=0.025)在3个月龄组的差异均有统计学意义.个人湿疹史(P=0.034,OR =3.143)可增加变应原致敏的可能性;个人湿疹史(P=0.015,OR=3.125)和总IgE ＞200 IU/ml(P=0.030,OR =3.119)则增加吸入组变应原致敏的可能性;未筛选出对食物组变应原致敏有统计学意义的临床特征;食物组和吸人组阳性率差异无统计学意义.吸入组变应原阳性(P=0.046,OR=3.594)、有蚊虫叮咬性皮炎(P=0.002,OR=11.941)为出现湿疹或哮喘任一阳性的危险因素.结论 1～3岁具有AR症状的幼儿中,吸入组和食物组变应原均可致敏,且吸入组阳性率略高;湿疹史是患儿变应原筛查阳性的危险因素之一,血清总IgE水平升高与吸人性变应原筛查阳性率升高有关;吸入组变应原阳性、有蚊虫叮咬性皮炎和父亲患AR与出现湿疹或哮喘病史有关.

Clinical analysis of allergic rhinitis in children between 1 and 3 years of age

Objective To study the atopy spectrum and its related factors in 1 to 3 years old children with allergic rhinitis.Methods Ninety-six children with allergic rhinitis,aged between 1 and 3years old,referred to ENT department of Beijing Children's Hospital between August 2009 and November 2010 were retrospectively reviewed.Data were recorded for patients' age,age stratification,sex,the age of first symptom,the duration of history,and the allergic history of children,the allergic history of parents.The screening tests on inhalant and food allergens were conducted by immunoblot assay using the Allergy Screen system.The total serum IgE level was also measured.The distribution of the inhalant and food allergens was summarized.The influence of the clinical characteristics was analyzed according to the age subgroup determined by month,allergen category and positiveness of eczema or asthma Logistic regression was used to analyze the relationship of clinical characteristics and allergen spectrum.Results The total positive rates of allergic screening test rate were 81.3％.The inhalant and food allergens were 62.5％ and 53.1％ respectively.The commonest allergy was mixed fungal(50.0％ ),followed by milk(34.4％ ),lamb (31.3％),beef(26.0％ ),dust mite ( 21.0％ ),wheat ( 18.8％ ),mugwort ( 12.5％ ),egg white or egg yolk( 11.5％ ).62.5％ of patients could be diagnosed as AR,the remaining could be diagnosed temporarily as non-allergic rhinitis temporarily.Single factor analysis of clinical characteristics in different subgroup determined by month showed that:inhalant allergen(positive/negative) ( x2 =13.699,P =0.001 ),father suffered from AR( x2 =14.060,P =0.001 ),and father or mother suffered from AR ( x2 =7.396,P =0.025) were statistically significant at three monthly age groups.The personal history of eczema ( OR =3.143,P=0.034 ) might increase the possibility of sensitization to allergens.The personal history of eczema ( OR=3.125,P=0.015) and the total serum IgE level ＞ 200 IU/ml ( OR=3.119,P=0.030)might increase the possibility of sensitization to inhalant allergens.No clinical features for food allergen sensitization was statistically significant.There was no significant difference in positive rates between inhalant and food allergens groups.The presence of inhalant allergens ( OR=3.594,P=0.046 ),insect bites dermatitis ( OR=11.941,P=0.002) were the risk factors for positiveness of eczema or asthma,and the father with AR ( OR=0.251,P=0.040 ) as protective factors.Conclusions Inhalant and food allergens all can be sensitized in the children with AR symptoms between 1 to 3 years old,and the positive rate of inhalant group is slightly higher.The differences of the inhalant allergen (positive/negative) and father suffered from AR are statistically significant at three monthly age groups.The history of eczema is the risk factor for allergen screening positive.Serum total IgE ＞ 200 IU/ml and eczema history are risk factors for inhalant allergen screening positive.The factors of inhalatant allergens,insect bites dermatitis and father suffered from AR relate to any positive of eczema or asthma.